Ingredients | AMOUNT |
---|---|
Pancreatin 4X
(Amylase, and Lipase, contains Protease)
(Pancreatin 4X (Form: contains protease Note: 33,000 USP units, amylase Note: 33,000 USP units, and lipase Note: 8250 USP units) )
|
330 mg |
(Papain Note: 2,000 u/g )
|
200 mg |
(Bromelain Note: 2400 GDU )
|
150 mg |
(Trypsin Note: 75,000 u/g
)
|
100 mg |
(Chymotrypsin Note: 1,000 u/g )
|
3.5 mg |
(Nattokinase Note: 20,000 u/g )
|
30 mg |
(Serrazimes(TM))
(600,000 u/g)
(Serratiopeptidase (Alt. Name: Serrazimes(TM)) Note: 600,000 u/g )
|
9 mg |
160 mg | |
Proprietary Blend
(Containing Amylase, Cellulase, Citrus Bioflavonoids, Lactase, Lipase, Protease)
(Proprietary Blend (Form: Containing amylase, lipase, protease, cellulase, lactase, citrus bioflavonoids) )
|
150 mg |
Enteric Coat with Vegetable Components (Form: and Calcium Phosphate (Alt. Name: Ca Phosphate), Cellulose, and Glycol, Magnesium (Alt. Name: Mg), Silicon (Alt. Name: Si), Titanium Trace)
Below is general information about the effectiveness of the known ingredients contained in the product Clinical Enzymes. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Clinical Enzymes. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
POSSIBLY SAFE ...when used orally and appropriately. Doses up to 240 mg daily have been used safely for up to a year (6252,6253,10622,11457,18281,18284,91104,91105,91106,91111)(96449,103298). Higher doses up to 3200 mg daily have been used safely, short-term (18283,110546). ...when used topically and appropriately. Bromelain has been used safely as a debriding agent for up to 4 hours (18275,91113,103297,108148,108149).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used ophthalmically, as approved by the US Food and Drug Administration (9).
POSSIBLY SAFE ...when used orally in combination with trypsin for up to 10 days (716). There is insufficient reliable information available about the safety of chymotrypsin when administered by other routes.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Nattokinase is a natural component of the soy food natto. It has been routinely consumed in Japan for hundreds of years (12072,12073).
POSSIBLY SAFE ...when used orally for medicinal purposes. Nattokinase has been used with apparent safety in doses of 2000 fibrinolytic units daily for up to 3 years or 10,800 fibrinolytic units daily for up to 12 months (64835,92312,106406,111252).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Papain has Generally Recognized as Safe (GRAS) status in the US (4912).
POSSIBLY SAFE ...when used orally and appropriately for medicinal purposes, short-term. Papain has been used in combination with other proteolytic enzymes at a dose of up to 1200 mg daily for up to 9 weeks (964,965,968,67831,67834). ...when used topically as a diluted solution in appropriate doses for up to 20 minutes (67835,67843,67845).
POSSIBLY UNSAFE ...when used orally in large amounts. In excessive doses, papain can cause significant side effects including esophageal perforation (6). ...when raw papain is used topically. Raw papain or papaya latex is a severe irritant and vesicant (6).
PREGNANCY: POSSIBLY UNSAFE
when used orally.
There is some concern that crude papain is teratogenic and embryotoxic (6).
LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts found in foods, such as fruits and vegetables.
POSSIBLY SAFE ...when used orally in medicinal amounts, short-term. Rutin has been used with apparent safety at doses of up to 600 mg daily for up to 12 weeks (6252,24560,91104,96766,105298). ...when applied topically as a cream (92236,99258,99260).
PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods.
There is insufficient reliable information available about the use of supplemental rutin; avoid amounts greater than those found in foods.
POSSIBLY SAFE ...when used orally and appropriately, short-term. Serrapeptase seems to be safe when used in clinical trials lasting up to 4 weeks (13151,13152,13153). There is insufficient reliable information available about the safety of serrapeptase when used long-term.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY SAFE ...when used topically by healthcare professionals trained in wound debridement (506). There is insufficient reliable information available about the safety of trypsin for its other uses. Although trypsin has been safely used in clinical research in doses of up to 288 mg orally daily in combination with other enzymes for up to 3 months, it is unclear if trypsin taken orally alone is safe (37193,92235,99473).
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
Below is general information about the interactions of the known ingredients contained in the product Clinical Enzymes. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Bromelain may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
Details
There is one case report of a patient experiencing minor bruising while taking bromelain with naproxen (14806). Bromelain is thought to have antiplatelet activity (10639,14806,18285,18286,37234). 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 (110547).
|
Theoretically, bromelain might increase levels of tetracycline antibiotics.
Details
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 (14296).
|
Nattokinase might increase the risk of bleeding when used with anticoagulant/antiplatelet drugs.
Details
|
Theoretically, nattokinase might increase the risk of hypotension when used with antihypertensive drugs.
Details
|
Theoretically, papain might increase the effects and side effects of warfarin.
Details
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 (613).
|
Theoretically, taking rutin with antidiabetes drugs might increase the risk of hypoglycemia.
Details
Animal research suggests that rutin has hypoglycemic effects (105299).
|
Serrapeptase might have fibrinolytic activity (13151,13152). Theoretically, taking serrapeptase with drugs that have antiplatelet or anticoagulant effects might increase the risk of bruising and bleeding. Some of these drugs include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.
|
Below is general information about the adverse effects of the known ingredients contained in the product Clinical Enzymes. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General
...Orally, bromelain seems to be well tolerated.
Most Common Adverse Effects:
Orally: Diarrhea, flatulence, gastric upset, headache.
Topically: Pruritus, urticaria.
Dermatologic
...Topically, bromelain may cause dermal allergic reactions including urticaria, pruritus, and skin swelling (9184).
Redness, swelling, burning, pain at the application site, and cellulitis have also been reported rarely (108148,113513). In one case, a fixed drug eruption with pruritis near the groin was reported in a 33-year-old male taking bromelain 50 mg orally daily for 10 days. After discontinuation of bromelain and treatment with topical corticosteroid, the lesion resolved. Upon re-challenge with bromelain, the lesion reappeared in the same area (103300).
In another case report, a 61-year-old male with a history of chronic lower leg ulceration secondary to chronic venous hypertension and recurrent deep vein thrombosis on rivaroxaban presented with a deep-dermal burn on his lower calf. Bromelain-based topical enzymatic debridement agent Nexobrid 2 grams was applied to the burn site. Thirty minutes later, the patient experienced two instances of hemorrhage at the site of debridement. The patient was stabilized and treated with fluids, packed red cells, and tranexamic acid, and then the Nexobrid was removed (111656). Caution should be used in patients with underlying coagulopathies.
Gastrointestinal ...Orally, bromelain may cause gastrointestinal disturbances, including diarrhea, nausea, vomiting, flatulence, and abdominal pain (9184,18274,18282,96216,113513).
Immunologic
...Immunoglobulin E (IgE)-mediated allergic reactions to bromelain may occur (9184).
If inhaled, bromelain may cause sensitization and allergic reactions such as asthma (37199,37215,37233). In case reports of occupational inhalation of bromelain, additional allergic symptoms included difficulty swallowing, throat itching, eye irritation, and rhinitis (37214).
General ...There is currently a limited amount of information available about the adverse effects of chymotrypsin. Orally, hypersensitivity reactions, including anaphylaxis, have been reported (9). When injected into the eye, chymotrypsin has been reported to cause increased intraocular pressure and uveitis (9,509).
Immunologic ...Rarely, chymotrypsin has been reported to cause anaphylactic reactions characterized by dyspnea, urticaria, edema, shock, vascular collapse, and unconsciousness, which can lead to death (9,509).
Ocular/Otic ...Intraocular injections of chymotrypsin have been reported to cause increased intraocular pressure, corneal edema, striation, uveitis, iridoplegia, and filamentary keratitis (9,509).
General
...Orally, nattokinase is generally well tolerated.
Preliminary clinical trials suggest that the incidence of adverse effects with nattokinase is similar to that with placebo.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis, hemorrhage.
Hematologic ...Orally, nattokinase has been associated with rare reports of hemorrhage (64834,109551). A case of intracranial hemorrhage (ICH) has been reported in a 52-year-old female who took nattokinase while taking low-dose aspirin for secondary prevention of ischemic stroke. Seven days after initiating nattokinase 400 mg daily, the patient reported vertigo and unsteady gait and was diagnosed with an acute cerebellar hemorrhage. It was suggested that the thrombolytic and anticoagulant effects of nattokinase combined with aspirin's antiplatelet effects contributed to the ICH (64834). In another case, a 92-year-old female taking nattokinase daily (dose unknown) for atrial fibrillation presented to the hospital after a fall. The patient was on no other anticoagulant or antiplatelet drugs. Abdominal CT showed a ruptured hepatic cystic lesion and intraperitoneal hemorrhage, which was difficult to stop despite several transfusions of red blood cells and fresh frozen plasma. The authors attributed the bleeding complications, in part, to nattokinase use (109551).
Immunologic ...Orally, nattokinase can cause hypersensitivity reactions, including anaphylaxis, in individuals sensitive to natto (109552,111253). A case series examining hypersensitivity reactions to natto shows that the causative allergen can be either nattokinase or polygamma glutamic acid (PGA), both of which are found in the sticky substance surrounding natto soybeans. In patients with hypersensitivity to nattokinase, specifically, symptoms occurred within 2 hours after ingestion, were limited to the pharynx and larynx, and included swelling, tightness, and itching in the throat and lips and dyspnea. All patients with nattokinase sensitivity shared a history of atopic dermatitis (111253).
General
...Orally and topically, papain seems to be well tolerated when used short-term at appropriate doses.
Taking high oral doses may be unsafe.
Most Common Adverse Effects:
Orally: Allergic reactions in sensitive individuals.
Topically: Urticaria and pruritus in sensitive individuals.
Serious Adverse Effects (Rare):
Orally: Esophageal perforation and severe gastritis with high doses.
Dermatologic ...Topically, papain can cause itching (966). Urticarial reactions and itching have been reported in people occupationally exposed to papain, with papain confirmed as the causative agent by skin prick tests or radioallergosorbent tests (RAST) (95533,95534). In a randomized controlled trial assessing the effects of papain, trypsin, and chymotrypsin on adverse effects from radiotherapy, moderate to severe epitheliolysis was more frequent in the enzyme-treated group than the placebo group (67834). It is unclear if this adverse effect is due to papain, other enzymes, or the combination.
Gastrointestinal ...Orally, papain has been associated with diarrhea. In a randomized controlled trial assessing the effects of papain, trypsin, and chymotrypsin on adverse effects from radiotherapy, moderate to severe diarrhea was more frequent in the enzyme-treated group than the placebo group (67834). However, it is unclear if this adverse effect is due to papain, other enzymes, or the combination. Papain has also been associated with gastric ulcers and esophageal perforation in case reports of phytobezoars treated with papain (67848). In general, large amounts of papain can cause esophageal perforation (6). Ingestion of papaya latex (raw papain) can cause severe gastritis.
Genitourinary ...Orally, papain has been associated with hypernatremia in case reports of phytobezoars treated with papain (67848).
Immunologic ...Orally, papain may cause allergic reactions, including itchy watery eyes, runny nose, sneezing, abdominal cramps, sweating, and diarrhea, in individuals sensitive to papain (6,967). Occupational exposure to airborne papain dust may also cause respiratory allergic reactions (95532,95533,95534,95535,95536).
Pulmonary/Respiratory ...Occupational exposure to airborne papain dust may cause respiratory allergic reactions. Symptoms include rhinitis, sneezing, conjunctivitis, dyspnea, wheezing, cough, and asthma. In most cases, papain is confirmed as the causative agent by skin prick tests, radioallergosorbent tests (RAST), or detection of papain-specific immunoglobulin E (IgE) and IgG (95532,95533,95534,95535,95536).
General ...Orally, rutin is generally well tolerated.
Dermatologic ...Orally, rutin may cause flushing and rashes in some people (313).
Gastrointestinal ...Orally, rutin may cause gastrointestinal disturbance in some people (313).
Neurologic/CNS ...Orally, rutin may cause headache in some people (313).
General ...Orally, serrapeptase seems to be well-tolerated. Some patients have reported epigastric pain, gastrointestinal upset, and nausea; however, these side effects appear to occur at the same rate as placebo (13152).
Gastrointestinal ...Orally, some patients have reported experiencing epigastric pain, gastrointestinal upset, and nausea; however, these side effects appear to occur at the same rate as placebo (13152).
Immunologic ...There is a case report of bullous pemphigoid, an autoimmune subepidermal dermatosis, in an elderly man who took serrapeptase (13154).
General ...Topically, trypsin can cause localized pain and transient burning (506). Orally, trypsin taken in combination with other enzymes can cause mild-to-moderate gastrointestinal symptom such as nausea, heartburn, and stomach pain (37193,92235). It is not known if trypsin or other enzymes causes these adverse effects.
Dermatologic ...Topically, trypsin can cause localized pain and transient burning (506).
Gastrointestinal ...Orally, trypsin taken in combination with other enzymes can cause mild-to-moderate gastrointestinal symptom such as nausea, heartburn, and stomach pain (37193,92235). It is not known if trypsin or other enzymes causes these adverse effects.