Double Strength Zymactive Ingredients & Drug Interactions
What is this page for?
First and foremost: checking Double Strength Zymactive 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
Double Strength Zymactive is a dietary supplement by Natural Factors with 4 active ingredients. Its ingredients are commonly taken for inflammation and swelling, sinus and nasal congestion, digestion support.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.
Check Your Meds Against Double Strength Zymactive by Natural Factors
Ask about any prescription or over-the-counter medication and we check it for interactions with Double Strength Zymactive by Natural Factors — and tell you which ingredient is responsible.
AI summaries are generated from our interaction database for education only — always confirm with your pharmacist. How we use AI
Ask the Pharmacist
A licensed pharmacist will answer your question by email — free, usually within 24 hours.
Got it — thank you!
A licensed pharmacist will answer within 24 hours. Keep an eye on your email (worth checking spam, just in case).
HelloPharmacist Scorecard of Double Strength Zymactive by Natural Factors
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.
What’s inside
Partial disclosure
Double Strength Zymactive contains 6 active ingredients: three digestive enzymes from animal sources (amylase, protease, and lipase from the pancreas), plus bromelain from pineapple, papain from papaya, and a serratia peptidase. These enzymes are meant to help break down proteins, carbohydrates, and fats during digestion.
The product also contains inactive ingredients — microcrystalline cellulose, croscarmellose sodium, magnesium stearate, and an aqueous coating — that serve as binders and fillers.
Does it work?
Insufficient evidence
The evidence we hold doesn't establish that bromelain works for the conditions listed (hay fever, burns, cancer, nerve damage, vein problems, or diabetes) — all are rated insufficient reliable evidence to rate. The same goes for papain and the conditions listed for it (cancer, tooth decay, radiation burns, muscle soreness, shingles, or parasite infection).
Lipase is also rated insufficient reliable evidence for the digestive and bowel conditions mentioned. We don't have effectiveness data on file for amylase, protease, or serratia peptidase.
How safe is it?
Well-documented data
Bromelain and papain are generally well tolerated short-term when taken by mouth, though both can cause digestive upset (diarrhea, nausea, gas, stomach pain) and allergic reactions in sensitive people — especially those allergic to pineapple or papaya. In rare cases, high doses of papain may cause severe stomach inflammation or even perforation of the esophagus.
If you inhale either enzyme's dust (a workplace concern), you may develop asthma or other breathing problems. Bromelain is best avoided in pregnancy due to lack of safety data, and its safety during breastfeeding is unknown — avoid it then too.
Papain is possibly unsafe in pregnancy (especially concentrated forms and unripe papaya products), and supplemental papain should be avoided while breastfeeding. Pancreatic protease and lipase have not been thoroughly studied in pregnancy or breastfeeding — talk with your doctor or pharmacist before using them if you're pregnant or nursing.
Meds to double-check
Moderate interaction found
Check before combining this product with warfarin (Coumadin) or any other blood thinner or antiplatelet drug (aspirin, clopidogrel, others) — the risk of bleeding is Moderate to serious. If you take a tetracycline antibiotic like doxycycline, ask your pharmacist whether the timing or dose needs adjusting.
No interactions are documented for the other ingredients we could check, but that doesn't mean none exist — run your full medication list through the tool on this page.
The bottom line
Scorecard at a glancePartially disclosed formula with insufficient evidence for its stated purpose. Moderate medication interactions have been identified, and safety information is well characterized.
This enzyme blend may appeal to people looking for digestive support, but the evidence for its effectiveness isn't established in our data. If you take any blood thinner, antiplatelet drug, or tetracycline antibiotic, check with your pharmacist or doctor before starting — the risk of serious bleeding or antibiotic changes is real.
Avoid it entirely if you're pregnant or breastfeeding unless your own healthcare provider advises otherwise.
Educational only — not medical advice; always confirm with your pharmacist. Our editorial policy · How we use AI
Assessment coverage: 4 of 6 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
General information
Key facts about Double Strength Zymactive, straight from the product label.
| Brand | Natural Factors |
|---|---|
| Barcode (UPC) | 068958017501 |
| Net contents | 90 Enteric Coated Tablet(s) |
| Market status | On market |
| Date entered into DSLD | May 22, 2020 |
| DSLD ID | 220820 |
| Product type | Non-nutrient/non-botanical |
| Supplement form | Tablet Or Pill |
| Dietary claims / uses | All Other, Structure/Function |
| Intended target group(s) | Adult (18 - 50 Years), Gluten Free, Dairy Free, Sugar Free |
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 Double Strength Zymactive by Natural Factors, sourced from the NIH Dietary Supplement Label Database.
Supplement Facts
| Ingredient | Amount | % DV |
|---|---|---|
| Bromelain | 38.8 mg | -- |
| Enzyme Blend | 510 mg | -- |
| Papain | 171.44 mg | -- |
| Pancreatic Enzymes 11x | 292 mg | -- |
| Amylase, Pancreatic | 0 NP | -- |
| Protease, Pancreatic | 0 NP | -- |
| Lipase, Pancreatic | 0 NP | -- |
| Serratia Peptidase | 9.44 mg | -- |
Other ingredients: Microcrystalline Cellulose, Aqueous Coating solution, Croscarmellose Sodium, Magnesium Stearate
Tap any ingredient to jump to its full detail below.
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.
Seals/Symbols
isura Non-GMO - Mass Spec Documentation Lab tested
Purity & Potency Guaranteed
Suggested/Recommended/Usage/Directions
Suggested Usage: 1-2 tablets 2-3 times per day or as directed by a health professional.
Precautions
Cautions: As with any supplement, consult your health professional before use if you are pregnant, breastfeeding, or trying to conceive, or if you are taking medication, have a medical condition, or anticipate a surgery.
Keep out of the reach of children.
Sealed for your protection. Do not use if seal is broken.
Formula
Zymactive is an advanced formula that provides systemic enzyme support for muscle, joint, and overall tissue health.
With serratia peptidase proteolytic enzymes
General Statements
Also available in regular strength.
Product of Canada Recyclable container and label.
Formulation
Manufactured by Natural Factors to ensure safety and potency in accordance with Good Manufacturing Practices (GMP) of the FDA and Health Canada.
Contains no artificial colors, preservatives, or sweeteners; no dairy, sugar, wheat, gluten, yeast, soy, egg, fish, shellfish, salt, or GMOs.
Systemic enzyme support
USP (United States Pharmacopeia), FCC (Food Chemical Codex), PU (Papain Unit), SU (Serrapeptase Unit).
Storage
For freshness, 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.
FDA Statement of Identity
Dietary Supplement
Brand IP Statement(s)
Isura is a trademark of Isura.
Is this label outdated? Report a formula or label change and our pharmacy team will review it.
Double Strength Zymactive by Natural Factors label
The label scan from the NIH Dietary Supplement Label Database. Tap to enlarge.
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)The Ingredients in Double Strength Zymactive by Natural Factors
These are the 4 active ingredients this product is made of. Select any to open its full monograph.
Serving size1 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.
Other (inactive) ingredients: Microcrystalline Cellulose, Aqueous Coating solution, Croscarmellose Sodium, Magnesium Stearate. These complete the product’s ingredient list but are not active constituents.
Double Strength Zymactive by Natural Factors Drug Interactions
HelloPharmacist Interaction Report
Natural Factors Double Strength Zymactive contains several enzymes — bromelain, papain, and pancreatic protease — that have documented interactions with medications.
The most serious concern is papain's interaction with warfarin (Coumadin), a blood thinner: a case report describes a patient whose blood-thinning level spiked dangerously after taking a papain-containing supplement. Bromelain carries a moderate risk of increased bleeding when combined with anticoagulants (blood thinners) or antiplatelet drugs like aspirin and clopidogrel (Plavix).
Read the full breakdown — every affected drug type, severity by severity
Bromelain may also theoretically raise levels of tetracycline antibiotics, though a study in healthy adults found no significant difference in blood levels when the two were taken together. We could not check amylase or serratia peptidase — we hold no interaction data for those ingredients.
Pancreatic lipase has no known interactions documented in our data, and protease has no interactions documented either.
Altogether, these interactions span 141 individual medications. If you take any blood thinner, antiplatelet drug, tetracycline antibiotic, or any other prescription medication, run it through the checker below before starting this product.
Check your own medications below · Editorial policy · How we use AI
Want to check YOUR meds against Double Strength Zymactive?
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 checkerIngredients driving the most interactions
Individual Drug Interactions
The ingredients in Double Strength Zymactive interact with 141 drugs. Click any drug to see the details.
2 of the 4 ingredients in Double Strength Zymactive interact with drugs. Each result below shows which ingredient is responsible. Bromelain Papain
AbciximabReoPro
How Abciximab interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Abciximab interactionAbrocitinibCibinqo
How Abrocitinib interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Abrocitinib interactionAcenocoumarolSintrom
How Acenocoumarol interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Acenocoumarol interactionAcetaminophen, AspirinGemnisyn
How Acetaminophen, Aspirin interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Acetaminophen, Aspirin interactionAcetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
How Acetaminophen, Aspirin, Caffeine interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Acetaminophen, Aspirin, Caffeine interactionAcetaminophen, IbuprofenCombogesic
How Acetaminophen, Ibuprofen interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Acetaminophen, Ibuprofen interactionAcetylsalicylic AcidEntrophen
How Acetylsalicylic Acid interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Acetylsalicylic Acid interactionAlteplase, TpaActilyse, Activase
How Alteplase, Tpa interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Alteplase, Tpa interactionAluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #2
How Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aluminum Hydroxide, Aspirin, Codeine Phosphate, Magnesium Hydroxide interactionAluminum Hydroxide, Aspirin, Magnesium HydroxideAscriptin
How Aluminum Hydroxide, Aspirin, Magnesium Hydroxide interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aluminum Hydroxide, Aspirin, Magnesium Hydroxide interactionAnacaulase-bcdbNexoBrid
How Anacaulase-bcdb interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Anacaulase-bcdb interactionAnagrelideAgrylin
How Anagrelide interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Anagrelide interactionAnisindioneMiradon
How Anisindione interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Anisindione interactionAntithrombin IiiThrombate III
How Antithrombin Iii interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Antithrombin Iii interactionApixabanEliquis
How Apixaban interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Apixaban interactionArgatrobanArgatroban
How Argatroban interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Argatroban interactionAspirinAngettes 75, ASA, Asaphen, Aspirin, Caprin, Cartia +8 more
How Aspirin interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin interactionAspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium HydroxideAscriptin Codeine #3
How Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Aluminum Hydroxide, Codeine Phosphate, Magnesium Hydroxide interactionAspirin, ButalbitalAxotal
How Aspirin, Butalbital interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital interactionAspirin, Butalbital, CaffeineFiorinal
How Aspirin, Butalbital, Caffeine interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital, Caffeine interactionAspirin, Butalbital, Caffeine, Codeine PhosphateFiorinal w/ Codeine
How Aspirin, Butalbital, Caffeine, Codeine Phosphate interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital, Caffeine, Codeine Phosphate interactionAspirin, Butalbital, Caffeine, PhenacetinMarnal
How Aspirin, Butalbital, Caffeine, Phenacetin interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Butalbital, Caffeine, Phenacetin interactionAspirin, CaffeineAnacin
How Aspirin, Caffeine interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine interactionAspirin, Caffeine, Codeine PhosphateAnacin w/ Codeine
How Aspirin, Caffeine, Codeine Phosphate interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Codeine Phosphate interactionAspirin, Caffeine, Dihydrocodeine BitartrateSynalgos DC
How Aspirin, Caffeine, Dihydrocodeine Bitartrate interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Dihydrocodeine Bitartrate interactionAspirin, Caffeine, Dover's PwdAcedoval, Dovacet
How Aspirin, Caffeine, Dover's Pwd interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Dover's Pwd interactionAspirin, Caffeine, HydrocodoneDamason-P
How Aspirin, Caffeine, Hydrocodone interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Hydrocodone interactionAspirin, Caffeine, Isobutylallylbarbituric Acid, PhenacetinLanorinal
How Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Isobutylallylbarbituric Acid, Phenacetin interactionAspirin, Caffeine, OrphenadrineInvagesic, Invagesic Forte, Norgesic, Norgesic Forte, Orphengesic, Orphengesic Forte
How Aspirin, Caffeine, Orphenadrine interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Orphenadrine interactionAspirin, Caffeine, Phenacetin, PropoxypheneMargesic Comp. 65
How Aspirin, Caffeine, Phenacetin, Propoxyphene interacts with Double Strength Zymactive — through 1 ingredient. Tap an ingredient for the detail:
BromelainAnticoagulant/antiplatelet Drugs Moderate
Interaction Summary
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Read the full Bromelain + Aspirin, Caffeine, Phenacetin, Propoxyphene interactionEach ingredient & the kinds of drugs it affects
For each ingredient in Double Strength Zymactive 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.
Bromelain
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.
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.
Papain
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.
Brand information
Manufacturer and brand details for Double Strength Zymactive, from the product label.
Double Strength Zymactive by Natural Factors: Common Questions
Does Double Strength Zymactive by Natural Factors interact with any medications?
How can one product interact with so many drugs?
Where does this information come from?
Can I take this if I'm pregnant?
Is it safe while I'm breastfeeding?
What side effects might I notice?
Does it actually work for digestion?
What's the difference between bromelain and papain?
Why are there so many different enzymes in one product?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
Not sure if Double Strength Zymactive is safe with your meds?
Our pharmacists answer your medication & supplement questions — free.
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.
The Full Monographs Behind Double Strength Zymactive’s Ingredients
Every ingredient we hold a full HelloPharmacist monograph for — uses, evidence, safety, and the complete interaction list.
Bromelain
Interacts with 141 drugsBromelain 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 monographPapain
Interacts with 2 drugsPapain 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 →Sources & How We Checked
Double Strength Zymactive'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.
- NIH Dietary Supplement Label Database (DSLD) — The official product label on file for this supplement.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference behind the ingredient interaction data.
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 34 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.
Bromelain 19 references
- Nettis E, Napoli G, Ferrannini A, Tursi A. IgE-mediated allergy to bromelain. Allergy 2001;56:257-8. PubMed
- 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
- 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
- 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.
- 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
- 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.
- Glaser D, Hilberg T. The influence of bromelain on platelet count and platelet activity in vitro. Platelets 2006;17:37-41. PubMed
- Heinicke R M, van der Wal L, Yokoyama M. Effect of bromelain (Ananase) on human platelet aggregation. Experientia 1972;28:844-5. PubMed
- 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
- 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.
- Galleguillos, F. and Rodriguez, J. C. Asthma caused by bromelin inhalation. Clin Allergy 1978;8(1):21-24. PubMed
- 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.
- Martin GJ, Ehrenreich J, and Asbell N. Bromelain: pineapple proteases with anti-edema activity. Exp Med Surg 1962;20:227-247.
- 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
- 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
- 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
- Pfister P, Garcia Wendel PD, Kim BS, et al. Coagulation side effects of enzymatic debridement in burned patients. Burns 2022. PubMed
- 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
- 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
Papain 11 references
- The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
- 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.
- 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.
- 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.
- 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
- Walker-Renard, P. Update on the medicinal management of phytobezoars. Am J Gastroenterol. 1993;88(10):1663-1666.
- Tymoszuk D, Wiszniewska M, Walusiak-Skorupa J. Papain-induced occupational rhinoconjunctivitis and asthma - A case report. Med Pr 2016;67(1):109-12. PubMed
- Soto-Mera MT, López-Rico MR, Filgueira JF, et al. Occupational allergy to papain. Allergy 2000;55(10):983-4. PubMed
- Tarlo SM, Shaikh W, Bell B, et al. Papain-induced allergic reactions. Clin Allergy 1978;8(3):207-15. PubMed
- 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
- 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
Proteolytic Enzymes (proteases) 3 references
- 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
- Marquès LI, Lara S, Abós T, Bartolomé B. Occupational rhinitis due to pepsin. J Investig Allergol Clin Immunol. 2006;16(2):136-7. DOI
- 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 →
Lipase 1 reference
- 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
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