Bromelain and medications.

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 and digestion. Timing changes its job: between meals it acts as an anti-inflammatory, with meals it works as a digestive enzyme, though that second use is Grade C and mechanism-led, since no trial we hold has measured a digestive outcome. The anti-inflammatory case is acute, not chronic: two pooled analyses of the third molar surgery trials agree it may reduce pain in the first week after surgery, though they disagree on swelling. 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. We do not recommend it for joints, for allergy or histamine support, or for recovery after illness, and the reason is worth stating plainly: the placebo-controlled knee osteoarthritis trial found no advantage over placebo on its main measure and concluded bromelain was not effective there, at a dose roughly twice the one used here, while the allergy and post-illness uses rest on no published trial at all. The interactions are practical to know: it may reduce platelet clumping, an effect seen in laboratory studies and in one small 1972 study in volunteers. Our reference puts the start of that effect at about 500mg a day, but that is a working figure rather than one taken from a study, and our literature search found no study measuring platelet function at the usual 200 to 400mg. It may add to the bleeding risk of an anticoagulant or antiplatelet medicine even at an ordinary dose, so we leave it out for anyone taking one, and it is worth pausing about two weeks before planned surgery. Anyone allergic to pineapple should not take it, because bromelain is an enzyme from pineapple itself. A useful sinus, anti-inflammatory and digestive option at sensible doses.