Bromelain (pineapple enzyme)

Proteolytic enzyme from Ananas comosus pineapple stem and fruit. EU registered NexoBrid (concentrate of proteolytic enzymes enriched in bromelain, EMA 2012) for enzymatic deep burn excision topical. Oral – supplement. AEMPS registered NexoBrid for specialised burn centre use

ATC code: A09AA-BROMELAIN

Brand names – supplements: NexoBrid (Smith & Nephew), Now Bromelain, Doctor's Best Bromelain, Source Naturals BromelainSupplements are not tested in clinical trials and are not registered as medications.

Updated 1 Jun 2026 · Methodology

Indications

Chronic rhinosinusitis

Adjunct

Bromelain in acute and chronic rhinosinusitis has one of the most substantiated evidence bases among supplement indications. Büttner 2013 prospective multicentre cohort study in 116 acute rhinosinusitis patients showed clinically meaningful symptom duration reduction (pain, nasal congestion, mucosal oedema) with bromelain 500 mg three times daily × 7 days added to standard therapy. Guo 2006 systematic review (4 RCTs) and later papers documented moderate positive effects. EPOS 2020 (European Position Paper on Rhinosinusitis and Nasal Polyps) for acute postviral rhinosinusitis recommends saline nasal irrigation, intranasal corticosteroids (mometasone, fluticasone, budesonide); bromelain is mentioned as an option with limited evidence base. This is adjunct therapy, not standard treatment replacement. Note bleeding risk in patients on antiplatelets and anticoagulants. If bromelain is recommended for chronic rhinosinusitis with polyps instead of intranasal steroids and ENT evaluation, consider seeking a second opinion.

Sources

ICD-10: J32.9 · ICD-11: CA0A

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Common cold

Not recommended

Bromelain is sold as a «natural common cold remedy», «cold duration reducer» and «anti-inflammatory throat shield». Adult cold evidence base is limited: no Cochrane bromelain systematic reviews on cold. Cochrane vitamin C cold review (Hemilä 2013) showed moderate symptom duration reduction in regular users; no comparable bromelain data. AAFP, , SEIMC for cold recommend symptomatic therapy: paracetamol for fever, fluids, rest, saline nasal irrigation; bromelain is not in guidelines. In patients on antiplatelets and anticoagulants bleeding risk is increased. If bromelain is self-taken for cold instead of family physician consultation for prolonged symptoms (>10 days), persistent high fever, dyspnoea, purulent discharge, consider seeking a second opinion.

Sources

Cochrane (Hemila and Chalker): Vitamin C for preventing and treating the common cold (2013)

ICD-10: J00 · ICD-11: CA00

Sports recovery

Not recommended

Bromelain is sold in the sports segment as a «natural muscle recovery aid», «delayed onset muscle soreness (DOMS) reducer» and «exercise recovery accelerator». Rondanelli 2018 systematic review analysed DOMS, postoperative and post-traumatic oedema data: effect small and inconsistent, RCT methodological quality low, samples small. IOC consensus statement 2018 (Maughan, Br J Sports Med) for endurance and recovery approves creatine, caffeine, beta-alanine, sodium bicarbonate, nitrates; bromelain is not on the approved list. In athletes on warfarin, apixaban, rivaroxaban, aspirin, bromelain raises bleeding and haematoma risk. If bromelain was recommended as a substitute for a supervised recovery protocol (sleep 7–9 h, active recovery, stretching, protein 1.4–2.0 g/kg body weight), consider seeking a second opinion from a sports physician.

Sources

IOC: IOC consensus statement: dietary supplements and the high-performance athlete (2018)

How to read tiers A–F

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit

Mechanism of action

Bromelain is a cysteine protease mixture (stem bromelain and fruit bromelain) with proteolytic activity. Breaks down proteins to peptides and amino acids. In topical use (NexoBrid) it dissolves necrotic tissue in deep burns, facilitating surgical excision. With oral intake bioavailability is 12–40% (precise data conflicting), retains partial proteolytic activity in systemic circulation. Proposed mechanisms: anti-inflammatory (reduced PGE2, bradykinin, TNF-α synthesis), fibrinolytic (via plasmin), antiplatelet. Systemic evidence base limited: Büttner 2013 RCT showed moderate symptom duration reduction in acute rhinosinusitis; Rondanelli 2018 systematic review – small effects in osteoarthritis, postoperative oedema, muscle soreness after exercise.

Safety

Contraindications

Pregnancy and lactation
Children under 18
Anticoagulant (warfarin, apixaban, rivaroxaban, dabigatran) and antiplatelet (aspirin, clopidogrel) therapy – bleeding risk
14 days before elective surgery and dental procedures
Allergy to pineapple, bromelain, latex, bee venom, olive pollen (cross-reactivity)
Active gastric and duodenal ulcers

Serious adverse effects

Bleeding in patients on anticoagulants and antiplatelets
Anaphylactic reactions in latex, pineapple, bee venom allergy
Bronchospasm on inhalation in sensitised subjects (occupational asthma in pineapple plantation workers)
Perioperative bleeding (discontinue 14 days before surgery)

Common adverse effects

Nausea, diarrhoea
Abdominal cramping
Allergic reactions (rash, itching)
Menstrual changes (heavier menses)

Pregnancy: can you take Bromelain (pineapple enzyme)?

No RCT data in pregnancy. Bromelain as a protease and fibrinolytic agent theoretically raises bleeding and preterm labour risk. Avoid in pregnancy. EMA NexoBrid SmPC (topical use) lists pregnancy as contraindication.

Breastfeeding: can you take Bromelain (pineapple enzyme)?

No data on milk transfer. Avoid biohacking doses (500 mg three times daily) in lactation.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Summary of a multi-drug list →

Medicine list: everything you take in one place →

Frequently asked

What is Bromelain (pineapple enzyme) used for?

Bromelain (pineapple enzyme) is evaluated for the following indications with varying evidence strength: Chronic rhinosinusitis (evidence tier C), Sports recovery (evidence tier D), Common cold (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Bromelain (pineapple enzyme)?

Common side effects of Bromelain (pineapple enzyme) (≥ 1 in 100): Nausea, diarrhoea, Abdominal cramping, Allergic reactions (rash, itching), Menstrual changes (heavier menses). See the Safety section for uncommon and serious reactions.

Is Bromelain (pineapple enzyme) safe during pregnancy?

Is Bromelain (pineapple enzyme) compatible with breastfeeding?

No data on milk transfer. Avoid biohacking doses (500 mg three times daily) in lactation.

Who should not take Bromelain (pineapple enzyme)?

Bromelain (pineapple enzyme) is contraindicated in: Pregnancy and lactation; Children under 18; Anticoagulant (warfarin, apixaban, rivaroxaban, dabigatran) and antiplatelet (aspirin, clopidogrel) therapy – bleeding risk; 14 days before elective surgery and dental procedures; Allergy to pineapple, bromelain, latex, bee venom, olive pollen (cross-reactivity). Full list in the Safety section.

Other drugs in this group

Betaine hydrochloride, Pancreatin