Recommended Dosing for Trypsin, Bromelain, and Rutoside Combination
The standard dose for the fixed-dose combination of trypsin (48 mg), bromelain (90 mg), and rutoside (100 mg) is 2 tablets taken orally three times daily for inflammatory conditions and postoperative recovery. 1, 2
Standard Dosing Regimen
The most commonly studied and effective dose is 2 tablets three times daily (providing 96 mg trypsin, 180 mg bromelain, and 200 mg rutoside per day total), administered for 5-7 days postoperatively or during acute inflammatory episodes 1, 2
For postoperative use following elective surgery, treatment should ideally begin pre-operatively when possible and continue for up to 42 days, though the critical period is the first 7 days 1
In the context of total hip replacement surgery, pre- and post-operative administration of this combination (90 mg bromelain, 48 mg trypsin, 100 mg rutoside per tablet, 2 tablets three times daily) significantly reduced C-reactive protein levels by 32% and decreased patient-reported pain during the first postoperative week 1
Clinical Context and Timing
For surgical procedures, initiate treatment pre-operatively when feasible and continue through the acute inflammatory phase (typically 5-7 days post-procedure) 1, 2
In mandibular third molar surgery, the combination of trypsin 48 mg, bromelain 90 mg, and rutoside 100 mg twice daily demonstrated superior efficacy in reducing pain and trismus compared to serratiopeptidase 3
The combination should be taken with standard analgesics (such as NSAIDs) rather than as monotherapy, as studies typically employed this approach 3, 4
Safety Profile and Tolerability
This enzyme combination demonstrates excellent safety with no treatment-related adverse events reported in controlled trials, making it suitable for extended use up to 42 days 1, 2
No deleterious effects on hematological parameters were observed, which is particularly important in the perioperative setting 1
When adverse effects occur with bromelain-containing products, they are predominantly mild gastrointestinal symptoms that are well-tolerated 5
Mechanism-Based Dosing Considerations
The anti-inflammatory effects are mediated through reduction of inflammatory markers including CRP, IL-6, IL-8, TNF-α, and PGE-2, with peak CRP reduction occurring during the first postoperative week 1, 5
Rutoside (a flavonoid) contributes to the anti-inflammatory effect by reducing capillary permeability and microvascular protein leakage, complementing the proteolytic enzyme activity 6
Important Clinical Caveats
Avoid crushing or opening tablets unless they emerge unchanged in output (relevant for patients with rapid gastrointestinal transit), though this is more commonly an issue with other medications 7
The combination is most effective when initiated early in the inflammatory process rather than after inflammation is well-established 1
For chronic inflammatory conditions, studies have used treatment durations ranging from 3 to 16 weeks, though optimal duration beyond acute use remains less well-defined 5
This combination should not replace standard surgical prophylaxis or postoperative care protocols, but rather serves as an adjunctive therapy to enhance recovery 1, 2