Meta Information
ID:bromelain
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bromelain possesses fibrinolytic and antiplatelet properties, which can significantly increase the risk of bleeding when combined with anticoagulant or antiplatelet medications like warfarin, clopidogrel, or aspirin.
Actionable advice:
Bromelain should be avoided with blood-thinning medications unless specifically approved by a doctor.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
They also present fibrinolytic and anticoagulant properties. Additionally, bromelain inhibits cyclooxygenase and modulates prostaglandins and thromboxane, affecting both inflammation and coagulation, and also hydrolyzes bradykinin.
Label source:
PubMed: Metabolism open (2020)
Source url:
Exact phrase from label:
Collectively, these findings suggest that bromelain exerts anticoagulant effects on NAFLD-induced deregulation of coagulation by inhibiting the activation of the coagulation cascade, decreasing the stability of clots, and promoting fibrinolytic activity.
Label source:
PubMed: Nutrients (2022)
Source url:
Exact phrase from label:
Herbal products that may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy include angelica root, arnica flower, anise, asafoetida, bogbean, borage seed oil, bromelain, capsicum, celery, chamomile, clove, fenugreek, feverfew, garlic, ginger ginkgo, horse chestnut, licorice root, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, sweet clover, turmeric, and willow bark.
Label source:
PubMed: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (2000)
Action type:
avoid
Target id:
/procedure/surgery
Target name:
Surgery
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
336
Hours after target:
48
Description:
Due to its effects on blood clotting, bromelain increases the risk of excessive bleeding during and after surgical procedures.
Actionable advice:
Bromelain should be discontinued at least 2 weeks before any scheduled surgery and should not be resumed until cleared by a surgeon.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
an enhanced bleeding tendency in case of concomitant therapy with anticoagulants was described as a possible interaction.
Label source:
PubMed: Sportverletzung Sportschaden : Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin (2011)
Source url:
Exact phrase from label:
This review summarizes scientific reports concerning the possible application of bromelain in treating cardiovascular diseases, blood coagulation and fibrinolysis disorders, infectious diseases, inflammation-associated diseases, and many types of cancer.
Label source:
PubMed: Nutrients (2021)
Source url:
Exact phrase from label:
Oral bromelain does not increase the risk of postoperative bleeding.
Label source:
PubMed: Journal of dentistry (Tehran, Iran) (2018)
Action type:
avoid
Target id:
/condition/bleeding-disorders
Target name:
Bleeding Disorders
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Individuals with conditions like hemophilia or von Willebrand disease have an inherently higher risk of bleeding, which is exacerbated by bromelain's anticoagulant properties.
Actionable advice:
Bromelain should be avoided completely with any type of bleeding disorder.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The addition of bromelain ex vivo reduced coagulability of both normal and hypercoagulable blood significantly and resulted in 47 and 22% prolongation of PT and 20 and 10% prolongation of APTT in normal and hypercoagulable samples, respectively and inhibited adenosine di-phosphate (ADP)-induced platelet aggregation by 19%.
Label source:
PubMed: Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis (2016)
Source url:
Exact phrase from label:
A wide range of therapeutic benefits has been claimed for bromelain, such as reversible inhibition of platelet aggregation, angina pectoris, bronchitis, sinusitis, surgical traumas, thrombophlebitis, pyelonephritis and enhanced absorption of drugs, particularly of antibiotics.
Label source:
PubMed: Cellular and molecular life sciences : CMLS (2001)
Source url:
Exact phrase from label:
In this statement, it was advised that caution should be taken when using Nexobrid® in patients who have blood clotting disturbances as this could increase the likelihood of bleeding.
Label source:
PubMed: Scars, burns & healing (2023)
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The safety of bromelain during pregnancy is not established, and there are theoretical concerns it could stimulate uterine contractions or affect fetal development.
Actionable advice:
Bromelain should be avoided completely during pregnancy.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Source url:
Exact phrase from label:
Little is known about whether it’s safe to use bromelain during pregnancy or while breastfeeding.
Label source:
Anecdotal: NIH NCCIH
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if bromelain or its metabolites pass into breast milk or what their effects might be on a nursing infant; therefore, it is not recommended.
Actionable advice:
Bromelain should be avoided completely while breastfeeding.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
Given the lack of evidence about its safety, bromelain is not recommended for children or for women who are pregnant or breastfeeding.
Label source:
Anecdotal: WebMD
Action type:
avoid
Target id:
/condition/pineapple-latex-allergy
Target name:
Allergy to Pineapple, Latex, or Certain Pollens
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Individuals with allergies to pineapple, latex, birch, carrot, celery, or grass pollens may experience a cross-reactive allergic reaction to bromelain, which is derived from pineapple.
Actionable advice:
Bromelain should be avoided with a known allergy to pineapple or related substances.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
It is revealed that patients allergic to a water-soluble fraction from wheat flour were sensitive to pineapple enzyme, bromelain.
Label source:
PubMed: [Cross-reactivity between bromelain and soluble fraction from wheat flour]. (PMID 9436335)
Action type:
avoid
Target id:
/dietary/meal
Target name:
Any Caloric Meal (for Systemic Use)
Severity:
major
Interaction type:
diminishing
Nature:
temporal
Temporal spacing:
Hours before target:
1
Hours after target:
2
Description:
When taken with food, bromelain acts as a digestive enzyme on the meal's proteins, preventing its absorption into the bloodstream for systemic anti-inflammatory effects.
Actionable advice:
For anti-inflammatory benefits, it should be taken on an empty stomach, at least 1 hour before or 2 hours after eating.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The claim that bromelain cannot be effective after oral administration is definitely refuted at this time.
Label source:
PubMed: Cellular and molecular life sciences : CMLS (2001)
Source url:
Exact phrase from label:
The results of this work confirm the existence of a small but significant intestinal transport of undegraded proteins in healthy men.
Label source:
PubMed: The American journal of physiology (1997)
Source url:
Exact phrase from label:
We successfully demonstrated the capability of bromelain to reduce an inflammatory stimulus by reproducing its exposure to the gastro-enteric environment in vitro and assaying its effect in human cell lines derived from stomach, intestinal, and chondrocytes.
Label source:
PubMed: International journal of immunopathology and pharmacology (2021)
Action type:
separate
Target id:
/dietary/high-protein-meal
Target name:
Protein-Containing Meal (for Digestive Use)
Severity:
major
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
To function as a digestive aid for protein, bromelain must be present in the stomach with the food it is intended to break down.
Actionable advice:
For digestive support, it should be taken directly with a protein-containing meal.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The study also highlights potential therapeutic uses, including biofilm degradation, anti-inflammatory effects, digestive assistance, wound healing, and fibrinolytic proteases.
Label source:
PubMed: Microbial Proteases: Pioneering Tools for Modern Therapeutic Innovations. (PMID 42227512)
Action type:
informational_none
Target id:
/class/chelating-antibiotics
Target name:
Certain Antibiotics (Amoxicillin, Tetracyclines)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bromelain may increase the absorption and concentration of certain antibiotics like amoxicillin and tetracyclines, potentially enhancing their effects but also their side effects.
Actionable advice:
It is important to consult a doctor before combining; a dose adjustment of the antibiotic may be necessary.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
A wide range of therapeutic benefits has been claimed for bromelain, such as reversible inhibition of platelet aggregation, angina pectoris, bronchitis, sinusitis, surgical traumas, thrombophlebitis, pyelonephritis and enhanced absorption of drugs, particularly of antibiotics.
Label source:
PubMed: Bromelain: biochemistry, pharmacology and medical use. (PMID 11577981)
Action type:
adjust_with_prescriber
Target id:
/condition/peptic-ulcer-disease
Target name:
Peptic Ulcer Disease (PUD)
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The proteolytic (protein-digesting) nature of bromelain could theoretically irritate or worsen existing stomach or duodenal ulcers.
Actionable advice:
Bromelain is best avoided with active peptic ulcer disease.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The most frequent adverse effects confirmed in people who overdose on bromelain include vomiting, nausea, diarrhea, heart palpitations, digestive problems, lack of appetite, fatigue, body discomfort, dizziness, drowsiness, and lethargy. Uterine bleeding and heavy menstruation can occur as well. People having peptic ulcer and any other digestive problems should not intake bromelain in any form—they need to consult with health care professionals prior to using bromelain.
Label source:
Action type:
avoid
Target id:
/class/herbal-anticoagulants
Target name:
Supplements with Blood-Thinning Effects
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining bromelain with other supplements that affect blood clotting (e.g., ginkgo, garlic, high-dose fish oil, ginger, vitamin E) can increase the cumulative risk of bleeding.
Actionable advice:
Caution is warranted, and it is important to talk to a healthcare provider when combining multiple supplements with blood-thinning properties.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Herbal products that may potentially increase the risk of bleeding or potentiate the effects of warfarin therapy include angelica root, arnica flower, anise, asafoetida, bogbean, borage seed oil, bromelain, capsicum, celery, chamomile, clove, fenugreek, feverfew, garlic, ginger ginkgo, horse chestnut, licorice root, lovage root, meadowsweet, onion, parsley, passionflower herb, poplar, quassia, red clover, rue, sweet clover, turmeric, and willow bark.
Label source:
PubMed: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (2000)
Source url:
Exact phrase from label:
To date, high hopes are associated with compounds of natural origin, which show anticoagulant action without undesirable effects and can be proposed as supportive therapies. We investigated the effect of the new combination of four natural compounds, escin-bromelain-ginkgo biloba-sage miltiorrhiza (EBGS), on the initial process of the coagulation cascade, which is the adhesion of platelets to activated vascular endothelium.
Label source:
PubMed: International journal of molecular sciences (2024)
Source url:
Exact phrase from label:
The thiol protease, bromelain, an extract from pineapple stem, was suggested to have antithrombotic and anticoagulant activities in vivo.
Label source:
PubMed: In vivo (Athens, Greece) (1999)
Action type:
informational_none
Target id:
/intervention/quercetin
Target name:
Quercetin
Severity:
moderate
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bromelain is believed to enhance the absorption of quercetin, a flavonoid with anti-inflammatory and antioxidant properties, leading to a combined synergistic effect.
Actionable advice:
It is best taken together with quercetin to potentially enhance its bioavailability and effects.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In a follow-up unblind, open-label study, 17 additional men received 1 month of a supplement containing quercetin, as well as bromelain and papain (Prosta-O), which enhance bioflavonoid absorption.
Label source:
PubMed: Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. (PMID 10604689)
Action type:
informational_none
Target id:
/class/chemotherapy-radiation
Target name:
Certain Chemotherapy Agents
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Preliminary research suggests bromelain may alter the effects of certain chemotherapy drugs (e.g., 5-fluorouracil, vincristine). This interaction is unpredictable and requires medical supervision.
Actionable advice:
This is best not used with chemotherapy unless under the direct supervision of an oncologist.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
In this study, we investigated if these agents have the potential to sensitize in vitro gastrointestinal cancer models to cisplatin, paclitaxel, 5-fluorouracil, and vincristine.
Label source:
PubMed: American journal of cancer research (2016)
Source url:
Exact phrase from label:
The cells were also treated with combinations of bromelain and cytotoxic drugs (cisplatin or 5-FU) and their viability was assessed at 72 h.
Label source:
PubMed: Anti-cancer drugs (2014)
Source url:
Exact phrase from label:
The combinations of Bromelain and Acetylcysteine (BromAc®) with cytotoxics such as Gemcitabine, 5-Fluorouracil or Oxaliplatin have shown a dramatic reduction in IC50 values in a variety of cancers, including colon cancer, suggesting the possibility of effective treatment without undesired side effects.
Label source:
PubMed: American journal of cancer research (2021)
Action type:
avoid
Target id:
/class/antihypertensives
Target name:
Antihypertensive Medications
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bromelain may have a mild blood pressure-lowering effect, which could be additive when taken with antihypertensive drugs, theoretically increasing the risk of hypotension.
Actionable advice:
It is a good idea to check blood pressure if combining bromelain with blood pressure-lowering medications.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Bromelain (BR), a protease extracted from Ananas comosus, reportedly possesses pharmacological activities including the reduction of thrombogenesis, and antihypertensive, and antimicrobial effects.
Label source:
PubMed: Food science & nutrition (2019)
Source url:
Exact phrase from label:
Similarly, the difference in mean change in other CVD risk factors (blood lipids, blood pressure), blood glucose, C-reactive protein and anthropometric measures between the bromelain and placebo groups was also not statistically significant.
Label source:
PubMed: Chinese journal of integrative medicine (2016)
Source url:
Exact phrase from label:
Recent studies emphasize its role in the production of protein hydrolysates with bioactive properties, including antioxidant and antihypertensive activities.
Label source:
PubMed: Journal of the science of food and agriculture (2026)
Action type:
monitor
Target id:
/class/cns-depressants
Target name:
CNS Depressants (e.g., Benzodiazepines, Alcohol)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
There is a theoretical possibility that bromelain could increase the sedative effects of central nervous system depressants, though clinical evidence is limited.
Actionable advice:
This is best used with caution, and it is worth monitoring for increased drowsiness when combined with sedative medications or alcohol.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The most frequent adverse effects confirmed in people who overdose on bromelain include vomiting, nausea, diarrhea, heart palpitations, digestive problems, lack of appetite, fatigue, body discomfort, dizziness, drowsiness, and lethargy. Uterine bleeding and heavy menstruation can occur as well. People having peptic ulcer and any other digestive problems should not intake bromelain in any form—they need to consult with health care professionals prior to using bromelain.
Label source:
Action type:
monitor
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
While not a direct contraindication, the metabolism of bromelain in individuals with severe liver disease is not well understood. Caution is advised.
Actionable advice:
It is a good idea to talk to a doctor before use with significant liver disease.
Validation status:
validated_via_clinical_guidance
Evidence tier:
tier_b
Evidence basis:
clinical_guidance_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Bromelain is generally recognized as safe (GRAS) and has not been linked to serum aminotransferase elevations nor to instances of clinically apparent liver injury
Label source:
Clinical guidance: NIH LiverTox — Bromelain
Action type:
informational_none
Target id:
/dietary/hot-foods-beverages
Target name:
Hot Foods or Beverages
Severity:
moderate
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Bromelain is a proteolytic enzyme that is denatured and inactivated by heat, so mixing it into hot liquids destroys its enzymatic activity.
Actionable advice:
Bromelain should not be added to hot drinks or food; it should be taken with cool or room-temperature liquid.
Validation status:
validated_via_class_inference
Evidence tier:
tier_c
Evidence basis:
class_inference_summary
Evidence anchors:
Source url:
Mechanism / enzyme thermal denaturation
Exact phrase from label:
Bromelain is a heat-labile proteolytic enzyme whose activity is lost upon exposure to high temperatures.
Label source:
Mechanistic inference
Action type:
avoid