Post by BMH on May 30, 2019 17:21:20 GMT 7
Pineapple
Scientific Name(s): Ananas comosus (L.) Merr.
Common Name(s): Bromelain, Debridase, Phlogenzym, Pineapple
Medically reviewed by Drugs.com. Last updated on Sep 3, 2018.
Clinical Overview
Use
Few well-controlled clinical trials have been published to support the wide range of therapeutic claims for bromelain, a crude, aqueous extract of pineapple. Evidence exists primarily for the use of bromelain in debridement of burns and as an anti-inflammatory agent.
Dosing
Scientific Name(s): Ananas comosus (L.) Merr.
Common Name(s): Bromelain, Debridase, Phlogenzym, Pineapple
Medically reviewed by Drugs.com. Last updated on Sep 3, 2018.
Clinical Overview
Use
Few well-controlled clinical trials have been published to support the wide range of therapeutic claims for bromelain, a crude, aqueous extract of pineapple. Evidence exists primarily for the use of bromelain in debridement of burns and as an anti-inflammatory agent.
Dosing
Two slices of pineapple contain approximately 100 mg of ascorbic acid (vitamin C). The usual dosage of bromelain is 40 mg taken 3 or 4 times daily. Pineapple products are available commercially in liquid, tablet, and capsule doseforms. Most products contain bromelain 500 mg; manufacturers suggest a dose of 500 to 1,000 mg daily.
Uses and Pharmacology
It is not clear whether proteinases can be absorbed from the GI tract in a functionally intact form, although enteric coating of the tablets may help to counteract this problem.10, 11
Analgesia
Clinical data
The effect of bromelain on perioperative pain, swelling, trismus, and quality of life (QOL) was assessed in a comparator double-blind, placebo-controlled randomized clinical trial (n = 45) in healthy adults undergoing surgery for removal of unilateral impacted mandibular third molar under local anesthesia. Patients were randomized to bromelain 250 mg, diclofenac sodium 25 mg, or placebo taken orally every 6 hours the morning before surgery and continuing for 4 days. Both bromelain and diclofenac significantly reduced pain leading to administration of less rescue analgesic tablets and QOL measures also improved in both treatment groups.58
Anti-inflammatory
Animal data
Various studies have investigated the anti-edematous effects of bromelain in animal models.9, 10, 12 The efficacy of bromelain has been compared with the anti-inflammatory effect of prednisone, etodolac, indomethacin, acetylsalicylic acid, and oxyphenbutazone. Oral and intraperitoneal routes have been investigated. The anti-edematous action may be the result of increased tissue permeability by fibrinolysis and the reabsorption of edema fluids into the circulatory system.9
Clinical data
Clinical trials have employed a variety of preparations including bromelain in combination with trypsin/rutin (as Phlogenzym) compared with diclofenac or placebo. Outcomes are equivocal9 with older trials suggesting anti-inflammatory and analgesic effects.13, 14, 15
In moderate to severe osteoarthritis during 12 weeks of administration of bromelain 800 mg daily, there was no change in total Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score compared with placebo.16 A trial comparing 6 weeks of a combination of bromelain and trypsin/rutin with diclofenac 100 mg daily in osteoarthritis of the hip found no difference in total WOMAC scores, but showed the combination to be equivalent to diclofenac.17
It is not clear whether proteinases can be absorbed from the GI tract in a functionally intact form, although enteric coating of the tablets may help to counteract this problem.10, 11
Analgesia
Clinical data
The effect of bromelain on perioperative pain, swelling, trismus, and quality of life (QOL) was assessed in a comparator double-blind, placebo-controlled randomized clinical trial (n = 45) in healthy adults undergoing surgery for removal of unilateral impacted mandibular third molar under local anesthesia. Patients were randomized to bromelain 250 mg, diclofenac sodium 25 mg, or placebo taken orally every 6 hours the morning before surgery and continuing for 4 days. Both bromelain and diclofenac significantly reduced pain leading to administration of less rescue analgesic tablets and QOL measures also improved in both treatment groups.58
Anti-inflammatory
Animal data
Various studies have investigated the anti-edematous effects of bromelain in animal models.9, 10, 12 The efficacy of bromelain has been compared with the anti-inflammatory effect of prednisone, etodolac, indomethacin, acetylsalicylic acid, and oxyphenbutazone. Oral and intraperitoneal routes have been investigated. The anti-edematous action may be the result of increased tissue permeability by fibrinolysis and the reabsorption of edema fluids into the circulatory system.9
Clinical data
Clinical trials have employed a variety of preparations including bromelain in combination with trypsin/rutin (as Phlogenzym) compared with diclofenac or placebo. Outcomes are equivocal9 with older trials suggesting anti-inflammatory and analgesic effects.13, 14, 15
In moderate to severe osteoarthritis during 12 weeks of administration of bromelain 800 mg daily, there was no change in total Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score compared with placebo.16 A trial comparing 6 weeks of a combination of bromelain and trypsin/rutin with diclofenac 100 mg daily in osteoarthritis of the hip found no difference in total WOMAC scores, but showed the combination to be equivalent to diclofenac.17