Drug Interaction Report

Bromelains and Fondaparinux: Interaction Details

A pharmacist-reviewed analysis of the Bromelains and Fondaparinux interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Fondaparinux

Arixtra
+

Bromelains

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 8 documented Bromelains interactions, 8 are rated moderate — including this one.
Onset
delayed
Evidence
theoretical
Severity
Moderate

What happens

Increased risk of bleeding

Interaction Deep Dive

Theoretically, bromelain may increase the risk of bleeding when taken with an anticoagulant. Oral bromelain decreased platelet sensitivity to ADP-induced platelet aggregation2. Bromelain contains a fibrinolytic enzyme activator which may contribute to its ability to increase the risk of bleeding 3. Caution is advised when using bromelain and an anticoagulant concomitantly 41.

Why it happens (mechanism)

Additive antiplatelet effects

Literature reports

1 report — tap to read

a) Bromelain reduced ADP-induced platelet aggregation in healthy subjects two hours after dosing. Subjects received two enteric coated bromeain tablets (Ananase(R) 100). Many of the subjects had high baseline platelet aggregation values and had experienced myocardial infarction or stroke within the prior year 2.

Common questions

Can I take Bromelains and Fondaparinux together?

Increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.

How serious is the Bromelains and Fondaparinux interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Bromelains or Fondaparinux need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (4)

  1. Heck AM, DeWitt BA, & Lukes AL: Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000; 57(13):1221-1227. DOI
  2. Heinicke RM, van der Wal L, & Yokoyama M: Effect of bromelain (Ananase(R)) on human platelet aggregation. Experientia 1972; 28:844-845.
  3. Ako H, Cheung AHS, & Matsuura PK: Isolation of a fibrinolysis enzyme activator from commercial bromelain. Arch Int Pharmacodyn 1981; 254:157-167.
  4. Norred CL & Brinker F: Potential coagulation effects of preoperative complementary and alternative medicines. Alt Ther 2001; 7(6):58-67.
Was this write-up helpful?
Fondaparinux

Keep reading about Fondaparinux

All Fondaparinux interactions (204) Fondaparinux drug information
Also serious with: Defibrotide Defibrotide Injection St John's Wort Streptokinase
Bromelains

Keep reading about Bromelains

All Bromelains interactions (8)
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Fondaparinux + Danshen Piracetam Aconite Allspice Aloe Alpha-lipoic Acid Andrographis Arnica + 194 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.