Bromelain

We evaluated 147 human studies on Bromelain, including 47 randomised controlled trials and 16 meta-analyses or systematic reviews; the controlled studies include 4,437 participants in total. As of 8 October 2026.

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1. What Is Bromelain? Occurrence, Origin and Forms

Bromelain is a mixture of proteolytic enzymes found in the pineapple (Ananas comosus); preparations are mainly made from the stem of the plant. It is sold as a powder, tablet or capsule with a stated enzyme activity, and also as an ingredient of combination products. It is studied, among other things, in swelling after surgery, in osteoarthritis, in inflammation and in sinusitis.

The enzymes occur in the pineapple, in the fruit and in particularly high concentration in the stem of the plant. As a preparation, bromelain is taken orally and is also used in food processing.

For production, the pineapple stem is pressed, the enzyme is precipitated from the juice and purified; its activity is stated in standardised units rather than in milligrams. Studies mainly examine stem bromelain as a tablet or capsule, sometimes as a single substance and sometimes together with other enzymes or plant compounds.

Forms and Preparations Studied

• Stem bromelain from the pineapple stem
• Fruit bromelain from the fruit
• Powders, tablets and capsules with a stated enzyme activity
• Preparations with additional enzymes or plant compounds (combination products)
• Pineapple fruit and pineapple juice as food

Not covered on this page:

• Other plant proteases such as papain, ficin or actinidin from papaya, fig and kiwi
• Animal proteases such as trypsin and chymotrypsin, even when they occur in the same preparations
• The technical use of bromelain as an aid in food processing

2. What Does Bromelain Do? Results by Area

How to read the table: counted are human studies whose results concern the area. “High” means at least one meta-analysis and two controlled studies showing improvement, or at least three controlled studies of which three quarters show improvement, with at least 300 participants in total. “Moderate” means at least two controlled studies showing improvement, as a majority, or one meta-analysis alongside controlled studies. “Low” means one controlled study showing improvement. Where an area has no controlled study, the strength of evidence is at most “low” (result “reviews only” or “observational data only”). Everything else is “unclear”. A study counts as showing improvement when at least half of its outcomes in this area improved. Reviews of combination products do not count as meta-analyses; results that only describe side effects or shares of users do not count as an effect. The same study is counted only once.

3. What the Studies Show in Detail

Bromelain, Dental and Maxillofacial Surgery: Human Studies

After wisdom tooth removal, bromelain reduced facial swelling compared with the procedure without bromelain 53 and relieved swelling and trismus more than aceclofenac 34. Purified bromelain and a bromelain-enriched pineapple extract each lowered ibuprofen need, pain and swelling after wisdom tooth removal more than placebo 42. After tooth removal with ridge preservation, pain and initially swelling were less under bromelain than under placebo 55. A mixture of baicalin, bromelain and escin relieved pain more than ibuprofen and placebo, but not swelling and trismus 32. After wisdom tooth, gum and root canal treatment, bromelain relieved pain similarly to aceclofenac, ibuprofen and diclofenac; the latter two acted faster at individual early time points 344652. A mouth rinse with bromelain did not remove more plaque than placebo 41; after gum surgery, the gums bled less often, and plaque and gum index did not differ 44. The studies were mostly small, some not randomized, and used different preparations, often without stating the enzyme activity.

Further studies in this area: 46 52 53 54 55 124

Bromelain, Swelling and Inflammation After Surgery: Human Studies

After operations, bromelain reduced swelling and bruises: after rhinoplasty, bruises and eye hemorrhages were less on the seventh day than with placebo, swelling was not 49. Bromelain capsules with a stated enzyme activity reduced edema more than placebo after eyelid surgery, bruises only on the third day 39. The evidence is moderate, as only a few controlled trials tested bromelain alone. Several studies tested mixtures, such as bromelain with trypsin and rutoside 2126 or with diosmin, melilotus and hesperidin 48; their results cannot be attributed to bromelain alone. It remains open what role the stated enzyme activity, the origin from stem or fruit and the respective preparation play in the extent of the benefit.

Further studies in this area: 67 69 72 73 76 79 86 97 104 106 123 124

Bromelain and Sinusitis: Human Studies

For bromelain alone in sinusitis, only review articles are available. According to a systematic review, bromelain could be effective in sinusitis 14. Another review describes a randomized study in children with acute sinusitis in which the children recovered faster with bromelain alone than with standard therapy with or without bromelain 7. In chronic sinusitis, a combination preparation of black currant, Boswellia serrata, bromelain and vitamin D in addition to the corticosteroid spray improved mucosal redness and runny nose more than the spray alone 68. The evidence is overall low; dedicated controlled trials with bromelain alone are still pending.

Bromelain, Inflammation and Inflammatory Markers: Human Studies

After traumatic brain injury, bromelain in a randomized trial lowered IL-6 more than placebo, while CRP, MDA and antioxidant capacity did not differ 47. In the same study, severity scores and mortality after two months were lower with bromelain 47. In hospitalized COVID-19 patients, a mixture of quercetin, vitamin C and bromelain lowered CRP and ferritin more than routine care, but did not reduce clinical events over the course 17. A randomized controlled trial with an oral enzyme combination of bromelain, trypsin and rutoside in knee osteoarthritis found higher levels of α2-macroglobulin and interleukin-10 40. The evidence is low; most controlled trials tested mixtures, studies with bromelain alone are still pending.

Further studies in this area: 82 88 93 100 101 108 109 116 122 123

Bromelain and Osteoarthritis: Human Studies

A systematic review of systemic enzyme therapy with trypsin, bromelain and rutoside trihydrate, partly together with diclofenac, reports less pain, better mouth opening, fewer joint sounds and easier eating and chewing in temporomandibular joint osteoarthritis 12. In knee osteoarthritis, an enzyme combination of bromelain, trypsin and rutoside improved pain and symptom scores compared with placebo, but not the overall score 40. Both results concern mixtures and cannot be attributed to bromelain alone. A study of a mixture of Boswellia serrata and bromelain found better quality of life, but had no comparison group 70. The evidence is overall low; controlled trials with bromelain alone in osteoarthritis are still pending.

Bromelain: Further Outcomes in Studies

In deep burns and chronic wounds, a bromelain-based enzyme preparation for topical application cleaned the wound faster and more often completely in meta-analyses and randomized trials 3614152933. Burns healed more often without excision or skin graft 345; however, the time to wound closure in burns and chronic wounds did not differ from the comparison treatment 3433. In venous leg ulcers, the bromelain preparation cleaned the wound faster and more often completely than a collagenase ointment, and granulation was also more often complete 51. A bromelain-enriched pineapple extract relieved pain and swelling in children with orchitis and epididymitis more than placebo, in addition to antibiotics in both groups 38. After Mohs surgery with flap reconstruction, wounds healed faster with oral bromelain than with standard care, with no confirmed difference in pain 36. The later scar quality did not differ from standard surgical treatment in meta-analyses and a randomized pediatric study 34550. A combination preparation of essential oils, bromelain and green propolis led to clinical healing more often than placebo in acute bronchitis 18. The robustness is high for enzymatic debridement; the study on venous leg ulcers was funded by the manufacturer 29.

Further studies in this area: 11 14 15 16 29 33 35 36 38 47 50 51 56 58 59 60 61 62 63 64 65 66 69 74 75 77 78 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 102 103 104 105 106 107 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 125

4. How Is Bromelain Dosed? Preparation, Dose and Duration in Studies

For oral use, bromelain was mostly given as a capsule, sometimes with stated enzyme activity 3944; on wounds, a bromelain-based enzyme product was used for wound cleaning 2933. In addition, a bromelain-enriched, freeze-dried pineapple extract was tested 3842. Several investigations tested mixtures, such as bromelain with trypsin and rutoside 212640, with baicalin and escin 32, or with quercetin and vitamin C 17; their results cannot be attributed to bromelain alone.

5. Is Bromelain Safe? Side Effects in Studies

The studies report predominantly good tolerability; mentioned were mainly flatulence, nausea and headache 14. For use on wounds, a meta-analysis names burning, pain, fever and sepsis, but their relation to the product is uncertain; serious health risks were not reported 14. In controlled studies and a meta-analysis, adverse events under bromelain did not occur more frequently than in the comparison groups 62939.

6. What Remains Open: Limits of the Evidence

• Many studies investigated combination products with other enzymes or plant substances, so the contribution of bromelain alone remains unclear.
• The stated enzyme activity, the origin from stem or fruit and the preparation form were often not reported.
• For osteoarthritis, controlled studies with bromelain alone are still pending, and for sinusitis, larger replications of the only pediatric study so far 7.
• Several studies were small, some not randomized or manufacturer-funded.
• Long-term data on tolerability and interactions with medications are still pending.

7. Bottom Line: What Is Established About Bromelain

Bromelain is a mixture of proteolytic enzymes from pineapple that is offered as a powder, tablet or capsule with stated enzyme activity. Bromelain is best studied for swelling after operations as well as a bromelain-based enzyme product for wound cleaning in burns and chronic wounds. Here, controlled studies and meta-analyses showed less swelling and bruising as well as fewer surgical interventions.

In dentistry, bromelain improved swelling and mouth opening; against pain, it worked better than placebo and similarly to common painkillers. For inflammatory markers, osteoarthritis and sinusitis, the results rest mainly on combination products or reviews, so the contribution of bromelain alone remains open. Tolerability is predominantly described as good, with gastrointestinal complaints as the most common side effects.