Major interaction on record — check this product against your medications before combining. Based on 3 of 6 ingredients. Check your meds →
Dietary supplement

Flex 19 Ingredients & Drug Interactions

by IVL Institute For Vibrant Living

Flex 19 label
See full label image
Capsule Category: Other Combinations
Most serious interaction: Major
Clinical methodology reviewed by · Updated Sep 16, 2026 · Label data from the NIH DSLD
What is this page for?

First and foremost: checking Flex 19 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: Major

Flex 19 is a dietary supplement by IVL Institute For Vibrant Living with 6 active ingredients. Its ingredients are commonly taken for digestive support for protein digestion, wound cleaning (debridement of dead tissue), sore throat and inflammation.Based on those ingredients, 305 medications have a known interaction with it, the most serious rated major. The ingredients most likely to interact are Glucosamine Sulfate, Bromelain, Papain. Use the checker below to test your specific medication, or read the full HelloPharmacist Interaction Report.

Jump to a section

Check Your Meds Against Flex 19 by IVL Institute For Vibrant Living

Ask about any prescription or over-the-counter medication and we check it for interactions with Flex 19 by IVL Institute For Vibrant Living — and tell you which ingredient is responsible.

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HelloPharmacist Scorecard of Flex 19 by IVL Institute For Vibrant Living

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 30, 2026

What’s inside

Full disclosure
Ingredient Transparency · database check
Full

Every active ingredient lists its own amount on the label.

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

Flex 19 contains 6 active ingredients. Three are well-known compounds: papain (a protein-digesting enzyme from papaya), bromelain (a similar enzyme from pineapple), and glucosamine sulfate (a building block for joint cartilage).

The product also includes MSM, cetyl myristoleate, and a proprietary herbal blend, though we hold limited interaction data on these three. The capsule also contains vegetable cellulose and water as inactive ingredients.

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: natural joint support and health.
  • We looked for evidence on: Joint pain, Knee pain, Osteoarthritis, Back pain, Sprains, Tendinopathy — and 4 related terms.
  • The strongest evidence on file: Glucosamine is rated "Likely Effective" for Osteoarthritis (Natural Medicines).
  • Also on file: Papain is rated "Insufficient Reliable Evidence To Rate" for Exercise-induced muscle soreness.
  • Also on file: Glucosamine is rated "Insufficient Reliable Evidence To Rate" for Back pain, Joint pain, Postoperative recovery, Knee pain.

The evidence on these ingredients is mixed and often limited. Glucosamine sulfate is rated likely effective for osteoarthritis, the main joint condition it's studied for.

Papain and bromelain have been used traditionally for wound healing, inflammation, and digestion, but the data we hold shows insufficient reliable evidence to rate them for the conditions they're proposed to treat—these include cancer, dental caries, radiation skin damage, exercise soreness, shingles, and parasite infection. Long-term effectiveness data on bromelain is also sparse.

The evidence, ingredient by ingredient Papain Bromelain Glucosamine

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 3 of the 3 matched ingredients.
  • Pregnancy & breastfeeding safety ratings cover 3 of 3.
  • General safety write-ups exist for 3 of 3.
  • Remember: this measures how much safety information exists. Thin data is not the same as being safe.

Papain and bromelain are generally well tolerated at normal oral doses, though both can cause digestive upset (diarrhea, nausea, gas) and allergic reactions in sensitive people—including itchy eyes, runny nose, sneezing, and abdominal cramps. Glucosamine is well tolerated by most adults, but adverse effects include bloating, constipation, diarrhea, and heartburn; rare allergic reactions including asthma flare-ups and anaphylaxis have been reported.

Papain is rated possibly unsafe in pregnancy and should be avoided; bromelain is best avoided during pregnancy because safety data is insufficient. Breastfeeding safety is unknown for both papain and bromelain, so they should be avoided unless your doctor advises otherwise.

Glucosamine is best avoided during pregnancy and breastfeeding due to lack of safety information.

Side effects, ingredient by ingredient Papain Bromelain Glucosamine

Meds to double-check

Major interaction found
Known Interaction Concern · database check
Major identified

At least one ingredient has a documented Major-severity interaction. Check your medications for a personalized result.

Why this rating?
  • 3 of the 3 matched ingredients can interact with medications — Papain, Glucosamine, Bromelain.
  • The most serious interaction on file is rated Major.
  • Some involve high-stakes drug classes: anticoagulant / antiplatelet drugs; diabetes medications.
  • For scale: 305 individual medications appear in the full list. A big number alone doesn't make a product dangerous — what matters is whether YOUR medication is on it, so run yours through the interaction checker on this page.

Before starting Flex 19, double-check with your doctor or pharmacist if you take warfarin or other blood thinners (anticoagulants) or antiplatelet drugs like aspirin—glucosamine and both enzymes may increase bleeding risk. Also confirm if you're on tetracycline antibiotics, diabetes medications, or regular acetaminophen, as documented interactions exist with those drug types.

Check your own medication Run your meds through the checker above

The bottom line

Scorecard at a glanceFully disclosed formula with clinical evidence supporting its stated purpose. Major medication interactions have been identified, and safety information is well characterized.

Flex 19 is most relevant if you're managing joint discomfort, since glucosamine is likely effective for osteoarthritis. However, if you take warfarin or other blood thinners, antiplatelet drugs, tetracycline antibiotics, diabetes medications, or regular acetaminophen, you need to check this product with your own doctor or pharmacist before starting—the interactions could affect how your drugs work or increase bleeding risk.

Allergic sensitivity to papaya or pineapple enzymes is also worth discussing.

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

Assessment coverage: 3 of 6 active ingredients matched to our full ingredient reviews (monographs). Based on the product label dated Nov 21, 2012.

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 Flex 19, straight from the product label.

Brand IVL Institute For Vibrant Living
Barcode (UPC) 893320002898
Net contents 120 Vegetable Capsule(s)
Market status On market
Date entered into DSLD Nov 21, 2012
DSLD ID 15432
Product type Other Combinations
Supplement form Capsule
Dietary claims / uses All Other, Structure/Function
Intended target group(s) Adult (18 - 50 Years)
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 Flex 19 by IVL Institute For Vibrant Living, sourced from the NIH Dietary Supplement Label Database.

Supplement Facts

Daily Value (DV) Target Group(s):
Adults and children 4 or more years of age
Minimum serving Sizes:
2 Capsule(s)
Maximum serving Sizes:
2 Capsule(s)
Servings per container
60
UPC/BARCODE
893320002898
IngredientAmount% DV
Papain25 mg--
Bromelain250 mg--
Glucosamine Sulfate500 mg--
MSM500 mg--
Cetyl Myristoleate25 mg--
Proprietary Herbal Blend455 mg--

Other ingredients: Vegetable Cellulose, Water

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.
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.

Precautions

Before you take any supplement, please consult your physician or other licensed healthcare professional to determine if it's appropriate for you.

KEEP OUT OF REACH OF CHILDREN

Pregnant or lactating women should consult a healthcare professional prior to use.

Seals/Symbols

NOT TESTED ON ANIMALS

PLEASE RECYCLE

FDA Statement of Identity

Dietary Supplement

Brand IP Statement(s)

Flex-19™ is a natural blend of the most comprehensive joint solution available.*

General Statements

JOINT FORMULA

Suggested/Recommended/Usage/Directions

Suggested Use: Take two (2) vegetable capsules twice daily (morning and evening) with water between meals or as recommended by your healthcare professional.

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

See for yourself

Flex 19 by IVL Institute For Vibrant Living label

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

Flex 19 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 Flex 19 by IVL Institute For Vibrant Living

These are the 6 active ingredients this product is made of. Select any to open its full monograph.

Serving size2 Capsule(s) Dosage formCapsule Servings per container60 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.

Papain

Interacts with
2 drugs
25 mg per serving

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

Bromelain

Interacts with
141 drugs
250 mg per serving

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

Glucosamine Sulfate

Interacts with
170 drugs
500 mg per serving

Glucosamine is a natural compound found in cartilage and joint fluid, and it is one of the most popular supplements for osteoarthritis, especially of...

Glucosamine Sulfate monograph & interactions

MSM

500 mg per serving

Cetyl Myristoleate

25 mg per serving

Proprietary Herbal Blend

455 mg per serving Form: Birch Extract, Boswellia serrata resin extract, Celery seed extract, Chondroitin, Curcumin extract, Devil's Claw root extract, Feverfew Flower Extract, Ginger root extract, Goldenrod Extract, Grape seed extract, Green Lipped Mussel, Polygonum Cuspidatum Root Extract, White WIllow bark extract, Yucca Root Extract

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

Interaction report

Flex 19 by IVL Institute For Vibrant Living Drug Interactions

Want to check YOUR meds against Flex 19?

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

 Go to the checker
305Drugs
2 Major 133 Moderate 170 Minor

Ingredients driving the most interactions

Glucosamine Sulfate 170
Bromelain 141
Papain 2

Individual Drug Interactions

The ingredients in Flex 19 interact with 305 drugs. Click any drug to see the details.

3 of the 6 ingredients in Flex 19 interact with drugs. Each result below shows which ingredient is responsible. Glucosamine Sulfate Bromelain Papain

Each ingredient & the kinds of drugs it affects

For each ingredient in Flex 19 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.

Glucosamine Sulfate4 drug types · 170 drugs

Warfarin (Coumadin)

Glucosamine might increase the anticoagulant effects of warfarin and increase the risk of bruising and bleeding.
In two individual case reports, glucosamine/chondroitin combinations were associated with a significant increase in international normalized ratio (INR) in patients previously stabilized on warfarin. In one case, the increase in INR occurred only after tripling the dose of a glucosamine/chondroitin supplement from 500 mg/400 mg daily to 1500/1200 mg daily. Additionally, 20 voluntary case reports to the U.S. Food & Drug Administration (FDA) have linked glucosamine plus chondroitin with increased INR, bruising, and bleeding in patients who were also taking warfarin. There have also been 20 additional case reports to the World Health Organization (WHO) that link glucosamine alone to increased INR in patients taking warfarin. The mechanism of this interaction is unclear. Glucosamine is a small component of heparin, but is not thought to have anticoagulant activity; however, animal research suggests that it might have antiplatelet activity.

Likelihood Probable Evidence D
Topoisomerase Ii Inhibitors

Theoretically glucosamine may induce resistance to topoisomerase II inhibitors.
In vitro research suggests that glucosamine might induce resistance to etoposide (VP16, VePesid) and doxorubicin (Adriamycin) by reducing inhibition of topoisomerase II, an enzyme required for DNA replication in tumor cells. This effect has not been reported in humans.

Likelihood Possible Evidence D
Acetaminophen (Tylenol, Others)

Acetaminophen might interfere with the activity of glucosamine sulfate by interacting with the sulfate portion.
Anecdotal reports suggest that adding glucosamine to an acetaminophen regimen might decrease pain control in patients with osteoarthritis. Some research suggests that the sulfate portion of glucosamine sulfate might contribute to its effect in osteoarthritis. Since acetaminophen metabolism requires sulfur and reduces serum sulfate concentrations, acetaminophen could theoretically interfere with the action of glucosamine sulfate. Conversely, the administration of sulfate could theoretically decrease the effectiveness of acetaminophen in sulfate-deficient people by increasing its clearance.

Likelihood Possible Evidence B
Antidiabetes Drugs

Despite initial concerns, it is unlikely that glucosamine will interfere with the effects of antidiabetes drugs.
In vitro and animal research has suggested that glucosamine might increase insulin resistance or decrease insulin production. This has raised concerns that taking glucosamine might worsen diabetes and decrease the effectiveness of diabetes drugs. However, clinical research suggests that glucosamine does not have adverse effects on blood glucose or glycated hemoglobin (HbA1C) in healthy, obese, or type 2 diabetes patients.

Likelihood Unlikely Evidence B
Glucosamine Sulfate full monograph & interactions

Bromelain2 drug types · 141 drugs

Anticoagulant/Antiplatelet Drugs

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

Likelihood Possible Evidence D
Tetracycline Antibiotics

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

Likelihood Possible Evidence B
Bromelain full monograph & interactions

Papain1 drug type · 2 drugs

Warfarin (Coumadin)

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

Likelihood Possible Evidence D
Papain full monograph & interactions
The maker

Brand information

Manufacturer and brand details for Flex 19, from the product label.

IVL Institute For Vibrant Living

See all IVL Institute For Vibrant Living products
Name
Institute For Vibrant Living
Street Address
P.O. Box 3840
City
Camp Verde
State
AZ
ZipCode
86322
Pharmacist Counseling Corner

Flex 19 by IVL Institute For Vibrant Living: Common Questions

Does Flex 19 by IVL Institute For Vibrant Living interact with any medications?
Yes. Based on its ingredients, Flex 19 has a known interaction with 305 medications, including 2 rated major. Use the checker to see how it interacts with a specific drug.
How can one product interact with so many drugs?
Flex 19 contains 6 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 Flex 19 if I'm pregnant or breastfeeding?
Papain is rated possibly unsafe in pregnancy and should be avoided. Bromelain and glucosamine lack enough safety data, so they're best avoided too unless your doctor says otherwise. Talk with your doctor or pharmacist about whether this product is right for you during pregnancy or breastfeeding.
What's papain, and what does it do in this product?
Papain is a protein-digesting enzyme extracted from papaya. It's used in supplements for a variety of purposes—wound healing, inflammation, and digestion—but the evidence we hold shows insufficient reliable data to rate it for these uses.
Does Flex 19 actually help with joint pain?
Glucosamine sulfate, one of the three main active ingredients, is rated likely effective for osteoarthritis specifically. The other enzymes (papain and bromelain) lack sufficient reliable evidence in our data for the joint and pain-related conditions they're proposed to treat.
What side effects might I experience?
The most common are digestive—diarrhea, bloating, constipation, nausea, gas, and heartburn. Allergic reactions are possible, especially in people sensitive to papaya or pineapple; these can range from itchy eyes and sneezing to, rarely, asthma flare-ups. Taking high doses of papain may cause serious stomach irritation.
Is there anything else in this product besides the active ingredients?
The capsule contains vegetable cellulose and water as inactive ingredients. Three of the six actives—MSM, cetyl myristoleate, and a proprietary herbal blend—have limited interaction data on file, so we can't fully assess their safety with medications.
Can I take Flex 19 long-term?
Glucosamine appears well tolerated over time. Papain and bromelain are generally well tolerated short-term, but long-term safety data is limited, especially for bromelain. Talk with your doctor about how long you plan to use it.

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.

Flex 19 label
Go deeper

The Full Monographs Behind Flex 19’s Ingredients

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

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

Glucosamine

Interacts with 170 drugs

Glucosamine is a natural compound found in cartilage and joint fluid, and it is one of the most popular supplements for osteoarthritis, especially of the knee. The evidence is mixed, with so...

Read the full Glucosamine monograph →
Sources

Sources & How We Checked

Flex 19'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 88 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 →

Glucosamine 58 references
  1. Adams ME. Hype about glucosamine. Lancet 1999;354:353-4. PubMed
  2. Balkan B, Dunning BE. Glucosamine inhibits glucokinase in vitro and produces a glucose-specific impairment of in vivo insulin secretion in rats. Diabetes 1994;43:1173-9. PubMed
  3. Giaccari A, Morviducci L, Zorretta D, et al. In vivo effects of glucosamine on insulin secretion and insulin sensitivity in the rat: possible relevance to the maladaptive responses to chronic hyperglycaemia. Diabetologia 1995;38:518-24. PubMed
  4. Holmang A, Nilsson C, Niklasson M, et al. Induction of insulin resistance by glucosamine reduces blood flow but not interstitial levels of either glucose or insulin. Diabetes 1999;48:106-11. PubMed
  5. Houpt JB, McMillan R, Wein C, Paget-Dellio SD. Effect of glucosamine hydrochloride in the treatment of pain of osteoarthritis of the knee. J Rheumatol 1999;26:2423-30.
  6. Barclay TS, Tsourounis C, McCart GM. Glucosamine. Ann Pharmacother 1998;32:574-9.
  7. Shankar RR, Zhu JS, Baron AD. Glucosamine infusion in rats mimics the beta-cell dysfunction of non-insulin-dependent diabetes mellitus. Metabolism 1998;47:573-7.
  8. Almada A, Harvey P, Platt K. Effects of chronic oral glucosamine sulfate on fasting insulin resistance index (FIRI) in non-diabetic individuals. FASEB J 2000;14:A750.
  9. Reginster JY, Deroisy R, Rovati LC, et al. Long-term effects of glucosamine sulfate on osteoarthritis progression: a randomised, placebo-controlled trial. Lancet 2001;357:251-6.
  10. Does glucosamine increase serum lipid levels and blood pressure? Pharmacist's Letter/Prescriber's Letter 2001;17(11):171115.
  11. Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2002.
  12. Monauni T, Zenti MG, Cretti A, et al. Effects of glucosamine infusion on insulin secretion and insulin action in humans. Diabetes 2000;49:926-35. PubMed
  13. Pouwels MJ, Jacobs JR, Span PN, et al. Short-term glucosamine infusion does not affect insulin sensitivity in humans. J Clin Endocrinol Metab 2001;86:2099-103. DOI
  14. Yun J, Tomida A, Nagata K, Tsuruo T. Glucose-regulated stresses confer resistance to VP-16 in human cancer cells through a decreased expression of DNA topoisomerase II. Oncol Res 1995;7:583-90.
  15. Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use and delay of progression of knee osteoarthritis: A 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162:2113-23. PubMed
  16. Tallia AF, Cardone DA. Asthma exacerbation associated with glucosamine-chondroitin supplement. J Am Board Fam Pract 2002;15:481-4..
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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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