Bromelain
Summary
Bromelain is a group of pineapple enzymes. Two meta-analyses found it eased pain a week after wisdom tooth surgery (grade C), but knee osteoarthritis and muscle soreness trials were mostly null, and one 8-week colitis trial was positive (grade D). Side effects are mainly stomach upset and diarrhea, and people allergic to pineapple can react.
Key facts
- Protein-digesting enzymes (cysteine proteases) from pineapple; a topical bromelain product is a prescription drug for serious burns[1][9]
- Pain after wisdom tooth removal (C); knee osteoarthritis (no clear effect, D); muscle soreness (no effect, D); ulcerative colitis activity (D)[7][8][2][3][4][5][6]
- None declared in the trial abstracts we cite; funding for most trials is not stated in PubMed[2][3][4][5][6]
- 5 graded human outcomes on this page
- October 10, 2026
How it works
ProposedBromelain enzymes break down proteins. Laboratory and animal studies show anti-swelling, anti-inflammatory and anti-clotting activity, and some bromelain is absorbed with its enzyme activity intact, but which components act in people is only partly known.[9][11][10]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
At a glance: strongest evidence per outcome
| Outcome | Grade | Effect | Strongest evidence | Rows |
|---|---|---|---|---|
| Dental surgery | Grade C | Improved | RCT · n = 45 · 2014 | 1 row |
| Gut | Grade D | Mixed | RCT · n = 70 · 2025 | 1 row |
| Joints | Grade D | No effect | RCT · n = 47 · 2006 | 2 rows |
| Exercise recovery | Grade D | No effect | RCT · n = 39 · 2002 | 1 row |
Every graded row
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Pain, swelling and quality of life after wisdom tooth removal | Improved | Grade C | RCT · n = 45 · 2014 Adults having a single impacted lower wisdom tooth removed under local anesthesia Form: Oral bromelain · Dose: 250 mg four times daily (1,000 mg/day) around surgery · Duration: 5 days (from 1 day before surgery to 4 days after) Pain fell versus placebo at all time points and quality-of-life scores improved, similar to diclofenac; the reduction in swelling and jaw stiffness was not significant. | 24589242 (opens PubMed)Source [2] |
| Ulcerative colitis disease activity and quality of life | Mixed | Grade D | RCT · n = 70 · 2025 Adults with mild to moderate ulcerative colitis (Iran) Form: Oral bromelain · Dose: 400 mg/day · Duration: 8 weeks Disease-activity scores fell more than with placebo (-3.29 vs -1.11); quality-of-life scores did not differ. | 41315628 (opens PubMed)Source [6] |
| Knee osteoarthritis symptoms (WOMAC) | No effect | Grade D | RCT · n = 47 · 2006 Adults with moderate to severe knee osteoarthritis Form: Oral bromelain · Dose: 800 mg/day · Duration: 12 weeks No difference from placebo in total WOMAC score, its subscales or quality of life; both groups improved on the disability subscale. Only 31 people completed the trial. | 17121765 (opens PubMed)Source [3] |
| Knee osteoarthritis symptoms versus diclofenac | Mixed | Grade D | RCT · n = 40 · 2016 Adults with mild to moderate knee osteoarthritis Form: Oral bromelain · Dose: 500 mg/day (diclofenac 100 mg/day as comparator) · Duration: 16 weeks No difference from diclofenac at 4 weeks, and the authors called the comparison inconclusive; WOMAC scores improved from baseline after 16 weeks of bromelain (no placebo group). | 27470088 (opens PubMed)Source [4] |
| Muscle soreness, range of motion and strength after eccentric exercise | No effect | Grade D | RCT · n = 39 · 2002 Untrained adults (US university laboratory) Form: Oral bromelain · Dose: 300 mg three times daily · Duration: 4 days after exercise Neither bromelain nor ibuprofen changed pain, range of motion or peak torque compared with placebo or control. | 12466693 (opens PubMed)Source [5] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Oral bromelain capsules or tablets | Varies[2][3][4][5][6] | Bromelain appears in blood with its enzyme activity retained after oral use, according to a 2023 systematic review.[10] | Generally well tolerated; stomach upset, diarrhea, flatulence, nausea and headache reported.[1][10] | Dental surgery, knee osteoarthritis, muscle soreness and ulcerative colitis trials |
| Enzyme combinations containing bromelain | Varies[1] | No separate absorption data in our sources.[1] | No separate tolerance data in our sources.[1] | NCCIH notes many studies tested mixtures, so the effect of bromelain alone is unclear |
| Topical bromelain (prescription) | Varies[1][10] | Applied to the skin, not absorbed as a supplement.[1] | Burning sensation, pain and fever reported with topical use for wound and burn debridement.[10] | Removal of dead tissue from serious burns and chronic wounds |
Studied doses
Doses studied in human trials ranged from 200–400 mg/day for a month in an open knee-pain study to 1,000 mg/day around wisdom tooth surgery. Knee osteoarthritis trials used 500–800 mg/day for 12–16 weeks, and the ulcerative colitis trial 400 mg/day for 8 weeks.[13][2][3][4][6]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
Medicines
- Anticoagulant and antiplatelet drugsReviewBromelain blocked platelet clumping in laboratory studies and has fibrinolytic activity; whether this adds to bleeding risk with these drugs in people has not been tested.[9][11]
- AntibioticsReviewOlder studies summarized in a pharmacology review reported that bromelain increased the absorption of some antibiotics.[9]
Who should be careful
- Pineapple, papain or bromelain allergy
- A pharmaceutical worker sensitized to bromelain developed asthma after eating pineapple, and most workers sensitized to papain also reacted to bromelain.[12]
- Pregnancy and breastfeeding
- NCCIH says little is known about whether bromelain is safe in pregnancy or while breastfeeding.[1]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
Safety
Oral bromelain is generally well tolerated in short trials.
- Common side effects
- Stomach upset and diarrhea are reported most often.[1]
- Pooled trials
- A 2023 meta-analysis reported flatulence, nausea and headache and no major health risks with oral bromelain.[10]
- Allergy
- Occupational exposure has caused asthma and rhinitis, with cross-reactions to papain and pineapple.[12]
- Long-term data
- The longest oral trial cited here lasted 16 weeks.[4]
How to read the label
- Label dose vs clinical doseTrials used 200–1,000 mg/day of bromelain; the dental trial used 250 mg four times daily and the colitis trial 400 mg/day.[2][6][4]
- Single ingredient or blendMany products mix bromelain with other enzymes; NCCIH notes that studies of mixtures cannot show what bromelain alone does.[1]
- Oral vs topicalThe prescription topical product for burns is not the same as oral supplements.[1]
Cost per studied dose, without the sales pitch
Compare any product you already have by the amount it delivers, not by capsule count or front-of-pack weight.
Cost per studied dose
Enter the price, servings and the amount per serving from your label.
Frequently asked questions
Does bromelain reduce swelling after surgery?
After wisdom tooth removal, one meta-analysis found less swelling and another did not; both found less pain a week after surgery.[7][8]
Does bromelain help knee arthritis?
Evidence is weak. A 12-week placebo-controlled trial of 800 mg/day found no benefit, and a 16-week study without placebo showed improvement from baseline only.[3][4]
Does bromelain help muscle soreness?
In 39 adults, 300 mg three times daily did not reduce soreness or strength loss after eccentric exercise.[5]
Does bromelain help ulcerative colitis?
One 8-week trial in 70 adults with mild to moderate disease found lower activity scores with 400 mg/day, but quality of life did not change.[6]
Sources
- [1]Bromelain: Usefulness and Safety (last updated November 2024). National Center for Complementary and Integrative Health (NCCIH), 2024. fact-sheet
- [2]Perioperative bromelain reduces pain and swelling and improves quality of life measures after mandibular third molar surgery: a randomized, double-blind, placebo-controlled clinical trial.. J Oral Maxillofac Surg, 2014. RCT
- [3]Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study.. QJM, 2006. RCT
- [4]Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis.. Clin Rheumatol, 2016. RCT
- [5]Preliminary comparison of bromelain and Ibuprofen for delayed onset muscle soreness management.. Clin J Sport Med, 2002. RCT
- [6]Effects of bromelain supplementation on disease activity and quality of life in patients with ulcerative colitis: a randomized, triple-blind, placebo-controlled study.. Sci Rep, 2025. RCT
- [7]Oral Bromelain for the Control of Facial Swelling, Trismus, and Pain After Mandibular Third Molar Surgery: A Systematic Review and Meta-Analysis.. J Oral Maxillofac Surg, 2019. meta-analysis
- [8]Efficacy of proteolytic enzyme bromelain on health outcomes after third molar surgery. Systematic review and meta-analysis of randomized clinical trials.. Med Oral Patol Oral Cir Bucal, 2019. meta-analysis
- [9]Bromelain: biochemistry, pharmacology and medical use.. Cell Mol Life Sci, 2001. review
- [10]Efficacy and safety of bromelain: A systematic review and meta-analysis.. Nutr Health, 2023. meta-analysis
- [11]Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation in rat vessels in vivo.. In Vivo, 1999. animal-study
- [12]Allergic reactions, including asthma, to the pineapple protease bromelain following occupational exposure.. Clin Allergy, 1979. observational
- [13]Bromelain reduces mild acute knee pain and improves well-being in a dose-dependent fashion in an open study of otherwise healthy adults.. Phytomedicine, 2002. open-label
What changed
- First draft. Every PMID checked against NCBI E-utilities esummary (title and year taken from the record) and abstracts read for the cited rows.
- Adversarial review pass: every evidence row re-read against its PubMed abstract. Official sources opened before citing: NCCIH Bromelain: Usefulness and Safety (last updated November 2024). No ODS fact sheet covers bromelain. Industry ties: the 2025 ulcerative colitis trial declares no competing interests; no PMC full text or funding statement for the other trials (coi.py). Retraction, expression-of-concern, erratum and withdrawn checks on all 12 PMIDs: none flagged. Page set indexable. Independent browser review (4 parallel reviewers, every evidence row checked against its abstract and official sources on the Vercel preview) found: dental trial duration (5 days, from 1 day before surgery) added from the abstract.