Trypsin-Chymotrypsin Dosing for Intervertebral Disc Bulge
The evidence provided does not contain any validated dosing information for trypsin-chymotrypsin 100,000 AU tablets for treatment of intervertebral disc bulge, and the single FDA label reference 1 describes a completely different formulation (sublingual spray) with dosing that is not applicable to oral tablets.
Critical Evidence Gap
The FDA label provided 1 describes trypsin-chymotrypsin as a sublingual spray formulation with dosing of "2 sprays under the tongue, 3x per day" for adult men, which is fundamentally different from the 100,000 AU tablet formulation asked about in the question 1
None of the guideline or research evidence provided addresses trypsin-chymotrypsin dosing for musculoskeletal conditions, disc bulge, or any orthopedic indication
All guideline evidence relates to unrelated conditions: tuberculosis treatment 2, acute coronary syndromes 2, hypertension in CKD 2, venous thromboembolism 2, and general medication dosing in elderly patients with renal impairment 2
Special Considerations for This Patient Population
Renal Function Concerns in Elderly Patients
Elderly patients frequently have unrecognized chronic kidney disease, with GFR decreasing approximately 8 ml/min each decade after age 40, and at least 26% of persons over 70 years having CKD 2
Serum creatinine may appear in the normal laboratory range despite significant underlying GFR impairment in elderly patients 2
For any medication in elderly patients with kidney stone history, careful assessment of actual renal function (not just serum creatinine) is essential before prescribing 3, 4, 5
Nephrolithiasis Management Considerations
High fluid intake targeting urine volume ≥2.5 liters daily is recommended to prevent kidney stone recurrence 6, 7
Limiting sodium intake to 2,300 mg daily reduces urinary calcium excretion and stone risk 6
Clinical Recommendation
Without validated evidence for trypsin-chymotrypsin tablet dosing for disc bulge, and given the patient's elderly status with kidney stone history, I cannot provide a specific dosing recommendation. The FDA label for a different formulation 1 cannot be extrapolated to tablets. Before prescribing any proteolytic enzyme therapy, verify the actual product labeling for the specific 100,000 AU tablet formulation, assess renal function beyond serum creatinine alone 2, and ensure adequate hydration given the nephrolithiasis history 6, 7.