Bromelain and medications.
Bromelain is in the Distil supplement database, evidence Grade B. The page below lists every medication we have explicitly assessed it against.
Bromelain is an enzyme from pineapple used for inflammation, particularly in the sinuses and upper airway, where it also thins mucus, plus post-surgical swelling, joint inflammation and digestion. Timing changes its job: between meals it acts as an anti-inflammatory, with meals it works as a digestive enzyme. Doses are 200 to 400mg a day at 2,000 to 3,000 GDU potency. The Grade B evidence is reasonable for sinusitis, including adjunctive use in acute cases, though a knee osteoarthritis trial found no advantage over placebo, so the joint claims are weaker. The interactions are practical to know: it can raise blood levels of amoxicillin and some antibiotics, and at higher doses above 500mg it has a low, reversible antiplatelet effect that matters mainly for people on anticoagulants. Anyone with a pineapple allergy should be cautious due to cross-reactivity. It combines sensibly with glucosamine and chondroitin for joints. A useful sinus and anti-inflammatory option at sensible doses.
Below are the 6 documented pairs we have explicitly assessed for Bromelain: 6 amber. The pairs cluster around 2 mechanisms: Additive anticoagulation and Additive antiplatelet effect. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Additive anticoagulation
Bromelain has a mild blood-thinning effect that may add to acenocoumarol's. If you take acenocoumarol, tell whoever monitors your INR before adding bromelain and check your INR if you do. If you have surgery planned, mention bromelain to your team; stopping high-dose bromelain about two weeks beforehand is a common precaution.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Bromelain has a mild blood-thinning effect of its own and may add to warfarin's. If you take warfarin, tell whoever monitors your INR before adding bromelain and check your INR if you do start it. If you have surgery planned, mention bromelain to your team; stopping high-dose bromelain about two weeks beforehand is a common precaution.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive antiplatelet effect
Bromelain has mild blood-thinning activity that can add to aspirin's. The combination is usually fine at typical doses, but watch for easy bruising or bleeding, and stop high-dose bromelain about two weeks before any planned surgery or dental procedure.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Bromelain has mild blood-thinning activity that can add to clopidogrel's. Tell your GP if you take bromelain alongside clopidogrel long-term, and stop high-dose bromelain about two weeks before any planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Bromelain has mild blood-thinning activity that can add to the bleeding risk of anti-inflammatory painkillers like naproxen. The combination is usually fine short term, but stop high-dose bromelain about two weeks before any planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Bromelain has mild blood-thinning activity that can add to ticagrelor's. Tell your GP if you take bromelain alongside ticagrelor, and stop high-dose bromelain about two weeks before any planned surgery.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
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