Interactions on record — worth a quick check against your medications. Based on 5 of 7 ingredients. Check your meds →
Dietary supplement

Chewable Nutri-Zyme Natural Peppermint Ingredients & Drug Interactions

by Natures Plus

Chewable Nutri-Zyme Natural Peppermint label
See full label image
Tablet Or Pill Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Chewable Nutri-Zyme Natural Peppermint 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

Chewable Nutri-Zyme Natural Peppermint is a dietary supplement by Natures Plus with 7 active ingredients. Its ingredients are commonly taken for blood sugar support, weight management, digestive upset.Based on those ingredients, 305 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Apple Cider Vinegar, Bromelain, Apple Pectin. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Chewable Nutri-Zyme Natural Peppermint by Natures Plus

Ask about any prescription or over-the-counter medication and we check it for interactions with Chewable Nutri-Zyme Natural Peppermint by Natures Plus — and tell you which ingredient is responsible.

Pharmacist-reviewed data Checks every ingredient Answer in seconds
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HelloPharmacist Scorecard of Chewable Nutri-Zyme Natural Peppermint by Natures Plus

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 11, 2026

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

Why this rating?
  • The label discloses an exact amount for 6 of its 6 active ingredients.
  • No proprietary blends here — you can verify the dose of every single component.

Chewable Nutri-Zyme Natural Peppermint contains six active ingredients: apple cider vinegar, papain, apple pectin, amylase, bromelain, and lipase — all digestive enzymes or compounds meant to support digestion. The product also contains inactive ingredients including fructose, stearic acid, magnesium stearate, and herbs like peppermint, fennel, ginger, rosemary, and catnip for flavor and additional herbal support.

Does it work?

Moderate 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

This product doesn't appear to be marketed for a specific use, so we graded its ingredients' overall clinical evidence instead.

Moderate

Some clinical evidence supports its ingredients for:

Why this rating?
  • The label markets general wellness (“digestive health and healthy digestive function”), not a specific health condition, so there is no single claim to grade against clinical-evidence data.
  • Since the label doesn't commit to one use, we graded the ingredients' overall clinical evidence instead.
  • On file: Hypercholesterolemia — rated "Possibly Effective" (Pectin) (Natural Medicines).

The evidence on most of these ingredients is not well established in our data. Apple pectin is rated possibly effective for high cholesterol, though the research is mixed.

For papain, bromelain, amylase, and lipase — their roles in digestion are plausible, but the evidence in our monographs is insufficient to say whether they work for their intended uses. Apple cider vinegar also lacks reliable evidence for the conditions listed in our data.

The evidence, ingredient by ingredient Apple Cider Vinegar Papain Pectin Bromelain Lipase

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 5 of the 5 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 5 of 5.
  • General safety write-ups exist for 5 of 5.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Apple cider vinegar in food amounts is generally well tolerated, but large supplement doses taken long-term may be unsafe — case reports describe low potassium, high renin levels, and osteoporosis with chronic heavy use. Papain may cause allergic reactions and digestive upset in sensitive people; concentrated papain and unripe papaya products are not recommended in pregnancy.

Bromelain is generally well tolerated short-term but should be avoided in pregnancy due to insufficient safety data and avoided while breastfeeding. Pectin from food and normal supplements is generally well tolerated but has not been well studied in pregnancy or breastfeeding at higher doses — ask your doctor.

Lipase has not reported adverse effects in adults, but safety data on supplemental lipase in pregnancy and breastfeeding is limited. No safety information on file for amylase.

Side effects, ingredient by ingredient Apple Cider Vinegar Papain Pectin Bromelain Lipase

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 5 matched ingredients can interact with medications — Papain, Pectin, Apple Cider Vinegar, Bromelain.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; diabetes medications; heart-rhythm medications.
  • For scale: 305 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.

Before taking this product, double-check with your pharmacist if you take blood thinners or antiplatelet drugs (Moderate risk with bromelain, Moderate with papain and warfarin specifically); diuretics, digoxin, or insulin (Moderate with apple cider vinegar); diabetes medication (Minor with apple cider vinegar); cholesterol-lowering drugs like lovastatin (Moderate with pectin); or tetracycline antibiotics (Moderate with pectin, Minor with bromelain).

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with some supporting evidence behind its ingredients' uses. Moderate medication interactions have been identified, and safety information is well characterized.

This product may help with digestion if enzymes are what you need, but evidence is limited. If you take diuretics, digoxin, insulin, diabetes medication, warfarin, or tetracycline antibiotics, check your exact medications using the tool on this page before starting.

Talk to your pharmacist about whether it's right for you, especially if you're pregnant, breastfeeding, or have a serious digestive condition.

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

Assessment coverage: 5 of 6 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Feb 25, 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 Chewable Nutri-Zyme Natural Peppermint, straight from the product label.

Brand Natures Plus
Barcode (UPC) 097467044555
Net contents 90 Tablet(s)
Market status On market
Date entered into DSLD Feb 25, 2019
DSLD ID 188634
Product type Other Combinations
Supplement form Tablet Or Pill
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Children 4 or More Years of Age, Adult (18 - 50 Years), Gluten Free, Dairy 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 Chewable Nutri-Zyme Natural Peppermint by Natures Plus, 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:
2 Chewable Tablet(s)
Maximum serving Sizes:
2 Chewable Tablet(s)
Servings per container
45
UPC/BARCODE
097467044555
IngredientAmount% DV
Calories10 Calorie(s)--
Total Carbohydrates3 Gram(s)1%
Sugar3 Gram(s)--
Apple Cider Vinegar25 mg--
Papain70 mg--
Apple Pectin60 mg--
Amylase20 mg--
Bromelain80 mg--
Lipase20 mg--

Other ingredients: Fructose, Stearic Acid, Magnesium Stearate, Saw Palmetto, Peppermint, natural Peppermint flavor, Fennel, Ginger, Rosemary, Catnip

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

Vegetarian Enzyme Supplement

Gluten free

Hypo-allergenic

Free from artificial colors and preservatives. Free from the common allergens yeast, wheat, soy and milk.

FDA Statement of Identity

Vegetarian Enzyme Supplement

General Statements

Digestive Aid

Nutritional support for healthy digestive function and overall well-being.

Seals/Symbols

Gluten free

Suggested/Recommended/Usage/Directions

Directions: As a dietary supplement, chew two tablets as symptoms occur.

Storage

Warnings: Keep tightly closed in a cool, dry place and out of reach of children.

Precautions

Warnings: Keep tightly closed in a cool, dry place and out of reach of children.

If symptoms of digestive discomfort persist, discontinue use and consult a physician.

Not to be used by children under 12 unless recommended by a physician.

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.

Brand IP Statement(s)

Natural Organics

General

PRODUCT NO. 4455 LBL. 1138142

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

See for yourself

Chewable Nutri-Zyme Natural Peppermint by Natures Plus label

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

Chewable Nutri-Zyme Natural Peppermint 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 Chewable Nutri-Zyme Natural Peppermint by Natures Plus

These are the 7 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 Chewable Tablet(s) Dosage formTablet Or Pill Servings per container45 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.

Sugar

3 Gram(s) per serving

Apple Cider Vinegar

Interacts with
162 drugs
25 mg per serving

Apple cider vinegar is a fermented apple product that many people use hoping to help with blood sugar, weight, or digestion. The evidence for most of...

Apple Cider Vinegar monograph & interactions

Papain

Interacts with
2 drugs
70 mg per serving Form: Papaya

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 an...

Papain monograph & interactions

Apple Pectin

Interacts with
23 drugs
60 mg per serving

Pectin is a natural soluble fiber found in fruits like apples and citrus, and it is widely used in foods and as a fiber supplement. It may modestly he...

Apple Pectin monograph & interactions

Amylase

20 mg per serving Form: Aspergillus oryzae

Bromelain

Interacts with
141 drugs
80 mg per serving Form: Pineapple

Bromelain is a group of protein-digesting enzymes from pineapple that people take mainly for inflammation, swelling, and sinus problems. Some early st...

Bromelain monograph & interactions

Lipase

No known
interactions
20 mg per serving Form: Rhizopus oryzae

Lipase is a digestive enzyme that helps your body break down dietary fats. It is well established as part of prescription pancreatic enzyme therapy fo...

Lipase monograph & interactions

Other (inactive) ingredients: Fructose, Stearic Acid, Magnesium Stearate, Saw Palmetto, Peppermint, Natural Peppermint flavor, Fennel, Ginger, Rosemary, Catnip. These complete the product’s ingredient list but are not active constituents.

Interaction report

Chewable Nutri-Zyme Natural Peppermint by Natures Plus Drug Interactions

Want to check YOUR meds against Chewable Nutri-Zyme Natural Peppermint?

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
305Drugs
232 Moderate 73 Minor

Ingredients driving the most interactions

Apple Cider Vinegar 162
Bromelain 141
Apple Pectin 23
Papain 2

Individual Drug Interactions

The ingredients in Chewable Nutri-Zyme Natural Peppermint interact with 305 drugs. Click any drug to see the details.

4 of the 7 ingredients in Chewable Nutri-Zyme Natural Peppermint interact with drugs. Each result below shows which ingredient is responsible. Apple Cider Vinegar Bromelain Apple Pectin Papain

Each ingredient & the kinds of drugs it affects

For each ingredient in Chewable Nutri-Zyme Natural Peppermint 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.

Apple Cider Vinegar4 drug types · 162 drugs

Digoxin (Lanoxin)

Theoretically, concomitant use of apple cider vinegar with digoxin might increase the risk of cardiac toxicity.
A case of hypokalemia related to chronic use of apple cider vinegar has been reported. Theoretically, overuse of apple cider vinegar could decrease potassium levels, increasing the risk of toxicity with digoxin.

Likelihood Possible Evidence D
Diuretic Drugs

Theoretically, concomitant use of apple cider vinegar with diuretic drugs might increase the risk of hypokalemia.
A case of hypokalemia related to chronic use of apple cider vinegar has been reported. There is some concern that people taking apple cider vinegar along with potassium depleting diuretics might have an increased risk for hypokalemia.

Likelihood Possible Evidence D
Insulin

Theoretically, concomitant use of apple cider vinegar with insulin might increase the risk of hypokalemia.
A case of hypokalemia related to chronic use of apple cider vinegar has been reported. Theoretically, overuse of apple cider vinegar concomitantly with insulin might increase the risk of hypokalemia.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, taking apple cider vinegar with antidiabetes drugs might increase the risk of hypoglycemia.
Apple cider vinegar might reduce fasting and postprandial blood glucose levels and decrease gastric emptying in people with diabetes. However, not all research agrees. Theoretically, it might have additive effects on glucose levels when used with antidiabetes drugs.

Likelihood Possible Evidence B
Apple Cider Vinegar 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

Apple Pectin3 drug types · 23 drugs

Digoxin (Lanoxin)

Theoretically, pectin might reduce the absorption of digoxin, potentially decreasing its effectiveness.
A small clinical study shows that taking digoxin with a kaolin-pectin suspension reduces the absorption of digoxin by about 62%. It is unclear if these effects are due to pectin, kaolin, or the combination.

Likelihood Possible Evidence B
Lovastatin (Mevacor)

Theoretically, pectin might reduce the absorption of lovastatin, potentially decreasing its effectiveness.
Case reports suggest that concomitant use of pectin and lovastatin might reduce the cholesterol-lowering effect of lovastatin, possibly due to reduced intestinal absorption of lovastatin.

Likelihood Possible Evidence D
Tetracycline Antibiotics

Theoretically, pectin might reduce the absorption of tetracycline antibiotics, potentially decreasing their effectiveness.
A small clinical study shows that taking tetracycline with bismuth subsalicylate in a kaolin-pectin suspension reduces the absorption of tetracycline by about 34%. It is unclear if these effects are due to pectin, kaolin, bismuth subsalicylate, or the combination.

Likelihood Possible Evidence B
Apple Pectin 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 Chewable Nutri-Zyme Natural Peppermint, from the product label.

Natures Plus

See all Natures Plus products
Name
Natural Organics Laboratories, Inc. makers of Nature's Plus
Street Address
9500 New Horizons Blvd.
City
Amityville
State
New York
ZipCode
11701
Web Address
www.naturesplus.com
Pharmacist Counseling Corner

Chewable Nutri-Zyme Natural Peppermint by Natures Plus: Common Questions

Does Chewable Nutri-Zyme Natural Peppermint by Natures Plus interact with any medications?
Yes. Based on its ingredients, Chewable Nutri-Zyme Natural Peppermint has a known interaction with 305 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Chewable Nutri-Zyme Natural Peppermint contains 7 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.
Does this product have any side effects?
Most people tolerate the active ingredients well at normal supplement doses. Apple cider vinegar and papain may upset digestion in some people. Papain can trigger allergic reactions in sensitive individuals. Bromelain may cause diarrhea, gas, or headache. If you have a sensitive stomach, start with a small dose and see how you feel.
Is this safe to take while pregnant?
The data on pregnancy safety is mixed. Papain (especially concentrated forms) is not recommended in pregnancy. Pectin is rated as possibly safe in pregnancy but has not been well studied at higher supplement doses — talk with your doctor. Apple cider vinegar, bromelain, and amylase lack sufficient pregnancy safety data. Ask your healthcare provider before starting this product if you're pregnant.
Can I take this while breastfeeding?
Safety data for supplemental doses while breastfeeding is limited for all the active ingredients. Papain, bromelain, and lipase are all listed as avoiding or unknown during breastfeeding. Food amounts are likely fine, but supplement safety has not been well studied. Check with your healthcare provider before taking this product while nursing.
What are these enzymes supposed to do?
Papain, bromelain, amylase, and lipase are digestive enzymes meant to break down protein, starch, and fat in food to support digestion. Apple cider vinegar and apple pectin may support digestive health as well. The evidence that they actually improve digestion in supplement form is not well established in our data.
Is there a risk with the peppermint and other herbs in here?
The inactive ingredients — peppermint, fennel, ginger, rosemary, and catnip — are present in small amounts for flavor and herbal support. We have no interaction data on file for amylase, and we could not check the herbal ingredients in this product for drug interactions.
Can I take this with my other medications?
It depends on what you take. This product interacts with diuretics, heart medications, insulin, diabetes drugs, blood thinners, tetracycline antibiotics, and cholesterol drugs. Use the medication interaction checker on this page to look up your exact prescriptions before starting, and talk to your pharmacist.

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

Not sure if Chewable Nutri-Zyme Natural Peppermint is safe with your meds?

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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.

Chewable Nutri-Zyme Natural Peppermint label
Go deeper

The Full Monographs Behind Chewable Nutri-Zyme Natural Peppermint’s Ingredients

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

Herb & supplement monograph

Apple Cider Vinegar

Interacts with 162 drugs

Apple cider vinegar is a fermented apple product that many people use hoping to help with blood sugar, weight, or digestion. The evidence for most of these uses is limited and mixed, and the...

Read the full Apple Cider Vinegar 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

Pectin

Interacts with 23 drugs

Pectin is a natural soluble fiber found in fruits like apples and citrus, and it is widely used in foods and as a fiber supplement. It may modestly help with cholesterol, blood sugar, and di...

Read the full Pectin 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

Lipase

Lipase is a digestive enzyme that helps your body break down dietary fats. It is well established as part of prescription pancreatic enzyme therapy for people who cannot make enough of their...

Read the full Lipase monograph →
Sources

Sources & How We Checked

Chewable Nutri-Zyme Natural Peppermint'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 53 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.

Apple Cider Vinegar 11 references
  1. Lhotta K, Hofle G, Gasser R, Finkenstedt G. Hypokalemia, hyperreninemia, and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron 1998;80:242-3. PubMed
  2. Hill LL, Woodruff LH, Foote JC, Barreto-Alcoba M. Esophageal injury by apple cider vinegar tablets and subsequent evaluation of products. J Am Diet Assoc 2005;105:1141-4. PubMed
  3. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of apple cider vinegar on delayed gastric emptying in patients with type 1 diabetes mellitus: a pilot study. BMC Gastroenterol 2007;7:46. PubMed
  4. Johnston CS, Kim CM, Buller AJ. Vinegar improves insulin sensitivity to a high-carbohydrate meal in subjects with insulin resistance or type 2 diabetes. Diabetes Care 2004;27:281-2. PubMed
  5. Lhotta, K., Hofle, G., Gasser, R., and Finkenstedt, G. Hypokalemia, hyperreninemia and osteoporosis in a patient ingesting large amounts of cider vinegar. Nephron 1998;80(2):242-243. PubMed
  6. Bunick CG, Lott JP, Warren CB, et al. Chemical burn from topical apple cider vinegar. J Am Acad Dermatol 2012;67(4):e143-4. PubMed
  7. Feldstein S, Afshar M, Krakowski AC. Chemical Burn from Vinegar Following an Internet-based Protocol for Self-removal of Nevi. J Clin Aesthet Dermatol. 2015 Jun;8(6):50.
  8. Luu LA, Flowers RH, Kellams AL, et al. Apple cider vinegar soaks [0.5%] as a treatment for atopic dermatitis do not improve skin barrier integrity. Pediatr Dermatol. 2019;36(5):634-639. PubMed
  9. Hadi A, Pourmasoumi M, Najafgholizadeh A, Clark CCT, Esmaillzadeh A. The effect of apple cider vinegar on lipid profiles and glycemic parameters: a systematic review and meta-analysis of randomized clinical trials. BMC Complement Med Ther 2021;21(1):179. PubMed
  10. Feise NK, Johnston CS. Commercial vinegar tablets do not display the same physiological benefits for managing postprandial glucose concentrations as liquid vinegar. J Nutr Metab 2020;2020:9098739. PubMed
  11. Gheflati A, Bashiri R, Ghadiri-Anari A, Reza JZ, Kord MT, Nadjarzadeh A. The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized contro

See these in context on the Apple Cider Vinegar 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 →

Pectin 11 references
  1. Jaakkola MS, et al. Asthma caused by occupational exposure to pectin. J Allergy Clin Immunol 1997;100:575-6. PubMed
  2. Westphal W, et al. [Exogenous allergic asthma following pectin exposure-a new occupational allergen]. Pneumologie 1990;44(Suppl 1):337-8.
  3. Baldwin JL, et al. Pectin-induced occupational asthma. Chest 1993;104:1936-7. PubMed
  4. Cohen AJ, Forse MS, Tarlo SM. Occupational asthma caused by pectin inhalation during the manufacture of jam. Chest 1993;103:309-11.
  5. Kraut A, et al. Christmas candy maker's asthma. IgG4-mediated pectin allergy. Chest 1992;102:1605-7. PubMed
  6. Richter WO, Jacob BG, Schwandt P. Interaction between fibre and lovastatin. Lancet 1991;338:706.
  7. Albert KS, Ayres JW, DiSanto AR, et al. Influence of kaolin-pectin suspension on digoxin bioavailability. J Pharm Sci 1978;67:1582-6. PubMed
  8. Albert KS, Welch RD, DeSante KA, et al. Decreased tetracycline bioavailability caused by a bismuth subsalicylate antidiarrheal mixture. J Pharm Sci 1979;68:586-8. PubMed
  9. Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Available at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?CFRPart=182
  10. Federal Register April 17,2003. Anti-Diarrheal Products for over-the-counter human use; final monograph. Available at: http://www.fda.gov/OHRMS/DOCKETS/98fr/03-9380.pdf (Accessed 27 December 2004).
  11. Washio K, Nakamura M, Sato N, et al. Anaphylaxis in a pectin- and cashew nut-allergic child caused by a citrus bath. Allergol Int 2022;71(1):155-157. PubMed

See these in context on the Pectin monograph →

Bromelain 19 references
  1. Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8. PubMed
  2. Taussig SJ, Batkin S. Bromelain, the enzyme complex of pineapple (Ananas comosus) and its clinical application. An update. J Ethnopharmacol 1988;22:191-203.. PubMed
  3. Bradbrook ID, Morrison PJ, Rogers HJ. The effect of bromelain on the absorption of orally administered tetracycline. Br J Clin Pharmacol 1978;6:552-4. PubMed
  4. Bush TM, Rayburn KS, Holloway SW, et al. Adverse interactions between herbal and dietary substances and prescription medications: a clinical survey. Altern Ther Health Med 2007;13:30-5.
  5. Brien S, Lewith G, Walker AF, et al. Bromelain as an adjunctive treatment for moderate-to-severe osteoarthritis of the knee: a randomized placebo-controlled pilot study. QJM 2006;99:841-50. PubMed
  6. Mori S, Ojima Y, Hirose T, et al. The clinical effect of proteolytic enzyme containing bromelain and trypsin on urinary tract infection evaluated by double blind method. Acta Obstet Gynaecol Jpn 1972;19:147-53.
  7. Glaser D, Hilberg T. The influence of bromelain on platelet count and platelet activity in vitro. Platelets 2006;17:37-41. PubMed
  8. Heinicke R M, van der Wal L, Yokoyama M. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972;28:844-5. PubMed
  9. Gailhofer, G., Wilders-Truschnig, M., Smolle, J., and Ludvan, M. Asthma caused by bromelain: an occupational allergy. Clin Allergy 1988;18(5):445-450. PubMed
  10. Mattei, O., Fabri, G., and Farina, G. [Occupational health experience regarding four cases of asthma due to bromelain (author's transl)]. Medicina del Lavoro 1979;70(5):404-409.
  11. Galleguillos, F. and Rodriguez, J. C. Asthma caused by bromelin inhalation. Clin Allergy 1978;8(1):21-24. PubMed
  12. Perez-Camo I, Quirce S, Duran MA, and et al. Latex allergy: evidence of cross-reactivity with papain and bromelain [abstract]. Allergy 1996;51(suppl 31):48.
  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
  15. Kutlu Ö, DemirbaS A, Elmas ÖF, Güvenç U, Metin A. Fixed drug eruption: a new side effect of bromelain. Contact Dermatitis 2020. Online ahead of print. PubMed
  16. Shoham Y, Shapira E, Haik J, et al. Bromelain-based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial. Wound Repair Regen 2021;29(6):899-907. PubMed
  17. Pfister P, Garcia Wendel PD, Kim BS, et al. Coagulation side effects of enzymatic debridement in burned patients. Burns 2022. PubMed
  18. Hasham S, Riyat H, Fletcher A, O'Boyle CP, Alexander S. To bleed or not to bleed? Case series and discussion of haemorrhage risk with enzymatic debridement in burn injuries. Scars Burn Heal 2023;9:20595131231168333. PubMed
  19. Leelakanok N, Petchsomrit A, Janurai T, Saechan C, Sunsandee N. Efficacy and safety of bromelain: A systematic review and meta-analysis. Nutr Health 2023. PubMed

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 →

Parts of this content are provided by the Therapeutic Research Center, LLC.

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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