Interactions on record — worth a quick check against your medications. Based on 6 of 20 ingredients. Check your meds →
Dietary supplement

Digestion Complex 4-20 Ingredients & Drug Interactions

by Nikken Wellness Kenzen

Digestion Complex 4-20 label
See full label image
Capsule Category: Non-nutrient/non-botanical
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 Digestion Complex 4-20 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

Digestion Complex 4-20 is a dietary supplement by Nikken Wellness Kenzen with 20 active ingredients. Its ingredients are commonly taken for digestive support, bloating and gas, fat digestion.Based on those ingredients, 141 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Bromelain, Papain. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

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Check Your Meds Against Digestion Complex 4-20 by Nikken Wellness Kenzen

Ask about any prescription or over-the-counter medication and we check it for interactions with Digestion Complex 4-20 by Nikken Wellness Kenzen — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Digestion Complex 4-20 by Nikken Wellness Kenzen

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

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 0 of its 20 active ingredients.
  • “Fat Digestion” is listed as a grouped ingredient — the label doesn't break down how much of each component you get.
  • “Carbohydrate Digestive Blend” is a proprietary blend — the label doesn't break down how much of each component you get.
  • “Protein Digestive Blend” is a proprietary blend — the label doesn't break down how much of each component you get.

Digestion Complex 4-20 is a multi-enzyme supplement with 20 active ingredients designed to aid the breakdown of food. The formula includes three main enzyme types: carbohydrate-digesting enzymes (amylase, glucoamylase, maltase, and others), fat-digesting enzymes (mainly lipase), and protein-digesting enzymes (bromelain, papain, and various proteases).

Also included are lactase (which breaks down milk sugar) and several fiber-digesting enzymes. The inactive ingredients are a vegetarian capsule and rice bran.

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: Dyspepsia, Lactose intolerance, Exercise-induced muscle soreness, Postoperative swelling, Rhinosinusitis, Sprains — and 4 related terms.
  • The strongest evidence on file: Lactase is rated "Effective" for Lactose intolerance (Natural Medicines).
  • Also on file: Papain is rated "Insufficient Reliable Evidence To Rate" for Exercise-induced muscle soreness, Wound healing.
  • Also on file: Lipase is rated "Insufficient Reliable Evidence To Rate" for Dyspepsia.

The evidence for most of these enzymes in supplement form is not well established in the data we hold. Lactase is rated Effective for lactose intolerance—if you have trouble digesting milk, this ingredient is supported.

For the others—including papain, bromelain, phytase, lipase, and the proteases—the evidence available is insufficient to rate their effectiveness for any condition. They are sold as digestive aids, but clinical proof of benefit in supplement doses is lacking.

The evidence, ingredient by ingredient Lipase Lactase Papain Bromelain Proteolytic Enzymes (proteases) Phytase

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 6 of the 6 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 6 of 6.
  • General safety write-ups exist for 6 of 6.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Overall, these enzymes are generally well tolerated when taken by mouth at normal doses. The main concern is allergic reaction; papain and bromelain in particular can trigger allergies—itchy eyes, runny nose, abdominal cramps, diarrhea, or in occupational settings, respiratory symptoms like wheezing or asthma.

High doses of papain may cause serious digestive tract irritation. Bromelain commonly causes mild digestive symptoms like diarrhea, gas, and stomach upset.

For pregnancy, papain and bromelain should be avoided; concentrated papain and unripe papaya products are specifically noted as unsafe. Lipase, phytase, and the proteases lack enough safety data in pregnancy—check with your doctor before use.

For breastfeeding, papain, bromelain, phytase, and the proteases all have insufficient data; lactase is the only ingredient rated likely safe while breastfeeding. Ask your pharmacist or doctor about the others if you're nursing.

Side effects, ingredient by ingredient Lipase Lactase Papain Bromelain Proteolytic Enzymes (proteases) Phytase

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?
  • 2 of the 6 matched ingredients can interact with medications — Papain, Bromelain.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs.
  • For scale: 141 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, double-check this product first—papain may increase its effect (Moderate). Similarly, if you're on any anticoagulant or antiplatelet medication (like aspirin, clopidogrel, or apixaban), bromelain may raise bleeding risk (Moderate).

If you take a tetracycline antibiotic, bromelain might increase its level (Minor)—mention this when you pick up your prescription. For all other medications, no interactions are documented for the ingredients we could check.

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 is a broad-spectrum digestive enzyme blend, best suited for people looking for general digestive support. If you take warfarin or other blood thinners, or if you're allergic to papaya or pineapple, talk to your pharmacist first.

Pregnant or breastfeeding? Check with your doctor before starting.

Most people tolerate it well, but if you have a history of food allergies or occupational enzyme exposure, be cautious.

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

Assessment coverage: 8 of 20 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated May 22, 2020.

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 Digestion Complex 4-20, straight from the product label.

Brand Nikken Wellness Kenzen
Barcode (UPC) #15471
Net contents 90 Capsule(s)
Market status On market
Date entered into DSLD May 22, 2020
DSLD ID 220972
Product type Non-nutrient/non-botanical
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Vegan, Vegetarian, Adult (18 - 50 Years), Kosher, 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 Digestion Complex 4-20 by Nikken Wellness Kenzen, 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:
1 Capsule(s)
Maximum serving Sizes:
1 Capsule(s)
Servings per container
90
UPC/BARCODE
#15471
IngredientAmount% DV
Amylase0 NP--
Papain0 NP--
Bromelain0 NP--
Lipase0 NP--
Lactase0 NP--
Cellulase0 NP--
Peptidase0 NP--
Invertase0 NP--
Glucoamylase0 NP--
Alpha-Galactosidase0 NP--
Xylanase0 NP--
Pectinase0 NP--
Beta-Glucanase0 NP--
Phytase0 NP--
Hemicellulase0 NP--
Protease 4.50 NP--
Protease 60 NP--
Acid Maltase0 NP--
Fat Digestion0 NP--
Neutral Protease, Bacterial0 NP--
Carbohydrate Digestive Blend0 NP--
Amylase, Bacterial0 NP--
Protein Digestive Blend0 NP--
Fiber/Cellulose Digestive Blend0 NP--

Other ingredients: 100% vegetarian Capsule, Rice Bran

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.
Suggested/Recommended/Usage/Directions

Recommended Use: Take one (1) capsule before each meal.

Precautions

If you are allergic to any of these ingredients, or are pregnant or nursing, consult a physician before taking this or any other dietary supplement.

Keep out of reach of children.

Do not use if safety seal under cap is broken or missing.

If you are allergic to any of these ingredients, or are pregnant or nursing, consult a physician before taking this or any other dietary supplement.

Storage

Store in a dry place at room temperature.

Formulation

Contains no dairy, preservatives, salt, sucrose, soy, wheat, yeast, corn, nuts, gluten, artificial colors or flavors.

Made in USA

V Certified Vegan Vegan.org

Supports optimal digestion and nutrient absorption

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)

2017 Nikken Inc.

Seals/Symbols

OU (Kosher)

V Certified Vegan Vegan.org

Formula

OU (Kosher)

vegetarian/vegan plant based enzymes

FDA Statement of Identity

Dietary Supplement

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

See for yourself

Digestion Complex 4-20 by Nikken Wellness Kenzen label

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

Digestion Complex 4-20 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 Digestion Complex 4-20 by Nikken Wellness Kenzen

These are the 20 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 Capsule(s) Dosage formCapsule Servings per container90 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.

Fat Digestion

0 NP per serving

Carbohydrate Digestive Blend

0 NP per serving
  • › Amylase
  • › Lactase
  • › Invertase
  • › Glucoamylase
  • › Alpha-Galactosidase
  • › Acid Maltase
  • › Amylase, Bacterial

Protein Digestive Blend

0 NP per serving

Fiber/Cellulose Digestive Blend

0 NP per serving
  • › Cellulase
  • › Xylanase
  • › Pectinase
  • › Beta-Glucanase
  • › Phytase
  • › Hemicellulase

Other (inactive) ingredients: 100% vegetarian Capsule, Rice Bran. These complete the product’s ingredient list but are not active constituents.

Interaction report

Digestion Complex 4-20 by Nikken Wellness Kenzen Drug Interactions

Want to check YOUR meds against Digestion Complex 4-20?

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
141Drugs
122 Moderate 19 Minor

Ingredients driving the most interactions

Bromelain 141
Papain 2

Individual Drug Interactions

The ingredients in Digestion Complex 4-20 interact with 141 drugs. Click any drug to see the details.

2 of the 20 ingredients in Digestion Complex 4-20 interact with drugs. Each result below shows which ingredient is responsible. Bromelain Papain

Each ingredient & the kinds of drugs it affects

For each ingredient in Digestion Complex 4-20 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.

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 Digestion Complex 4-20, from the product label.

Nikken Wellness Kenzen

See all Nikken Wellness Kenzen products
Name
Nikken Inc.
Street Address
2 Corporate Park, Suite 200
City
Irvine
State
CA
ZipCode
92606
Web Address
www.nikken.com
Pharmacist Counseling Corner

Digestion Complex 4-20 by Nikken Wellness Kenzen: Common Questions

Does Digestion Complex 4-20 by Nikken Wellness Kenzen interact with any medications?
Yes. Based on its ingredients, Digestion Complex 4-20 has a known interaction with 141 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Digestion Complex 4-20 contains 20 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.
What does each enzyme in this blend actually do?
They're meant to help your body break down food. Amylase and related enzymes break down carbs; lipase handles fats; bromelain and papain (proteases) break down protein. Lactase specifically breaks down milk sugar if you have trouble digesting dairy. The goal is to ease the digestive burden, though clinical proof that supplements help healthy adults is limited.
Can I take this if I'm pregnant or breastfeeding?
Papain and bromelain should be avoided in pregnancy. For lipase, phytase, and the proteases, there isn't enough safety data—ask your doctor. If you're breastfeeding, lactase is the only ingredient we rate as likely safe. For the others, safety data is too limited; check with your doctor or pharmacist first.
I have a pineapple or papaya allergy. Can I take this?
Be very careful. This product contains both papain (from papaya) and bromelain (from pineapple), and both can trigger allergic reactions in sensitive people—itchy eyes, runny nose, stomach cramps, diarrhea, or even breathing trouble. Talk to your pharmacist before trying it.
What are the most common side effects I might notice?
Mild digestive upset—diarrhea, gas, stomach discomfort, or headache—is most common. Allergic reactions (runny nose, itchy eyes, sneezing, abdominal cramps) can occur, especially if you're sensitive to enzymes. If you experience severe stomach pain or difficulty swallowing, stop and contact your doctor.
Will this help me digest food better if I have normal digestion?
The evidence isn't there. Most of these enzymes lack solid proof they improve digestion or nutrient absorption in people with healthy digestive systems. Lactase is an exception—it works well for lactose intolerance. For others, clinical benefit is not established in the data we hold.

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

Not sure if Digestion Complex 4-20 is safe with your meds?

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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.

Digestion Complex 4-20 label
Go deeper

The Full Monographs Behind Digestion Complex 4-20’s Ingredients

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

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 → 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

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

Proteolytic Enzymes (proteases)

Proteolytic enzymes are proteins that help break down other proteins, and common examples include bromelain (from pineapple), papain (from papaya), trypsin, chymotrypsin, and pancreatin. Peo...

Read the full Proteolytic Enzymes (proteases) 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 →
Sources

Sources & How We Checked

Digestion Complex 4-20'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 42 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.

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
  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 →

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
  3. van Heemst RC, Sander I, Rooyackers J, et al. Hypersensitivity pneumonitis caused by occupational exposure to phytase. Eur Respir J. 2009;33(6):1507-9. PubMed
  4. Baur X, Melching-Kollmuss S, Koops F, Strassburger K, Zober A. IgE-mediated allergy to phytase -- a new animal feed additive. Allergy. 2002;57(10):943-5. PubMed
  5. Doekes G, Kamminga N, Helwegen L, Heederik D. Occupational IgE sensitisation to phytase, a phosphatase derived from Aspergillus niger. Occup Environ Med. 1999;56(7):454-9. PubMed
  6. Brnic M, Hurrell RF, Songré-Ouattara LT, et al. Effect of phytase on zinc absorption from a millet-based porridge fed to young Burkinabe children. Eur J Clin Nutr. 2017;71(1):137-141. PubMed
  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 →

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.

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