Systemic therapy with bromelain-trypsin-rutoside combination in inflammation: A narrative review of the pharmacodynamics

Daftary, Gautam V.; Divekar, Ganesh; John, James St; Patil, Nikita; Khemnar, Bhushan

doi:10.5455/njppp.2022.12.10374202125022022

Cited by 6 publications

(8 citation statements)

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“…Also, considering the relatively better safety profile of these natural-origin drugs, this therapy provides a very promising alternative to conventional therapies for managing chronic rheumatic conditions. 4 In the present study, it was demonstrated that the oral administration of trypsin-bromelain-rutoside combination was able to show significant reduction in pain and swelling associated with diverse orthopaedic conditions affecting the joints and soft tissues surrounding the joints as early as day 3 of treatment. By day 8, 97% patients had no/mild pain.…”

Section: Discussionmentioning

confidence: 57%

“…These include anti-inflammatory, anti-oedematous, anti-kinin, pro-fibrinolytic, anti-platelet and antioxidant actions. 4 The present study was conducted at a single centre to evaluate the efficacy and safety of an enzymebioflavonoid combination of trypsin-bromelain-rutoside in managing the chronic pain and swelling in patients with various orthopaedic conditions, attending the orthopaedic out-patient department (OPD).…”

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confidence: 99%

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Oral enzyme therapy using trypsin-bromelain-rutoside combination to counter pain and swelling in orthopaedic conditions: a single-centre experience

Dhadiwal

Khemnar²,

John³

2022

Int J Res Orthop

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Background: Various orthopaedic conditions end up being painful, chronic and progressive, and are associated with persistent inflammation. The present study aimed to evaluate the efficacy and safety of an enzyme-bioflavonoid combination of trypsin-bromelain-rutoside in managing the chronic pain and swelling in out-patients with various orthopaedic conditions.Methods: The study was a prospective, observational study, conducted in 100 patients attending the orthopaedics department at a multi-speciality hospital located in Nashik, Maharashtra, India. Verbal rating scales were used for grading the pain intensity and extent of swelling at baseline and on days 3 and 8, after being prescribed oral tablets of trypsin-bromelain-rutoside combination. Scores were analysed using paired t test. A 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling at days 3 and 8.Results: At baseline, 68 patients reported moderate-severe pain, while 74 patients had moderate swelling. The mean scores for pain and swelling showed statistically significant reduction at both day 3 (p<0.0001) and day 8 (p<0001). By day 8, 98 patients reported good-excellent improvement and the investigator reported good-excellent improvement in 97 patients. No adverse event was reported by any patient.Conclusions: The results indicate that this therapy led to significant improvement in the pain and swelling as early as day 3 and further improvement with continued therapy, and can, thus, provide a safe alternative in patients with various orthopaedic conditions and reduce the need for other analgesic and anti-inflammatory drugs.

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Section: Discussionmentioning

confidence: 57%

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confidence: 99%

Oral enzyme therapy using trypsin-bromelain-rutoside combination to counter pain and swelling in orthopaedic conditions: a single-centre experience

Dhadiwal

Khemnar²,

John³

2022

Int J Res Orthop

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“…The pharmacodynamic effects of combination of trypsin, bromelain, rutoside are pictorially depicted by Daftary et al which will further help in understanding the superior efficacy of combination of trypsin, bromelain, rutoside vs combination of trypsin and chymotrypsin. 2 In another clinical study with comparison of combination of trypsin, bromelain, rutoside and serratiopeptidasediclofenac combination was studied in patients undergoing third molar extraction. Though the sample size is limited in this study, it showed better reduction of swelling in combination of trypsin, bromelain, rutoside group as compared to serratiopeptidase-diclofenac combination.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanism of action and synergistic effects of trypsin, bromelain, rutoside combination have been described in detail elsewhere; a summary is provided in Table 1. 2 Based on the perceived clinical practice benefit of this combination, searched various real-world investigator-initiated clinical studies published in India. Descriptive metanalysis of these studies is added in this article.…”

Section: Introductionmentioning

confidence: 99%

Trypsin, bromelain and rutoside in dental pathologies-synergistic action and qualitative metanalysis of investigator-initiated studies

Tiwari

Khemnar²,

John³

et al. 2022

Int J Sci Rep

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Inflammation, which manifests as pain and swelling, forms the basis of various dental pathologies like dental caries and pulpitis. Inflammation is also associated with tissue injury in cases of surgical processes like tooth extraction, root canal treatment or third molar extraction. Various drugs which help reducing inflammation are used in the treatment of dental pathologies. In this article, the mechanism of action of trypsin, bromelain and rutoside is mapped to show the clinical benefit. To demonstrate comparative benefit of trypsin, bromelain, and rutoside combination, a literature search was carried out for real-world investigator-initiated studies. A qualitative analysis of these studies was carried out. All 7 studies, identified in literature, controlled clinical studies comparing efficacy and safety of combination of trypsin, bromelain, and rutoside with that of non-steroidal anti-inflammatory drugs like diclofenac, versus other anti-inflammatory enzymes like trypsin-chymotrypsin combination or serratiopeptidase. All studies have demonstrated efficacy benefit of combination of trypsin, bromelain and rutoside. Importance and place of trypsin-bromelain-rutoside combination in therapy of dental pathologies, is further emphasized based on the results of this review.

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“…These enzymes, including the serine protease trypsin and the cysteine protease bromelain, when given in combination with an antioxidant bioflavonoid like rutoside, are believed to exert anti-kinin, antioxidant, antiplatelet, anti-chemokine, pro-fibrinolytic, and pro-fibrotic activities; with more recent evidence indicating inhibition of pro-inflammatory signal transduction. 1 They are effective in reducing pain, controlling post-operative inflammation and infection, and have higher patient satisfaction compared to other available drugs like steroids and non-steroidal antiinflammatory drug (NSAID) medications, they are widely accepted as alternate therapy. This is based on evidence, gathered over the decades, from multiple 1 M. V. Hospital and Research Centre, Lucknow, Uttar Pradesh, India 2 SIRO Clinpharm Ltd., Thane, Maharashtra, India studies in myriad inflammatory conditions.…”

Section: Introductionmentioning

confidence: 99%

Management of post-operative wound in dental surgeries using proteolytic enzyme-flavonoid combination of trypsin, bromelain and rutoside: a single-centre experience

Tiwari

Khemnar²,

John³

2022

Int J Res Med Sci

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Background: Appropriate surgical wound management is required to prevent post-operative complications, including delayed wound-healing which may result in increased hospital stay. The present study aimed to evaluate the efficacy and safety of oral administration of a fixed dose combination of trypsin-bromelain-rutoside in the post-operative management after dental surgeries.Methods: The study was a prospective, observational data collection exercise. Hundred subjects undergoing dental surgeries, who were administered trypsin-bromelain-rutoside combination, were observed over a period of 8 days post-surgery. Verbal rating scales were used for grading the pain intensity and extent of swelling, while a 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling. Scores at day 3 and day 8 were analysed using paired t test.Results: At day 3 and day 8, the mean scores of pain and swelling were significantly reduced from baseline (all p<0.0001). By day 8, 100% of the patients achieved complete resolution of pain, while mild swelling was reported in only 2 patients. At day 3, 95% patients reported good/ very good global improvement in pain and swelling; while at day 8, 100% reported good/ very good improvement. No adverse event was reported in any of the patients.Conclusions: The study results demonstrate that treatment with trypsin-bromelain-rutoside combination led to significant improvement in the post-operative pain and swelling. The use of this combination is useful for wound recovery and reducing the need for other analgesic and anti-inflammatory drugs.

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Systemic therapy with bromelain-trypsin-rutoside combination in inflammation: A narrative review of the pharmacodynamics

Cited by 6 publications

References 0 publications

Oral enzyme therapy using trypsin-bromelain-rutoside combination to counter pain and swelling in orthopaedic conditions: a single-centre experience

Oral enzyme therapy using trypsin-bromelain-rutoside combination to counter pain and swelling in orthopaedic conditions: a single-centre experience

Trypsin, bromelain and rutoside in dental pathologies-synergistic action and qualitative metanalysis of investigator-initiated studies

Management of post-operative wound in dental surgeries using proteolytic enzyme-flavonoid combination of trypsin, bromelain and rutoside: a single-centre experience

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