What is the recommended dosage of Serratiopeptidase (serine protease) for treating inflammatory conditions?

Serratiopeptidase Dosage for Inflammatory Conditions

The recommended dosage of serratiopeptidase for adults is 10 drops sublingually up to 3 times daily, taken 30 minutes before or after meals, though the clinical evidence supporting its efficacy as an anti-inflammatory agent is insufficient and of poor methodological quality. 1

FDA-Approved Dosing

The only established dosing guideline comes from the FDA drug label, which specifies:

• Adults and children ≥12 years: 10 drops sublingually up to 3 times per day 1
• Timing: Administer 30 minutes before or after meals 1
• Children <12 years: Requires physician consultation before use 1

Critical Evidence Limitations

The scientific foundation for serratiopeptidase use is fundamentally weak:

• No high-quality randomized controlled trials exist to support specific dosing recommendations for inflammatory conditions 2
• A systematic review found that existing clinical studies suffer from poor methodology, small sample sizes, undefined treatment durations, and unclear outcome measures 2
• Long-term safety data is completely lacking 2

Dosing Reported in Low-Quality Studies

Historical clinical trials (which should not guide practice due to poor quality) have used:

• 30 mg daily (10 mg three times daily) in venous inflammatory disease, though this study compared it unfavorably to seaprose S 3
• 5.4 mg/kg orally in animal models, where it showed no significant anti-inflammatory effect compared to control 4

Critical Safety Concerns

Serratiopeptidase may worsen certain infections due to its fibrinolytic properties:

• One case report documented spread of a buccal space abscess into deeper muscular layers after serratiopeptidase administration 5
• Contraindicated in abscess or localized infection where fibrinolytic activity could facilitate bacterial spread 5

Clinical Recommendation

Given the absence of robust evidence, serratiopeptidase cannot be recommended as a first-line anti-inflammatory agent. 2 If a patient insists on using this supplement despite counseling about limited evidence, the FDA-labeled dosing of 10 drops sublingually three times daily represents the only established guideline. 1 However, conventional NSAIDs or corticosteroids (depending on the specific inflammatory condition) have vastly superior evidence for efficacy and safety profiles. 6, 2

Avoid serratiopeptidase entirely in patients with:

• Active infections or abscesses 5
• Bleeding disorders (due to fibrinolytic properties) 6
• Situations requiring evidence-based anti-inflammatory therapy 2