Papain

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Actinidin, aleurain, bromelain, Carica papaya, caricain, cathepsin B, cathepsin C, cathepsin H, cathepsin K, cathepsin L, cathepsin S, chymopapain, ficin, human cysteine proteases, meat tenderizer, papain-like enzyme, papaya, papaya enzyme, proteolytic enzymes.

  • Combination product examples: Prosta-Q (quercetin, saw palmetto, cranberry, bromelain, papain, zinc), Wobenzym® (pancreatin, bromelain, papain, lipase, amylase, trypsin, alpha chymotrypsin, rutin).

Background

  • Papain is an enzyme (a molecule that speeds up a chemical reaction) found in the latex produced by the fruit of the papaya plant (Carica papaya). The release of this enzyme-rich latex may be part of the plant’s defense mechanism and aids in cleaning and sealing the damaged areas of the plant.

  • In some parts of Africa, papain is used to treat burn wounds, especially in children, and to stimulate healing. In standard Western medical care, papain-containing agents are commonly used to remove dead tissue from burns and many types of wounds and skin ulcers. Traditionally, papain has also been used as digestive aid. Today, papain remains a popular after-meal supplement.

  • Allergic sensitivity to papain may cause symptoms ranging from itchiness to abdominal cramps, diarrhea, and excessive sweating. Papain is used as a meat tenderizer and in processing beer, so symptoms may occur after ingestion of foods seemingly unrelated to papain.

Scientific Evidence

Uses

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Exercise recovery

Research suggests that a combination product containing papain may speed muscle recovery and reduce soreness in runners. Additional research on the effects of papain alone is needed.

Gastrointestinal disorders (phytobezoar)

Papain may be useful in the treatment of phytobezoars (masses of partially digested or undigested plant material in the gastrointestinal tract). Papain treatment may also damage the esophagus and stomach. More research is needed to determine if papain can be useful while avoiding these adverse effects.

Jellyfish stings

Limited research has investigated the treatment of jellyfish stings with papain. Additional research is needed in this area.

Lung conditions (lung abscess)

Research suggests that papain may be useful in the treatment of lung abscesses when used together with other therapies. Additional research is needed in this area.

Radiation therapy side effects

Limited research on the use of papain to reduce the negative side effects of radiation therapy has shown mixed results. Additional research is needed before a conclusion can be made.

Recovery from surgery (prevention of postoperative adhesion formation)

Papain and other enzymes have been used to prevent postoperative adhesions. Additional research is needed in this area.

Rheumatic disorders

Limited research suggests that papain and other protein-digesting enzymes may reduce pain and inflammation in rheumatic disorders.

Skin conditions (xerotic skin)

Papain has shown some benefits in reducing scaling of xerotic (excessively dry) skin. More high-quality studies are needed in this area before a conclusion can be made.

Sore throat

Papain has shown some benefits in reducing the symptoms of pharyngitis and tonsillitis. More high-quality studies are needed before a conclusion can be made.

Wound healing

Studies suggest that papain may be very useful for removing dead tissue from wounds and stimulating healing. More high-quality research is needed in this area.

Insect bites (fire ants)

Limited research exploring the treatment of fire ant bites with papain found a lack of benefit. Additional research is needed in this area.

*Key to grades:

Tradition

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Antiviral, arthritis, bile duct disorders (bile duct stones), cancer, chronic prostatitis (chronic prostate inflammation), eye diseases, food uses, heart disease, immune system regulation, malaria, mouth and throat inflammation, osteochondrosis (bone disease of children), osteoporosis, parasites, recovery from surgery (reducing mucus production after urinary reconstruction), rheumatoid arthritis, SARS (severe acute respiratory syndrome), tuberculosis.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

  • There is no proven safe or effective dose for papain in adults.

Children (under 18 years old)

  • There is no proven safe or effective dose for papain in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with known allergy or hypersensitivity to papain, papaya (Carica papaya), or other plants or foods that may contain papain.

  • Papain is used as a meat tenderizer and to process beer, so symptoms may occur after ingestion of foods seemingly unrelated to papain.

  • Upon exposure to papain, people sensitive to papain experienced symptoms including specific airway sensitization, itching in the mouth, watering itchy eyes, sneezing, “runny nose,” abdominal cramps, diarrhea, and excessive sweating.

  • The commercial papain supplement Caroid, sold during the early to mid-20th Century, was noted to cause allergic symptoms, including severe coughing attacks, rhinitis (“stuffy nose” and watery eyes), shortness of breath, swelling under the skin, and asthma.

Side Effects and Warnings

  • Use cautiously in people being treated for prostatitis (prostate inflammation), as papain may reduce prostatitis symptoms.

  • Use cautiously in combination with radiation therapy, as papain may cause some symptoms to worsen. Diarrhea, fatigue, and destruction of epithelial tissue have been reported as side effects with the use of a combination product containing papain and other enzymes.

  • Avoid the combination product Wobenzym®, which contains papain, in people with bleeding disorders, or those taking anticoagulants, antiplatelet agents, or other drugs, herbs, or supplements that may increase the risk of bleeding. Symptoms of Coumadin® overdose (increased bleeding) have been reported in a person taking Coumadin® and Wobenzym® that was possibly contaminated with Coumadin®.

  • Avoid in people with gastroesophageal reflux disease or gastrointestinal ulcers, as papain may cause gastric ulcer and esophageal perforation.

  • Avoid in people using therapy that suppresses the immune system, as papain may stimulate the immune system.

  • Avoid in people sensitive to papain or with known allergy or hypersensitivity to papain, papaya (Carica papaya), or other plants or foods that may contain papain. Papain is used as a meat tenderizer and to process beer, so symptoms may occur after ingestion of foods seemingly unrelated to papain. People sensitive to papain may have itching in the mouth, watering itchy eyes, sneezing, runny nose, abdominal cramps, diarrhea, and excessive sweating.

Pregnancy and Breastfeeding

  • Avoid in pregnant or breastfeeding women, due to a lack of available scientific evidence.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

  • Papain may further increase the risk of bleeding when taken with drugs that increase the risk of bleeding. The combination product Wobenzym®, which contains papain, may have been contaminated with the anticoagulant warfarin (Coumadin®) and may also further increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

  • Papain may also interact with agents that affect the immune system, agents used to treat diarrhea, agents used to treat ulcers, dry skin treatments, or hormonal agents.

Interactions with Herbs and Dietary Supplements

  • Papain may further increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. The combination product Wobenzym®, which contains papain, may have been contaminated with the anticoagulant warfarin (Coumadin®) and may also further increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

  • Papain may also interact with alpha-chymotrypsin, amylase, bromelain, dry skin treatments, herbs and supplements that affect the immune system, herbs and supplements used to treat diarrhea, herbs and supplements used to treat ulcers, hormonal herbs and supplements, lipase, pancreatin, rutin, sodium, or trypsin.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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  7. Martin T, Uhder K, Kurek R, et al. Does prophylactic treatment with proteolytic enzymes reduce acute toxicity of adjuvant pelvic irradiation? Results of a double-blind randomized trial. Radiother Oncol 2002;65(1):17-22. View Abstract
  8. N’Dow J, Robson CN, Matthews JN, et al. Reducing mucus production after urinary reconstruction: a prospective randomized trial. J Urol 2001;165(5):1433-1440. View Abstract
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  10. Pieper B, Caliri MH. Nontraditional wound care: A review of the evidence for the use of sugar, papaya/papain, and fatty acids. J Wound Ostomy Continence Nurs 2003;30(4):175-183. View Abstract
  11. Rosenthal PJ, Sijwali PS, Singh A, et al. Cysteine proteases of malaria parasites: targets for chemotherapy. Curr Pharm Des 2002;8(18):1659-1672. View Abstract
  12. Steverding D, Caffrey CR, Sajid M. Cysteine proteinase inhibitors as therapy for parasitic diseases: advances in inhibitor design. Mini Rev Med Chem 2006;6(9):1025-1032. View Abstract
  13. Taylor SL, Hefle SL. Ingredient and labeling issues associated with allergenic foods. Allergy 2001;56 Suppl 67:64-69. View Abstract
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  15. Yasuda Y, Kaleta J, Bromme D. The role of cathepsins in osteoporosis and arthritis: rationale for the design of new therapeutics. Adv Drug Deliv Rev 5-25-2005;57(7):973-993. View Abstract

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.