Oral enzyme therapy using trypsin-bromelain-rutoside combination to counter pain and swelling in orthopaedic conditions: a single-centre experience


  • Rajesh K. Dhadiwal Director, Dhadiwal Hospital, Trimbak Road, Nashik, Maharashtra, India
  • Bhushan M. Khemnar SIRO Clinpharm Pvt. Ltd., Thane, Mumbai, Maharashtra, India
  • James John SIRO Clinpharm Pvt. Ltd., Thane, Mumbai, Maharashtra, India




Inflammation, Antioxidant, Arthralgia, Flavonoid


Background: Various orthopaedic conditions end up being painful, chronic and progressive, and are associated with persistent inflammation. The present study aimed to evaluate the efficacy and safety of an enzyme-bioflavonoid combination of trypsin-bromelain-rutoside in managing the chronic pain and swelling in out-patients with various orthopaedic conditions.

Methods: The study was a prospective, observational study, conducted in 100 patients attending the orthopaedics department at a multi-speciality hospital located in Nashik, Maharashtra, India.  Verbal rating scales were used for grading the pain intensity and extent of swelling at baseline and on days 3 and 8, after being prescribed oral tablets of trypsin-bromelain-rutoside combination. Scores were analysed using paired t test. A 5-point Likert scale was used to evaluate patient- and investigator-reported global assessment of improvement in pain and swelling at days 3 and 8.

Results: At baseline, 68 patients reported moderate-severe pain, while 74 patients had moderate swelling. The mean scores for pain and swelling showed statistically significant reduction at both day 3 (p<0.0001) and day 8 (p<0001). By day 8, 98 patients reported good-excellent improvement and the investigator reported good-excellent improvement in 97 patients. No adverse event was reported by any patient.

Conclusions: The results indicate that this therapy led to significant improvement in the pain and swelling as early as day 3 and further improvement with continued therapy, and can, thus, provide a safe alternative in patients with various orthopaedic conditions and reduce the need for other analgesic and anti-inflammatory drugs.


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