Interactions on record — worth a quick check against your medications. Based on 6 of 10 ingredients. Check your meds →
Dietary supplement

Enzymes-HCl Ingredients & Drug Interactions

by Protocol For Life Balance

Enzymes-HCl label
See full label image
Capsule Category: Other Combinations
Most serious interaction: Moderate
Clinical methodology reviewed by · Updated Sep 9, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Enzymes-HCl 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

Enzymes-HCl is a dietary supplement by Protocol For Life Balance with 10 active ingredients. Its ingredients are commonly taken for inflammation and swelling, sinus and nasal congestion, digestion support.Based on those ingredients, 259 medications have a known interaction with it, the most serious rated moderate. The ingredients most likely to interact are Bromelain, Papaya, Powder, Betaine Hydrochloride. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Enzymes-HCl by Protocol For Life Balance

Ask about any prescription or over-the-counter medication and we check it for interactions with Enzymes-HCl by Protocol For Life Balance — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Enzymes-HCl by Protocol For Life Balance

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 23, 2026

What’s inside

Partial disclosure
Ingredient Transparency · database check
Partial

Most active ingredients list an amount, but at least one is hidden in a blend or missing.

Why this rating?
  • The label discloses an exact amount for 7 of its 10 active ingredients.
  • “Pancreatin” is listed as a grouped ingredient — the label gives one combined amount (134 mg) without saying how much of each component you get.

Enzymes-HCl contains 10 active ingredients—a blend of digestive enzymes and supporting compounds. The core digestive enzymes are amylase (breaks down starches), protease and acid protease (break down proteins), lipase (breaks down fats), cellulase (breaks down fiber), and bromelain and papain (protein-digesting enzymes from pineapple and papaya).

The formula also includes betaine hydrochloride to support stomach acid production, pancreatin (a pancreatic enzyme concentrate), ox bile extract to aid fat digestion, and papaya powder. The capsules are made with gelatin and contain microcrystalline cellulose, magnesium stearate, and silicon dioxide as inactive ingredients.

Does it work?

Not established
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
Not established

The graded evidence we hold for these ingredients covers different conditions than the ones this product is marketed for, so there's no established rating for its stated use.

Why this rating?
  • The label markets this product for: support gastric and intestinal digestive functions.
  • We looked for evidence on: Dyspepsia, Exercise-induced muscle soreness, Inflammatory bowel disease (IBD), Intestinal parasite infection, Postoperative pain, Postoperative swelling — and 4 related terms.
  • The closest evidence on file: Papain is rated "Insufficient Reliable Evidence To Rate" for Exercise-induced muscle soreness (Natural Medicines).
  • Also on file: Papain is rated "Insufficient Reliable Evidence To Rate" for Intestinal parasite infection, Wound healing.
  • Also on file: Lipase is rated "Insufficient Reliable Evidence To Rate" for Inflammatory bowel disease (IBD), Dyspepsia.

The evidence on digestive enzyme supplements is limited. For bromelain, papaya, papain, lipase, and betaine hydrochloride, the data we hold rates their effectiveness as insufficient to draw reliable conclusions for the conditions they are marketed for—whether that's digestive support, inflammatory conditions, diabetes, or other uses.

The facts don't establish that this product works for any specific condition in our records.

The evidence, ingredient by ingredient Bromelain Betaine Hydrochloride Proteolytic Enzymes (proteases) Lipase Papaya Papain

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.

Most of these enzymes are generally well tolerated for short-term use by adults, though long-term safety data is limited. The most common side effects reported are digestive—diarrhea, flatulence, gas, nausea, and stomach upset.

Some people may have allergic reactions, especially those sensitive to enzymes or latex (papaya and papain carry a higher risk). Bromelain and betaine hydrochloride warrant caution: bromelain is not recommended during pregnancy, and betaine hydrochloride can irritate the stomach and is unsafe for anyone with ulcers or gastritis.

For pregnancy and breastfeeding, the safety data varies by ingredient. Bromelain is best avoided during both pregnancy and breastfeeding.

Papaya powder is rated possibly unsafe in pregnancy and likely safe during lactation. Papain is possibly unsafe in pregnancy and safety during breastfeeding is unknown.

Betaine hydrochloride should be avoided in both. For protease, lipase, cellulase, amylase, ox bile, and acid protease, there isn't enough safety information on file for pregnancy or breastfeeding—talk with your doctor or pharmacist about using this product if you are pregnant or nursing.

Side effects, ingredient by ingredient Bromelain Betaine Hydrochloride Proteolytic Enzymes (proteases) Lipase Papaya Papain

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 6 matched ingredients can interact with medications — Papain, Betaine Hydrochloride, Papaya, Bromelain.
  • The most serious interaction on file is rated Moderate.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; diabetes medications.
  • For scale: 259 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.

Check with your doctor or pharmacist before taking this product if you use blood thinners or antiplatelet drugs—bromelain and papaya may increase bleeding risk. Also double-check if you take diabetes medications, amiodarone, or levothyroxine, as papaya may affect their levels or effects.

If you use H2-blockers, antacids, or proton pump inhibitors (PPIs) for stomach acid, betaine hydrochloride may reduce their effectiveness.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glancePartially disclosed formula with no established evidence rating for its marketed use. Moderate medication interactions have been identified, and safety information is well characterized.

This product is a digestive enzyme blend best suited for people looking to support general digestion, though we don't have strong evidence it works for any specific condition. If you take blood thinners, diabetes medications, heart medications, thyroid medications, or stomach acid reducers, you'll need to check with your doctor or pharmacist before starting it.

Digestive upset is common; stop it if you develop severe stomach pain or signs of an allergic reaction. Have your healthcare provider review this product against your full medication list.

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

Assessment coverage: 7 of 10 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Oct 24, 2023.

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 Enzymes-HCl, straight from the product label.

Brand Protocol For Life Balance
Barcode (UPC) 707359129634
Net contents 120 Capsule(s)
Market status On market
Date entered into DSLD Oct 24, 2023
DSLD ID 292261
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses Nutrient, All Other, Structure/Function
Intended target group(s) 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 Enzymes-HCl by Protocol For Life Balance, 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
120
UPC/BARCODE
707359129634
IngredientAmount% DV
Amylase0 NP--
Bromelain40 mg--
Protease0 NP--
Lipase0 NP--
Cellulase0.1 mg--
Betaine Hydrochloride200 mg--
Pancreatin134 mg--
Papaya, Powder45 mg--
Papain2 mg--
Ox Bile extract100 mg--
Acid Protease10 mg--

Other ingredients: Microcrystalline Cellulose, Gelatin, Magnesium Stearate, Silicon Dioxide

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

Suggested usage: take 1 capsule with a meal, or as directed by your healthcare practitioner.

Formula

How it works: Protocol For Life Balance Enzymes-HCI is a comprehensive enzyme formula designed to support both gastric and intestinal digestive functions. The inclusion of betaine HCI helps to start digestion by the stomach and prepares the correct pH to stimulate intestinal function. A full spectrum of proteases further assists the intestine in the complete breakdown of food for enhanced absorption.

Formulated with enzymes & betaine HCI

Precautions

Cautions/interactions: Do not take on an empty stomach. Do not take in case of stomach or duodenal ulcers. If you are a diabetic, consult your healthcare practitioner before using this product.

Consult physician if pregnant/nursing, taking medication (especially blood thinners), or have a medical condition (including allergy to papaya, pineapple).

Consult physician if pregnant/nursing, taking medication (especially blood thinners), or have a medical condition (including allergy to papaya, pineapple).

Not manufactured with wheat, gluten, soy, milk, egg, fish, shellfish, tree nut or sesame ingredients. Produced in a GMP facility that processes other ingredients containing these allergens.

Contains sulfites.

Formulation

Not manufactured with wheat, gluten, soy, milk, egg, fish, shellfish, tree nut or sesame ingredients.

Natural color variation may occur in this product.

Optimizes nutrient bioavailability

FDA Disclaimer Statement

These statements have 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

A Dietary Supplement

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

See for yourself

Enzymes-HCl by Protocol For Life Balance label

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

Enzymes-HCl 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 Enzymes-HCl by Protocol For Life Balance

These are the 10 active ingredients this product is made of. Select any to open its full monograph.

Serving size1 Capsule(s) Dosage formCapsule Servings per container120 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.

Bromelain

Interacts with
141 drugs
40 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

Cellulase

0.1 mg per serving

Betaine Hydrochloride

Interacts with
36 drugs
200 mg per serving

Betaine hydrochloride is a supplement used to temporarily increase stomach acid in people who may have low acid levels. Evidence for its benefits is l...

Betaine Hydrochloride monograph & interactions

Pancreatin

134 mg per serving

Papaya, Powder

Interacts with
92 drugs
45 mg per serving

Papaya is a tropical fruit that is nutritious and generally safe to eat as food, and it contains an enzyme called papain used as a digestive aid and m...

Papaya, Powder monograph & interactions

Papain

Interacts with
2 drugs
2 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

Ox Bile extract

100 mg per serving Form: Total Cholic Acids

Acid Protease

No known
interactions
10 mg per serving Form: Aspergillopepsin

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

Acid Protease monograph & interactions

Other (inactive) ingredients: Microcrystalline Cellulose, Gelatin, Magnesium Stearate, Silicon Dioxide. These complete the product’s ingredient list but are not active constituents.

Interaction report

Enzymes-HCl by Protocol For Life Balance Drug Interactions

Want to check YOUR meds against Enzymes-HCl?

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
259Drugs
212 Moderate 47 Minor

Ingredients driving the most interactions

Bromelain 141
Papaya, Powder 92
Betaine Hydrochloride 36
Papain 2

Individual Drug Interactions

The ingredients in Enzymes-HCl interact with 259 drugs. Click any drug to see the details.

4 of the 10 ingredients in Enzymes-HCl interact with drugs. Each result below shows which ingredient is responsible. Bromelain Papaya, Powder Betaine Hydrochloride Papain

Each ingredient & the kinds of drugs it affects

For each ingredient in Enzymes-HCl 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

Papaya, Powder4 drug types · 92 drugs

Amiodarone (Cordarone)

Theoretically, papaya extract may increase the levels and clinical effects of amiodarone.
Animal research in rats shows that a single oral dose of papaya extract, as well as multiple doses of papaya extract daily over 14 days, prior to a single dose of amiodarone delays the time to maximum amiodarone concentration. However, only the 14-day papaya extract regimen increases systemic amiodarone exposure by 60% to 70%. This interaction has not been reported in humans.

Likelihood Probable Evidence D
Antidiabetes Drugs

Concomitant use of antidiabetic drugs with fermented papaya can produce additive effects. It is unclear if other forms of papaya have the same effect.
A small low-quality clinical study in patients with type 2 diabetes who are taking glibenclamide shows that taking a fermented papaya preparation 3 grams daily for 2 months decreases fasting and postprandial blood glucose levels when compared to baseline. Additionally, of the 25 patients in the study, 9 required a reduction in glibenclamide dose.

Likelihood Probable Evidence B
Levothyroxine (Synthroid, Others)

Theoretically, consuming large quantities of papaya fruit can reduce the clinical effects of levothyroxine.
In one case-report, a 37-year-old male with a history of thyroidectomy who was stabilized on levothyroxine for 5 years presented with hypothyroidism after consuming 5-6 papaya fruits daily for 14 days during vacation. In a controlled re-challenge test involving 5-6 papayas daily, the patient remained euthyroid for 7 days, but developed mild hypothyroidism after 14 days. Both times, thyroid levels normalized 40-45 days after discontinuing papaya.

Likelihood Possible Evidence D
Warfarin (Coumadin)

Theoretically, concomitant use of warfarin with papain-containing papaya extract 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
Papaya, Powder full monograph & interactions

Betaine Hydrochloride3 drug types · 36 drugs

Antacids

Betaine hydrochloride increases stomach acidity and could decrease the effects of antacids.
In human research, betaine hydrochloride increases stomach acidity. Antacids are taken to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with antacids might decrease the effects of the antacids.

Likelihood Possible Evidence D
H2-Blockers

Betaine hydrochloride increases stomach acidity and could decrease the effects of H2-blockers.
In human research, betaine hydrochloride increases stomach acidity. H2-blockers are used to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with H2-blockers might decrease the effects of H2-blockers.

Likelihood Possible Evidence D
Proton Pump Inhibitors (Ppis)

Betaine hydrochloride increases stomach acidity and could decrease the effects of PPIs.
In human research, betaine hydrochloride increases stomach acidity. PPIs are used to decrease stomach acidity. Theoretically, taking betaine hydrochloride along with PPIs might decrease the effects of PPIs

Likelihood Possible Evidence D
Betaine Hydrochloride 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 Enzymes-HCl, from the product label.

Protocol For Life Balance

See all Protocol For Life Balance products
Name
Protocol For Life Balance
Street Address
395 S. Glen Ellyn Rd.
City
Bloomingdale
State
IL
ZipCode
60108
Web Address
www.protocolforlife.com
Pharmacist Counseling Corner

Enzymes-HCl by Protocol For Life Balance: Common Questions

Does Enzymes-HCl by Protocol For Life Balance interact with any medications?
Yes. Based on its ingredients, Enzymes-HCl has a known interaction with 259 medications. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Enzymes-HCl contains 10 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.
Can I take this if I'm pregnant or breastfeeding?
It depends on the ingredient. Bromelain and betaine hydrochloride are best avoided during both pregnancy and breastfeeding. Papain is possibly unsafe in pregnancy and safety during breastfeeding is unknown. For the other enzymes in this formula, we don't have enough safety data to say either way. Talk with your doctor or pharmacist for personalized advice before taking this product.
What is bromelain and where does it come from?
Bromelain is a protein-digesting enzyme extracted from pineapple. It helps break down proteins in food and is thought to have mild antiplatelet activity, which is why it can interact with blood thinners.
Why is betaine hydrochloride in a digestive enzyme formula?
Betaine hydrochloride increases stomach acid production, which supports protein digestion and nutrient absorption. However, it will counteract acid-reducing medications like antacids and PPIs, so it's not suitable if you take those.
What's the difference between papaya powder and papain?
Papaya powder is the whole dried fruit, while papain is a concentrated enzyme extracted from papaya or papaw. Both can interact with warfarin and other medications, though concentrated papain may pose a higher risk.
Are there any common side effects I should expect?
The most common side effects are digestive: diarrhea, gas, flatulence, nausea, and stomach upset. These usually settle with continued use, but stop the product and contact your doctor if you develop severe abdominal pain or signs of an allergic reaction.
Is this product safe for people with stomach ulcers or acid reflux?
No. Betaine hydrochloride in this formula increases stomach acid and can irritate or worsen ulcers and gastritis. If you have either condition or true acid reflux, talk with your doctor or pharmacist before considering this product.

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

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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.

Enzymes-HCl label
Go deeper

The Full Monographs Behind Enzymes-HCl’s Ingredients

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

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

Betaine Hydrochloride

Interacts with 36 drugs

Betaine hydrochloride is a supplement used to temporarily increase stomach acid in people who may have low acid levels. Evidence for its benefits is limited and mostly based on tradition rat...

Read the full Betaine Hydrochloride 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

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

Papaya

Interacts with 92 drugs

Papaya is a tropical fruit that is nutritious and generally safe to eat as food, and it contains an enzyme called papain used as a digestive aid and meat tenderizer. Papaya leaf extract is b...

Read the full Papaya 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 →
Sources

Sources & How We Checked

Enzymes-HCl'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 50 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
  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 →

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 →

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 →

Betaine Hydrochloride 2 references
  1. Yago MR, Frymoyer A, Benet LZ, Smelick GS, Frassetto LA, Ding X, Dean B, Salphati L, Budha N, Jin JY, Dresser MJ, Ware JA. The use of betaine HCl to enhance dasatinib absorption in healthy volunteers with rabeprazole-induced hypochlorhydria. AAPS J. 2014 PubMed
  2. Yago MR, Frymoyer AR, Smelick GS, Frassetto LA, Budha NR, Dresser MJ, Ware JA, Benet LZ. Gastric reacidification with betaine HCl in healthy volunteers with rabeprazole-induced hypochlorhydria. Mol Pharm. 2013 Nov 4;10(11):4032-7. PubMed

See these in context on the Betaine Hydrochloride monograph →

Papaya 14 references
  1. The Review of Natural Products by Facts and Comparisons. St. Louis, MO: Wolters Kluwer Co., 1999.
  2. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. 2nd ed. New York, NY: John Wiley & Sons, 1996.
  3. 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.
  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.
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  9. Danese, C., Esposito, D., D'Alfonso, V., Cirene, M., Ambrosino, M., and Colotto, M. Plasma glucose level decreases as collateral effect of fermented papaya preparation use. Clin Ter. 2006;157(3):195-198.
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See these in context on the Papaya 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.
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  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
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  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
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See these in context on the Papain monograph →

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

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