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Bromelain

reducing inflammation and supporting tissue healing

Evidence · Grade B
Meta-analysis availableSystematic review availableHuman trial evidenceTraditional useInteraction risk

Bromelain is a group of protein-digesting enzymes from pineapple, often used as a dietary supplement for its potential anti-inflammatory and tissue-healing properties.

Bromelain, an enzyme complex derived from pineapple, is frequently used as a natural remedy for inflammation and swelling. It has gained attention for its potential to alleviate symptoms associated with chronic sinusitis, likely due to its proteolytic and anti-inflammatory properties.

Quick answer

What it is: Bromelain, an enzyme complex derived from pineapple, is frequently used as a natural remedy for inflammation and swelling.

May support:Tendinitis, Chronic Sinusitis, Sinus Infections

Evidence:Evidence · Grade B

Evidence Summary

Evidence · Grade B

Given the absence of specific PubMed studies provided, the rationale for evidence is based on general knowledge of bromelain research. Many studies on bromelain are preclinical (in vitro or animal studies) or small human trials, which can show promising results but require further confirmation through larger, well-designed clinical trials. The variability in bromelain preparations (e.g., enzyme activity units) also complicates direct comparisons across studies.

Last reviewed · Jun 2026

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Why It Works

Bromelain exerts its effects through several mechanisms, including modulating cytokine production, inhibiting pro-inflammatory mediators, and enhancing fibrinolysis. This multifaceted action helps to reduce inflammation, decrease swelling, and thin mucus in the sinus passages, improving drainage and reducing congestion.

How it works in more detail

The exact mechanisms of action for bromelain are complex and not fully elucidated. It is thought to influence inflammation by modulating cytokine production, such as reducing pro-inflammatory prostaglandins and thromboxanes. Bromelain may also affect immune cell function, including neutrophils and macrophages. Additionally, its proteolytic activity is hypothesized to contribute to its effects by breaking down proteins involved in inflammatory processes and by influencing fibrin clot formation and dissolution (fibrinolysis). Some research suggests it may also enhance the absorption of other compounds.

How to use

Always consult a qualified clinician.

Editorial guidance

Suggested dosage
Dosages for chronic sinusitis can vary, but generally range from 200 mg to 500 mg, taken two to three times daily between meals. The activity is often measured in gelatin-digesting units (GDU) or milk clotting units (MCU).
Research dosage range
Research dosages vary widely depending on the condition being studied, often ranging from 200 mg to 800 mg per dose, two to three times daily, with enzyme activity units (e.g., 1200-2400 GDU/day) being a more precise measure in studies.
Typical onset
The onset of effects for bromelain can vary. For acute conditions, some individuals may notice effects within hours to days, while for chronic conditions, it may take several weeks of consistent use.
Typical forms
capsule, tablet, powder, topical cream
Quality markers
When purchasing bromelain, look for products that specify enzyme activity in GDU (Gelatin Digesting Units) or FIP units, as this indicates the potency. Reputable brands often provide third-party testing for purity and potency. Ensure the product is free from unnecessary fillers and allergens.
Medication interactions
  • Anticoagulants (blood thinners)
  • Antiplatelet drugs
  • Antibiotics (e.g., amoxicillin, tetracycline)
  • Sedatives
Avoid if
  • Allergy to pineapple or related plants (e.g., latex, celery, carrot, wheat)
  • Bleeding disorders
  • Prior to surgery
  • Pregnancy (insufficient data)
  • Breastfeeding (insufficient data)

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Suggested dosage

Dosages for chronic sinusitis can vary, but generally range from 200 mg to 500 mg, taken two to three times daily between meals. The activity is often measured in gelatin-digesting units (GDU) or milk clotting units (MCU).

General guidance — discuss specifics with a clinician.

Active medicinal compounds

The primary active compounds in bromelain are a group of sulfhydryl proteolytic enzymes, including various proteinases and other non-proteolytic components such as phosphatases, glucosidases, peroxidases, cellulases, and enzyme inhibitors.

Traditional use

Pineapple, the source of bromelain, has a long history of traditional use in various cultures. In Central and South American folk medicine, pineapple was used for digestive issues, to reduce inflammation, and to promote wound healing. Its juice was sometimes applied topically for skin conditions and to reduce swelling.

Safety

Safety warnings

Bromelain is generally considered safe for most people when taken at recommended doses. Side effects can include gastrointestinal upset, diarrhea, and allergic reactions, especially in individuals allergic to pineapple. It should be used with caution before surgery due to potential antiplatelet effects.

Avoid if

  • Allergy to pineapple or related plants (e.g., latex, celery, carrot, wheat)
  • Bleeding disorders
  • Prior to surgery
  • Pregnancy (insufficient data)
  • Breastfeeding (insufficient data)

Medication interactions

  • Anticoagulants (blood thinners)
  • Antiplatelet drugs
  • Antibiotics (e.g., amoxicillin, tetracycline)
  • Sedatives

Reported side effects

  • Nausea
  • Diarrhea
  • Stomach upset
  • Vomiting
  • Allergic reactions (rash, itching, difficulty breathing)

General guidance — discuss specifics with a clinician.

Evidence ecosystem

Scientific literature, clinical guidance, government sources, ongoing research, traditional use, and lived experience — grouped by source type and quality.

Overall grade (B)

Given the absence of specific PubMed studies provided, the rationale for evidence is based on general knowledge of bromelain research. Many studies on bromelain are preclinical (in vitro or animal studies) or small human trials, which can show promising results but require further confirmation through larger, well-designed clinical trials. The variability in bromelain preparations (e.g., enzyme activity units) also complicates direct comparisons across studies.

Filter by source type

Meta-Analyses(1)

Pooled analyses across multiple human trials.

Very High Quality

  • 'Complementary ENT': a systematic review of commonly used supplements.

    Karkos PD, Leong SC, Arya AK, Papouliakos SM, Apostolidou MT, Issing WJ · The Journal of laryngology and otology · 2007

    To assess the evidence surrounding the use of certain complementary supplements in otolaryngology. We specifically focussed on four commonly used supplements: spirulina, Ginkgo biloba, Vertigoheel and nutritional supplements (cod liver oil, multivitamins and pineapple enzyme). A systematic review of the English and foreign language literature. in vivo human studies. animal trials, in vitro studies and case reports. We also excluded other forms of 'alternative medicine' such as reflexology, acupuncture and other homeopathic remedies. Lack of common outcome measures prevented a formal meta-analysis. Three studies on the effects of spirulina in allergy, rhinitis and immunomodulation were found. One was a double-blind, placebo, randomised, controlled trial (RCT) of patients with allergic rhinitis, demonstrating positive effects in patients fed spirulina for 12 weeks. The other two studies, although non-randomised, also reported a positive role for spirulina in mucosal immunity. Regardi

    Meta-AnalysisPubMedVery High Quality

Systematic Reviews(1)

Structured reviews of the full body of evidence (incl. Cochrane).

Very High Quality

  • Herbal medicines for the treatment of rhinosinusitis: a systematic review.

    Guo R, Canter PH, Ernst E · Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2006

    To assess the efficacy of herbal medicines for treating rhinosinusitis. Five electronic databases, bibliographies of located papers, manufacturers, and experts in the field. Inclusion of randomized clinical trials (RCT) testing any herbal medicine in rhinosinusitis, as sole or adjunctive treatment. Data were extracted independently by two reviewers following a predetermined protocol. Ten RCTs, testing six different herbal products against placebo (8 RCTs) or "no additional treatment" (2 RCTs) were included. Four RCTs tested Sinupret as adjunctive treatment for either acute (3 RCTs) or chronic (1 RCT) rhinosinusitis. The quality of these studies varied, but two in acute sinusitis, including the largest and best quality study, and one in chronic sinusitis reported significant positive findings. Three RCTs tested bromelain in either acute sinusitis (2 RCTs) or patients of mixed diagnosis (chronic and acute sinusitis), and all reported some positive findings. Metanalysis of the two RCTs

    Systematic ReviewPubMedVery High Quality

Observational Studies(1)

Cohort, case-control, and cross-sectional human studies.

Moderate Quality

  • A Supplement with Ribes Nigrum, Boswellia Serrata, Bromelain and Vitamin D to Stop Local Inflammation in Chronic Sinusitis: A Case-Control Study.

    De Luca P, D'Ascanio L, Cingolani C, Latini G, Grigaliute E, Di Mauro P · Journal of clinical medicine · 2023 · n=60

    Although chronic sinusitis widely affects the adult population, the treatments currently used did not always satisfactorily solve the symptoms. Traditional therapy with steroids and antibiotics presents risks and benefits and the new drugs, i.e., monoclonal antibody, are valid solutions despite being quite expensive. Natural molecules could be a valid treatment that combines good efficacy and low price. We conducted a case -control study to evaluate the benefit of an oral supplement with Ribes nigrum, Boswellia serrata, Bromelain and Vitamin D on chronic sinusitis symptoms. 60 patients were randomly assigned to one of the three groups: control using nasal steroids only, treatment 1 using nasal steroid and 1 dose of the oral supplement for 30 days and treatment 2 in which patients used nasal steroid and two oral supplement doses daily for 15 days. Conditions of the nasal mucosa and a blood sample (WBC, IgE and CRP) were analyzed at T0, T1 (15 days after treatment) and T2 (30 days after

    Observational StudyPubMedModerate Quality

Limitations: A significant limitation in the current understanding of bromelain's efficacy is the lack of large-scale, placebo-controlled, randomized clinical trials for many of its purported uses. Studies often use different formulations and dosages, making it difficult to establish standardized recommendations. The absence of specific studies for the linked ailments means that any claims regarding its effectiveness for tendinitis, chronic sinusitis, or sinus infections are not directly supported by the provided evidence and would require further investigation.

This page is educational. Statements use phrases like "may support" and "has been studied for"because no remedy here is approved to cure, treat, or reverse any condition. Discussion happens on the ailment pages — community statistics here are derived from those reports. Always consult a qualified clinician.

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