Interactions on record — worth a quick check against your medications. Based on 6 of 19 ingredients. Check your meds →
Dietary supplement

Break it Down. Organic Pineapple Ingredients & Drug Interactions

by Ora

Break it Down. Organic Pineapple label
See full label image
Powder Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 23, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Break it Down. Organic Pineapple against your medications. The heart of this page is the interaction checker and the full interaction report — how this product’s ingredients may interact with prescription and over-the-counter medicines you may be taking.

Around that, we add a pharmacist’s high-level view of the product as a whole — what’s inside, the evidence for its stated use, how transparent the label is, and what safety data exists — so you can see the full picture in one place. It’s educational information from our licensed clinical databases and the clinical staff at HelloPharmacist — not medical advice — and we don’t sell or endorse products. Our editorial policy

The interaction bottom line Most serious interaction: Moderate

Break it Down. Organic Pineapple is a dietary supplement by Ora with 19 active ingredients. Its ingredients are commonly taken for constipation, diarrhea, high cholesterol.Based on those ingredients, 2,103 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Dietary Fiber, Bacillus subtilis, Bromelain. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Break it Down. Organic Pineapple by Ora

Ask about any prescription or over-the-counter medication and we check it for interactions with Break it Down. Organic Pineapple by Ora — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of Break it Down. Organic Pineapple by Ora

Our pharmacy team’s full take, with four database checks built into the cards below — a summary of what is known, not a grade of the product itself.

From our pharmacy team — supplement deep dive

Generated from HelloPharmacist’s pharmacist-curated databases and editorial rules · Last generated Jul 12, 2026

What’s inside

Low disclosure
Ingredient Transparency · database check
Low

Most active ingredients don't disclose an individual amount — you can't tell how much of each you're getting.

Why this rating?
  • The label discloses an exact amount for 1 of its 19 active ingredients.
  • “Ora Organic Enzyme Blend” is a proprietary blend — the label gives one combined amount (4.50 Gram(s)) without saying how much of each component you get.
  • “Vegetarian Pancreatin Alternative” is listed as a grouped ingredient — the label doesn't break down how much of each component you get.

This powder contains 18 ingredients, including several active digestive enzymes. The ones we have data on are papain and bromelain (fruit enzymes), lipase and lactase (which help break down fats and milk sugar), phytase (which may help with mineral absorption), bacterial protease and Bacillus subtilis (a live beneficial organism), and several others including a pineapple juice powder base.

The product also contains maltodextrin as an inactive ingredient.

Does it work?

Strong evidence
Evidence for Intended Use · database check
By FDA rules, dietary supplements can’t claim to treat, cure, or prevent disease — so labels speak in careful marketing language. We discern each product’s intended use from its name, label claims, and label statements, then grade the clinical evidence for that use. How these ratings are computed
Strong

Clinical evidence supports at least one of this product's ingredients for its stated purpose.

Why this rating?
  • The label markets this product for: Digestive enzyme support.
  • We looked for evidence on: Constipation, Diarrhea, Dyspepsia, Flatulence, Inflammatory bowel disease (IBD), Irritable bowel syndrome (IBS) — and 4 related terms.
  • The strongest evidence on file: Black Psyllium is rated "Effective" for Constipation (Natural Medicines).
  • Also on file: Lactase is rated "Effective" for Lactose intolerance.
  • Also on file: Bacillus Subtilis is rated "Possibly Effective" for Antibiotic-associated diarrhea.

The evidence for most ingredients in this product isn't well established. Papain hasn't got reliable evidence for cancer, dental caries, radiation dermatitis, exercise soreness, shingles, or parasites.

Bromelain similarly lacks strong evidence for hay fever, burns, cancer, nerve damage, vein problems, or diabetes. Lactase is effective for lactose intolerance, and Bacillus subtilis is possibly effective for antibiotic-associated diarrhea—that's the only use we have solid support for.

For the other conditions these enzymes have been studied for, the data just isn't there yet.

The evidence, ingredient by ingredient Black Psyllium Papain Bromelain Lactase Phytase Bacillus Subtilis

How safe is it?

Well-documented data
Safety Information · database check
Well characterized

Adverse-effect, pregnancy, and general safety data are on file for most of these ingredients.

Why this rating?
  • We hold adverse-effect (side-effect) data for 8 of the 8 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 8 of 8.
  • General safety write-ups exist for 8 of 8.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Papain is generally tolerated as a food but can irritate the digestive tract and cause allergic reactions in sensitive people; concentrated papain and unripe papaya should be avoided in pregnancy. Bromelain is well tolerated short-term but data on long-term use is limited, and it should be avoided in pregnancy and breastfeeding.

Lactase is likely safe in pregnancy and is generally well tolerated. Lipase is generally well tolerated but people with serious digestive issues should use it only under medical supervision.

Bacillus subtilis is generally well tolerated in healthy adults, though quality and safety vary by product. We have limited or no safety data for Phytase and bacterial protease in pregnancy or breastfeeding.

Rare serious side effects include esophageal perforation with high doses of papain, and in occupational settings, people exposed to airborne papain or phytase dust have had respiratory allergic reactions.

Side effects, ingredient by ingredient Black Psyllium Papain Bromelain Lactase Phytase Bacillus Subtilis

Meds to double-check

Moderate interaction found
Known Interaction Concern · database check
Moderate identified

The most serious documented interaction for these ingredients is Moderate. Check your medications for a personalized result.

Why this rating?
  • 4 of the 8 matched ingredients can interact with medications — Papain, Black Psyllium, Bromelain, Bacillus Subtilis.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; heart-rhythm medications; lithium.
  • For scale: 2,104 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

If you take warfarin or another blood thinner (anticoagulant), antiplatelet drugs like aspirin or clopidogrel, tetracycline antibiotics, or any other regular medication, double-check before using this product. The interaction between papain and warfarin is moderate in severity, and bromelain may raise bleeding risk with blood thinners.

If you're on antibiotics, separate them from this product by a few hours, since antibiotics could kill the live Bacillus subtilis in it.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFormula with limited ingredient disclosure with clinical evidence supporting its stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.

This product is an enzyme blend mainly for digestive support. If you take warfarin, any blood thinner, antiplatelet drugs, tetracycline antibiotics, or any other regular medication, check your exact prescriptions with the tool on this page before you start.

Talk to your pharmacist or doctor if you're pregnant or breastfeeding, or if you have a serious digestive condition.

Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI

Assessment coverage: 8 of 19 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Oct 23, 2019.

This Scorecard evaluates available label information, ingredient evidence, and known medication-safety considerations. It does not independently verify product identity, purity, potency, contamination, or manufacturing quality. How these ratings are computed

At a glance

General information

Key facts about Break it Down. Organic Pineapple, straight from the product label.

Brand Ora
Barcode (UPC) 856720007504
Net contents 1.73 Oz(s); 0.1 lbs; 49 Gram(s)
Market status On market
Date entered into DSLD Oct 23, 2019
DSLD ID 208587
Product type Other Combinations
Supplement form Powder
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Vegan, Vegetarian, Adult (18 - 50 Years), Kosher, Organic, Gluten Free
From the label
Everything in this section is reproduced from the manufacturer’s own product label — it’s the label speaking, not HelloPharmacist. We show it so you can see exactly what the maker states; we don’t verify or endorse those statements.

Supplement Facts

The label details for Break it Down. Organic Pineapple by Ora, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
7 Gram(s)
Maximum serving Sizes:
7 Gram(s)
Servings per container
7
UPC/BARCODE
856720007504
IngredientAmount% DV
Calories25 Calorie(s)--
Total Carbohydrates7 Gram(s)2%
Dietary Fiber1 Gram(s)20%
Papain0 NP--
Protein2 Gram(s)--
Bromelain0 NP--
Lipase0 NP--
Total Sugars3 Gram(s)--
Lactase0 NP--
Cellulase0 NP--
Aspergillopepsin0 NP--
Peptidase0 NP--
Glucoamylase0 NP--
Xylanase0 NP--
Pectinase0 NP--
Beta-Glucanase0 NP--
Phytase0 NP--
Hemicellulase0 NP--
Amylase, Fungal0 NP--
organic Pineapple juice powder0 NP--
Protease, Bacterial0 NP--
Ora Organic Enzyme Blend4.5 Gram(s)--
organic Maple Sugar0 NP--
Vegetarian Pancreatin Alternative0 NP--
Bacillus subtilis0 NP--

Other ingredients: Maltodextrin

Tap any ingredient to jump to its full detail below.

Label statements
These statements are the manufacturer’s wording, reproduced from the product label — the label is saying it, not HelloPharmacist. We don’t verify or endorse them.
Formulation

Vegan

Non-GMO Gluten-free Dairy-free Soy-free No artificial ingredients

Organic About Ora Organic Our products are sustainably sourced from organic and plant-based foods. We believe in clean nutrition for a healthy body and a healthy planet.

Vegan Digestive Enzymes

Contains No: dairy, gluten, soy, GMOs, tree nuts, nor artificial colors, flavors, artificial sweeteners or preservatives.

Certified Organic by QAI

How can I help? Finding something a little hard to stomach? Let me help with that! I’m designed to support your digestive system by breaking down nutrients for absorption. Easier on your gut, easier on you!

General Statements

Sustainably sourced Chef designed

By Ora Organic

Product sold by weight not volume. Contents may settle.

Formula

Digestive Enzymes

OU

What am I? I’m a vegan digestive enzymes powder. I contain a total of 15 different digestive enzymes including papain from papaya and bromelain from pineapple. I want you to enjoy taking care of yourself, that’s why I have a delicious organic pineapple flavor crafted by a chef.

FDA Statement of Identity

Digestive Enzymes Powder Supplement

Seals/Symbols

USDA Organic Certified Vegan Vegan.org

OU

Suggested/Recommended/Usage/Directions

Suggested Use: Mix one packet with a 1/4 cup (2 oz) of water or add to a smoothie.

Storage

Storage: Store in a cool, dry place.

FDA Disclaimer Statement

This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

Is this label outdated? Report a formula or label change and our pharmacy team will review it.

See for yourself

Break it Down. Organic Pineapple by Ora label

The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.

Break it Down. Organic Pineapple label

Label images are published by the NIH Dietary Supplement Label Database for the version of this product on file. Always read your actual product label.

View the full label (PDF)
What’s inside

The Ingredients in Break it Down. Organic Pineapple by Ora

These are the 19 active ingredients this product is made of. Select any to open its full monograph.

Serving size7 Gram(s) Dosage formPowder Servings per container7 Amounts shown are per serving.

Most supplement products combine several ingredients, and a medication can interact with the product through any one of them. Each ingredient below shows whether it has known drug interactions.

Dietary Fiber

Interacts with
2,025 drugs
1 Gram(s) per serving

Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. I...

Dietary Fiber monograph & interactions

Protein

2 Gram(s) per serving

Ora Organic Enzyme Blend

4.5 Gram(s) per serving
  • › Papain
  • › Bromelain
  • › Lactase
  • › Cellulase
  • › Aspergillopepsin
  • › Peptidase
  • › Glucoamylase
  • › Xylanase
  • › Pectinase
  • › Beta-Glucanase
  • › Phytase
  • › Hemicellulase
  • › Amylase, Fungal
  • › Organic Pineapple juice powder
  • › Organic Maple Sugar
  • › Vegetarian Pancreatin Alternative
  • › Bacillus subtilis

Other (inactive) ingredients: Maltodextrin. These complete the product’s ingredient list but are not active constituents.

Interaction report

Break it Down. Organic Pineapple by Ora Drug Interactions

Want to check YOUR meds against Break it Down. Organic Pineapple?

Ask about interactions with your drugs in plain English — “Can I take it with lisinopril?” — and we find you the answer in seconds, ingredient by ingredient.

 Go to the checker
2,103Drugs
326 Moderate 1,777 Minor

Ingredients driving the most interactions

Dietary Fiber 2,025
Bacillus subtilis 182
Bromelain 141
Papain 2

Individual Drug Interactions

The ingredients in Break it Down. Organic Pineapple interact with 2,103 drugs. Click any drug to see the details.

4 of the 19 ingredients in Break it Down. Organic Pineapple interact with drugs. Each result below shows which ingredient is responsible. Dietary Fiber Bacillus subtilis Bromelain Papain

Each ingredient & the kinds of drugs it affects

For each ingredient in Break it Down. Organic Pineapple with known interactions, here are the types of medications they can affect. Open any type for the detail — or search your exact drug in the checker above.

Dietary Fiber7 drug types · 2,025 drugs

Carbamazepine (Tegretol)

Theoretically, black psyllium might reduce the effects of carbamazepine and increase the risk for convulsions.
Theoretically, black psyllium might reduce carbamazepine absorption. A preliminary study using blond psyllium reported decreased carbamazepine bioavailability due to binding of the drug to psyllium, as well as reduction of available fluid in the gut for dissolution of the drug. This interaction may also occur with black psyllium.

Likelihood Probable Evidence D
Lithium

Theoretically, taking black psyllium at the same time as lithium might reduce lithium absorption.
The fiber in black psyllium might reduce lithium absorption and plasma levels. Some case reports describe a reduction in plasma lithium levels with concomitant administration of blond psyllium. This was reversed when psyllium was stopped. This interaction may also occur with black psyllium.

Likelihood Probable Evidence D
Metformin (Glucophage)

Theoretically, black psyllium might increase the therapeutic and adverse effects of metformin.
Animal research shows that concurrent consumption of blond psyllium with metformin slows and increases the absorption of metformin. This interaction may also occur with black psyllium. To avoid changes in absorption, take psyllium 30-60 minutes after metformin.

Likelihood Possible Evidence D
Olanzapine (Zyprexa)

Theoretically, taking black psyllium at the same time as olanzapine might reduce olanzapine absorption.
The fiber in black psyllium might decrease the absorption of olanzapine. A single case report describes a reduction in the effectiveness of olanzapine when it was concomitantly administered with an unspecified type of psyllium 3 grams orally twice daily. This effect was reversed when psyllium was stopped.

Likelihood Possible Evidence D
Digoxin (Lanoxin)

Theoretically, taking black psyllium at the same time as digoxin might reduce digoxin absorption and decrease digoxin levels.
Psyllium might bind digoxin in the gut. However, some clinical evidence suggests that psyllium does not impact digoxin absorption.

Likelihood Unlikely Evidence B
Ethinyl Estradiol

Theoretically, taking black psyllium at the same time as ethinyl estradiol might alter levels of estradiol.
Concurrent use of blond psyllium with ethinyl estradiol results in a slight increase in the extent of ethinyl estradiol absorption and a slower rate of absorption. This is unlikely to be clinically significant.

Likelihood Unlikely Evidence D
Oral Drugs

Theoretically, psyllium might increase, decrease, or have no effect on the absorption of oral drugs.
Psyllium seems to have variable effects on drug absorption. To avoid changes in absorption, take psyllium 30-60 minutes after oral medications. Animal research shows that blond psyllium delays and increases the absorption of metformin and ethinyl estradiol. Case reports and animal research suggest that blond psyllium might reduce absorption of lithium, digoxin, olanzapine, and carbamazepine. Finally, some pharmacokinetic studies show that psyllium does not affect the absorption of levothyroxine or warfarin. Although many of these studies evaluated blond psyllium, the fiber content in black psyllium may have similar effects.

Likelihood Possible Evidence B
Dietary Fiber full monograph & interactions

Bacillus subtilis1 drug type · 182 drugs

Antibiotic Drugs

Theoretically, taking Bacillus subtilis with antibiotic drugs might decrease the effectiveness of B. subtilis.
Since B. subtilis preparations usually contain live and active organisms, simultaneously taking antibiotics might kill a significant number of the organisms. Tell patients to separate administration of antibiotics and B. subtilis preparations by at least 2 hours.

Likelihood Probable Evidence D
Bacillus subtilis full monograph & interactions

Bromelain2 drug types · 141 drugs

Anticoagulant/Antiplatelet Drugs

Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
There is one case report of a patient experiencing minor bruising while taking bromelain with naproxen. Bromelain is thought to have antiplatelet activity. Whether this interaction is of concern with topical bromelain is unclear. Interference with coagulation of burn wounds has been reported in a patient receiving bromelain-based enzymatic debridement. However, observational research has found that topical bromelain debridement is not associated with increases or decreases in laboratory markers of coagulation when compared with surgical debridement.

Likelihood Possible Evidence D
Tetracycline Antibiotics

Theoretically, bromelain might increase levels of tetracycline antibiotics.
Laboratory research suggests that bromelain might increase the absorption of tetracycline antibiotics. However, a study in healthy adults reported no difference in tetracycline plasma levels when a 500 mg dose was taken with or without bromelain 80 mg.

Likelihood Possible Evidence B
Bromelain full monograph & interactions

Papain1 drug type · 2 drugs

Warfarin (Coumadin)

Theoretically, papain might increase the effects and side effects of warfarin.
In one case report, a patient previously stable on warfarin was found to have an international normalization ratio (INR) of 7.4, which was attributed to ingestion of a supplement containing papain from papaya extract.

Likelihood Possible Evidence D
Papain full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Break it Down. Organic Pineapple, from the product label.

Ora

See all Ora products
Name
Ora Organic
City
San Diego
State
CA
ZipCode
92101
Phone Number
1 (858) 429-5591
Web Address
www.ora.organic
Pharmacist Counseling Corner

Break it Down. Organic Pineapple by Ora: Common Questions

Does Break it Down. Organic Pineapple by Ora interact with any medications?
Yes. Based on its ingredients, Break it Down. Organic Pineapple has a known interaction with 2,103 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Break it Down. Organic Pineapple contains 19 active ingredients, and an interaction can come from any of them. We check every ingredient, combine the results into one list per medication, and show which ingredient and mechanism is responsible.
Where does this information come from?
The product label data comes from the NIH Dietary Supplement Label Database (DSLD); the interaction data is built on the Natural Medicines database and reviewed by HelloPharmacist pharmacists.
Is this safe if I'm pregnant?
The data advises against papain (concentrated forms and unripe papaya especially) during pregnancy. Bromelain and bacterial protease should be avoided too. Lactase is likely safe. For the other enzymes, there isn't enough safety data—talk to your doctor or pharmacist for personalized advice.
Is this safe if I'm breastfeeding?
There isn't enough reliable data on papain, bromelain, bacterial protease, phytase, or lipase while breastfeeding. Lactase has limited data but acts only in the gut, so check with your doctor first. Bacillus subtilis also has limited data—best to ask before using.
Can this help me digest better?
This is an enzyme blend designed for digestive support, but the evidence for most of these enzymes isn't well established yet. The one ingredient we do have good evidence for is lactase, which works for lactose intolerance.
What's Bacillus subtilis and why is it in here?
It's a live beneficial organism (a probiotic-type ingredient) that may help with antibiotic-associated diarrhea. If you're taking antibiotics, separate them from this powder by a few hours so the antibiotics don't kill off the live bacteria.
Will this cause allergic reactions?
Papain and bromelain can trigger allergic reactions in sensitive people—itching, rash, throat irritation, breathing trouble, or stomach cramps. Lactase can too, though it's rare. Stop taking it and talk to your pharmacist or doctor if you notice any of these signs.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Not sure if Break it Down. Organic Pineapple is safe with your meds?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

Label information is sourced from the NIH Dietary Supplement Label Database and reflects the product version on file; always read your actual product label. This page is for education only and is not a substitute for professional medical advice. Confirm with your pharmacist or doctor before combining supplements and medications.

Break it Down. Organic Pineapple label
Go deeper

The Full Monographs Behind Break it Down. Organic Pineapple’s Ingredients

Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.

Herb & supplement monograph

Black Psyllium

Interacts with 2,025 drugs

Black psyllium is a soluble-fiber supplement made from the seeds of a Plantago plant, used mostly to ease constipation and support digestive health. It is best known and most studied for rel...

Read the full Black Psyllium monograph → Herb & supplement monograph

Papain

Interacts with 2 drugs

Papain is a protein-digesting enzyme from the papaya plant that is used in digestive supplements and some topical products. While it has clear food and laboratory uses, strong human evidence...

Read the full Papain monograph → Herb & supplement monograph

Bromelain

Interacts with 141 drugs

Bromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early studies are promising, but the overall evi...

Read the full Bromelain monograph → Herb & supplement monograph

Lactase

Lactase is a digestive enzyme supplement that helps people who lack enough natural lactase break down lactose, the sugar in milk and dairy. It can reduce gas, bloating, cramping, and diarrhe...

Read the full Lactase monograph → Herb & supplement monograph

Phytase

Phytase is an enzyme that breaks down phytic acid (phytate) found in grains, beans, nuts, and seeds, which can free up minerals like iron, zinc, and calcium for absorption. It is widely used...

Read the full Phytase monograph → Herb & supplement monograph

Bacillus Subtilis

Interacts with 182 drugs

Bacillus subtilis is a spore-forming probiotic bacterium found in soil and some fermented foods, and it is used mainly to support gut health and digestion. Early research is promising for ce...

Read the full Bacillus Subtilis monograph →
Sources

Sources & How We Checked

Break it Down. Organic Pineapple's label data comes from the NIH Dietary Supplement Label Database; the ingredient interaction data is from the Natural Medicines database, reviewed by our pharmacists.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

The 70 references behind this product’s interaction data

Every citation that drives the interaction findings for this product’s ingredients, from the evidence-graded Natural Medicines (TRC Healthcare) database. Open an ingredient to browse its citations — links open the study on PubMed or the publisher’s site.

Black Psyllium 18 references
  1. McGuffin M, Hobbs C, Upton R, Goldberg A, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, LLC 1997.
  2. Gruenwald J, Brendler T, Jaenicke C. PDR for Herbal Medicines. 1st ed. Montvale, NJ: Medical Economics Company, Inc., 1998.
  3. Covington TR, et al. Handbook of Nonprescription Drugs. 11th ed. Washington, DC: American Pharmaceutical Association, 1996.
  4. Etman M. Effect of a bulk forming laxative on the bioavailablility of carbamazepine in man. Drug Dev Ind Pharm 1995;21:1901-6.
  5. Perlman BB. Interaction between lithium salts and ispaghula husk. Lancet 1990;335:416.
  6. Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF. Psyllium laxative-induced anaphylaxis, asthma, and rhinitis. Allergy 1996;51:266-8. PubMed
  7. Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. Anaphylaxis following ingestion of a psyllium-containing cereal. JAMA 1990;264:2534-6. DOI
  8. Kaplan MJ. Anaphylactic reaction to "Heartwise." N Engl J Med 1990;323:1072-3. DOI
  9. Nordstrom M, Melander A, Robertsson E, Steen B. Influence of wheat bran and of a bulk-forming ispaghula cathartic on the bioavailability of digoxin in geriatric in-patients. Drug Nutr Interact 1987;5:67-9..
  10. Robinson DS, Benjamin DM, McCormack JJ. Interaction of warfarin and nonsystemic gastrointestinal drugs. Clin Pharmacol Ther 1971;12:491-5. PubMed
  11. Garcia JJ, Fernandez N, Diez MJ, et al. Influence of two dietary fibers in the oral bioavailability and other pharmacokinetic parameters of ethinyloestradiol. Contraception 2000;62:253-7. PubMed
  12. Fernandez N, Lopez C, Díez R, et al. Drug interactions with the dietary fiber Plantago ovata husk. Expert Opin Drug Metab Toxicol 2012;8(11):1377-86.
  13. Semen plantaginis in: WHO Monographs on Selected Medicinal Plants, volume 1. World Health Organization, Geneva, 1999. Available at http://apps.who.int/medicinedocs/en/d/Js2200e/. Accessed November 26, 1026.
  14. Code of Federal Regulations, Title 21 (21CFR 101.17). Food labeling warning, notice, and safe handling statements. Available at www.ecfr.gov/cgi-bin/text-idx?SID=20f647d3b74161501f46564b915b4048&mc=true&node=se21.2.101_117&rgn=div8. Accessed December 3, 2
  15. Code of Federal Regulations, Title 21 (21CFR 201.319). Specific labeling requirements - water-soluble gums, hydrophilic gums, and hydrophilic mucilloids. Available at www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=201.319. Accessed Dece
  16. Diez R, Garcia JJ, Diez MJ, Sierra M, Sahagun AM, Fernandez N. Influence of Plantago ovata husk (dietary fiber) on the bioavailability and other pharmacokinetic parameters of metformin in diabetic rabbits. BMC Complement Altern Med. 2017 Jun 7;17(1):298. PubMed
  17. Chiu AC, Sherman SI. Effects of pharmacological fiber supplements on levothyroxine absorption. Thyroid. 1998;8(8):667-71. PubMed
  18. Merrick C, Madden CA, Capurso NA. A Case of Blunted Orally Disintegrating Olanzapine Effect Due to Coadministered Psyllium. J Clin Psychiatry 2021;82(2):20cr13633. PubMed

See these in context on the Black Psyllium monograph →

Papain 11 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Saf 1997;17:342-56.
  3. Shuttleworth D, Hill S, Marks R, Connelly DM. Relief of experimentally induced pruritus with a novel eutectic mixture of local anaesthetic agents. Br J Dermatol 1988;119:535-40.
  4. Mansfield LE, Ting S, Haverly RW, Yoo TJ. The incidence and clinical implications of hypersensitivity to papain in an allergic population, confirmed by blinded oral challenge. Ann Allergy 1985;55:541-3.
  5. Martin, T., Uhder, K., Kurek, R., Roeddiger, S., Schneider, L., Vogt, H. G., Heyd, R., and Zamboglou, N. Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial PubMed
  6. Walker-Renard, P. Update on the medicinal management of phytobezoars. Am J Gastroenterol. 1993;88(10):1663-1666.
  7. Tymoszuk D, Wiszniewska M, Walusiak-Skorupa J. Papain-induced occupational rhinoconjunctivitis and asthma - A case report. Med Pr 2016;67(1):109-12. PubMed
  8. Soto-Mera MT, López-Rico MR, Filgueira JF, et al. Occupational allergy to papain. Allergy 2000;55(10):983-4. PubMed
  9. Tarlo SM, Shaikh W, Bell B, et al. Papain-induced allergic reactions. Clin Allergy 1978;8(3):207-15. PubMed
  10. Baur X, König G, Bencze K, Fruhmann G. Clinical symptoms and results of skin test, RAST and bronchial provocation test in thirty-three papain workers: Evidence for strong immunogenic potency and clinically relevant proteolytic e?ects of airborne papain. C
  11. Novey HS, Keenan WJ, Fairshter RD, Wells ID, Wilson AF, Culver BD. Pulmonary disease in workers exposed to papain: clinico-physiological and immunological studies. Clin Allergy 1980;10(6):721-31. PubMed

See these in context on the Papain monograph →

Bromelain 19 references
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  13. Martin GJ, Ehrenreich J, and Asbell N. Bromelain: pineapple proteases with anti-edema activity. Exp Med Surg 1962;20:227-247.
  14. Kasemsuk T, Saengpetch N, Sibmooh N, Unchern S. Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis. Clin Rheumatol. 2016 Oct;35(10):2531-40. PubMed
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See these in context on the Bromelain monograph →

Lipase 1 reference
  1. Casper C, Hascoet JM, Ertl T, et al. Recombinant bile salt-stimulated lipase in preterm infant feeding: A randomized phase 3 study. PLoS One. 2016;11(5):e0156071. PubMed

See these in context on the Lipase monograph →

Lactase 1 reference
  1. Laukkanen A, Ruoppi P, Remes S, Koistinen T, Mäkinen-Kiljunen S. Lactase-induced occupational protein contact dermatitis and allergic rhinoconjunctivitis. Contact Dermatitis. 2007;57(2):89-93. PubMed

See these in context on the Lactase monograph →

Phytase 7 references
  1. Lei XG, Weaver JD, Mullaney E, Ullah AH, Azain MJ. Phytase, a new life for an "old" enzyme. Annu Rev Anim Biosci. 2013;1:283-309. PubMed
  2. Smuts CM, Matsungo TM, Malan L, et al. Effect of small-quantity lipid-based nutrient supplements on growth, psychomotor development, iron status, and morbidity among 6- to 12-mo-old infants in South Africa: a randomized controlled trial. Am J Clin Nutr. 2 PubMed
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  7. Koshy JC, Sharabi SE, Feldman EM, Hollier LH Jr, Patrinely JR, Soparkar CN. Effect of dietary zinc and phytase supplementation on botulinum toxin treatments. J Drugs Dermatol. 2012;11(4):507-12.

See these in context on the Phytase monograph →

Proteolytic Enzymes (proteases) 3 references
  1. Weeks JA, Harper RA, Simon RA, Burdick JD. Assessment of sensitization risk of a laundry pre-spotter containing protease. Cutan Ocul Toxicol. 2011;30(4):272-9. PubMed
  2. Marquès LI, Lara S, Abós T, Bartolomé B. Occupational rhinitis due to pepsin. J Investig Allergol Clin Immunol. 2006;16(2):136-7. DOI
  3. Cartier A, Malo JL, Pineau L, Dolovich J. Occupational asthma due to pepsin. J Allergy Clin Immunol. 1984;73(5 Pt 1):574-7. PubMed

See these in context on the Proteolytic Enzymes (proteases) monograph →

Bacillus Subtilis 10 references
  1. Pierce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: The Stonesong Press, 1999:19.
  2. Lampropoulos PK, Gkentzi D, Tzifas S, Dimitriou G. Neonatal sepsis due to Bacillus subtilis. Cureus 2021;13(9):e17692. PubMed
  3. La Jeon Y, Yang JJ, Kim MJ, et al. Combined Bacillus licheniformis and Bacillus subtilis infection in a patient with oesophageal perforation. J Med Microbiol 2012;61(Pt 12):1766-1769. PubMed
  4. Wallet F, Crunelle V, Roussel-Delvallez M, Fruchart A, Saunier P, Courcol RJ. Bacillus subtilis as a cause of cholangitis in polycystic kidney and liver disease. Am J Gastroenterol 1996;91(7):1477-8.
  5. Velasco E, Martins CA, Tabak D, Bouzas LF. "Bacillus subtilis" infection in a patient submitted to a bone marrow transplantation. Rev Paul Med 1992;110(3):116-7.
  6. Kato A, Yoshifuji A, Komori K, et al. A case of Bacillus subtilis var. natto bacteremia caused by ingestion of natto during COVID-19 treatment in a maintenance hemodialysis patient with multiple myeloma. J Infect Chemother 2022;28(8):1212-1215. PubMed
  7. Freedman KE, Hill JL, Wei Y, et al. Examining the gastrointestinal and immunomodulatory effects of the novel probiotic Bacillus subtilis DE111. Int J Mol Sci 2021;22(5):2453. PubMed
  8. Lefevre M, Racedo SM, Denayrolles M, et al. Safety assessment of Bacillus subtilis CU1 for use as a probiotic in humans. Regul Toxicol Pharmacol 2017;83:54-65. PubMed
  9. Hanifi A, Culpepper T, Mai V, et al. Evaluation of Bacillus subtilis R0179 on gastrointestinal viability and general wellness: a randomised, double-blind, placebo-controlled trial in healthy adults. Benef Microbes 2015;6(1):19-27. PubMed
  10. Tokano M, Tarumoto N, Imai K, et al. A case of bacterial meningitis caused by Bacillus subtilis var. natto. Intern Med. 2022. Epub ahead of print.

See these in context on the Bacillus Subtilis monograph →

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DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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