Papain

Common Name: Papaya enzymes

Clinical Name: Papain

Summary

Papain

overview of interactions:
• nutrient constituent affecting drug performance and toxicity: Warfarin


Interactions

nutrient constituent affecting drug performance and toxicity: Warfarin

• report: A single case report involving a woman in Mexico using an enzyme preparation containing a variety of substances seems to have generated a number of warnings against potential interactions of the part of the individual constituents of that formulation. The substance in question is a multi-enzyme formulation marketed under the brand name non-steroidal anti-inflammatory drug, sold in Mexico under the name of Wobenzym (R), and containing pancreatin, bromelain, papain, lipase, amylase, trypsin, alpha chymotrypsin and rutin. Some writers have mistakenly referred to this compound as a "non-steroidal anti-inflammatory drug." Apparently, in conjunction with warfarin, the patient in question demonstrated many symptoms of coumadin overdose, such as prolonged prothrombin time, prolonged activated thromboplastin time, and low functional and antigenic levels of prothrombin. However, her platelet count, and the thrombin, reptilase and bleeding times were all normal, and all laboratory and clinical abnormalities returned to normal after administration of fresh frozen plasma and parenteral vitamin K.
(Perez-Jauregui J, et al. Rev Invest Clin 1995 Jul-Aug;47(4):311-313; Shaw D, et al. Drug Safety 1997;17(5):342-356; Innerfield I, Rowley GR. Life Sci [II] 1970 Dec 8;9(23):1359-1367.)

• herbal concerns: Individuals taking warfarin should avoid the consumption of papaya-derived substances such as papain and be watchful for its presence in enzyme formulas or other digestive aids. Although Carica papaya is not commonly prescribed as an herbal medicine per se, papain is commonly used as a digestive enzyme and in anti-inflammatory formulations. Individuals using warfarin should consult with their prescribing physician and a healthcare professional trained in botanical prescribing before using papaya or derivatives as a medicinal herb.

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Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.


References

Innerfield I, Rowley GR. Low dosage proteases, clotting factors, capillary permeability and cellular viability. Life Sci [II] 1970 Dec 8;9(23):1359-1367.

Neubauer RA. A plant protease for potentiation of and possible replacement of antibiotics. Exp Med Surg 1961;19:143-160.

Perez-Jauregui J, Escate-Cavero A, Vega-Galina J, Ruiz-Arguelles GJ, Macip-Nieto G. [Probable coumarin poisoning upon ingestion of an anti-inflammatory agent]. Rev Invest Clin 1995 Jul-Aug;47(4):311-313. [Article in Spanish]
Abstract: Warfarin overdose leads to hypoprothrombinemia and bleeding diathesis. We report here the case of a 47 year old woman who ingested an overdose of a non-steroidal anti-inflammatory drug, sold in Mexico under the name of Wobenzym (R), and containing, according to the manufacturer: pancreatin, bromelin, papain, lipase, amylase, trypsin, alpha chymotrypsin and rutin. She developed skin, urinary and gastrointestinal bleeding and was found to be apparently under the effect of a coumadin overdose, i.e. prolonged prothrombin time, prolonged activated thromboplastin time, and low functional and antigenic levels of prothrombin. A platelet count, and the thrombin, reptilase and bleeding times were normal. All laboratory and clinical abnormalities reverted to normal by using fresh frozen plasma and parenteral vitamin K. In addition, we were able to show that the commercial preparation could prolong the prothrombin time in rabbits and, by high-performance liquid chromatography, a pike consonant with purified coumadin was found in the drug. It is concluded that this drug is probably contaminated by coumadin, and that physicians must be aware of its potential side effects.

Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997;17(5):342-356.