What are the indications, recommended dosage, contraindications, precautions, and side‑effects of Chymoral (chymotrypsin)?

Chymoral (Trypsin:Chymotrypsin) - Clinical Uses and Side Effects

Primary Clinical Indications

Chymoral (trypsin:chymotrypsin combination) is primarily indicated for facilitating tissue repair and reducing inflammation following acute tissue injuries, including surgical wounds, traumatic injuries, fractures, and burns. 1

• The enzyme preparation has been in clinical use since the 1960s as an oral proteolytic enzyme for managing acute tissue damage 1
• It provides better resolution of inflammatory symptoms and promotes speedier recovery compared to several other enzyme preparations 1
• The mechanism involves modulation of the inflammatory response through effects on acute-phase proteins and cytokines 2, 3

Mechanism of Action and Clinical Effects

Anti-inflammatory Properties

• Chymoral significantly reduces inflammatory markers in burn patients, including C-reactive protein levels, while enhancing protective acute-phase proteins (alpha-1-antitrypsin, alpha-2-macroglobulin) 2
• The preparation modulates cytokine levels, specifically reducing IL-1β and IL-6 by post-burn days 7-10, which correlates with decreased severity of the inflammatory phase 3
• Treatment results in decreased formation of lipid peroxidation products and maintains higher levels of enzymatic antioxidants (superoxide dismutase, catalase, glutathione peroxidase) 4

Tissue Repair Enhancement

• The enzyme facilitates the physiological healing process across all four phases: hemostasis, inflammation, proliferation, and remodeling 1
• By reducing tissue destruction and free radical formation, it prevents progression to chronic wounds, which are associated with significant morbidity and mortality 1, 4

Dosage and Administration

• Standard formulation is Chymoral Forte DS (double strength) 2, 3
• Administered orally for systemic effects 1, 5
• Important caveat: The exact optimal dosing regimen is not definitively established in the provided evidence, though clinical use has been documented since the 1960s 1

Side Effects and Safety Profile

General Safety

• The evidence shows a favorable safety profile with minimal documented adverse effects 1, 5
• Studies in burn patients treated with trypsin:chymotrypsin preparation did not report significant adverse events 2, 3, 4

Comparative Safety Context

• Unlike certain antimicrobials used for other conditions (such as tuberculosis medications like pyrazinamide and ethionamide which cause hepatotoxicity in 1-2% of patients), proteolytic enzymes like chymoral do not require intensive hepatic monitoring 6

Limitations in Evidence

• A critical caveat is that the exact mechanism of action remains incompletely understood, which contributes to some uncertainty about therapeutic value 5
• Studies showing favorable results lack completely precise measurement techniques, and the effectiveness of systemically administered proteolytic enzymes as anti-inflammatory agents requires further establishment 5

Contraindications and Precautions

• Topical use of trypsin-chymotrypsin (Biozyme) has demonstrated value, but the merits of oral, buccal, or intramuscular administration are not conclusively demonstrated in all contexts 5
• No specific absolute contraindications are documented in the provided evidence
• Clinical judgment should prioritize use in acute tissue injury settings where inflammatory modulation is beneficial 1, 2

Clinical Monitoring

• When used in burn patients, monitoring should include assessment of inflammatory markers and wound healing progress 2, 3
• Serum acute-phase proteins and cytokine levels can serve as markers of therapeutic efficacy 2, 3
• Antioxidant status and trace element levels (copper, selenium) may be monitored in severe burn cases 4