📋 Clinical Overview

A fixed-dose combination of proteolytic enzymes and a bioflavonoid, primarily used as an anti-inflammatory, anti-edematous, and fibrinolytic agent. It is widely prescribed in India for the management of post-operative and post-traumatic inflammation, swelling, and pain, as well as for venous disorders. The combination synergistically reduces inflammation, improves microcirculation, and accelerates tissue healing.

💊 Dosage & Administration

Adult: One tablet (Bromelain 90mg + Rutoside 100mg + Trypsin Chymotrypsin 50000 AU) twice daily, preferably on an empty stomach (30-60 minutes before meals or 2 hours after meals). In acute conditions, the dose may be initiated as one tablet three times daily for the first 3-4 days, then reduced to twice daily.

Note: Swallow the enteric-coated tablet whole with a glass of water. Do not crush, chew, or break. Take at least 30 minutes before food for optimal absorption. If gastrointestinal upset occurs, it may be taken with food, but efficacy may be reduced.

⚠️ Contraindications

Known hypersensitivity to bromelain (pineapple), rutoside, trypsin, chymotrypsin, or any excipient
Patients with coagulation disorders (e.g., hemophilia) or on anticoagulants with high INR (relative, but often considered absolute in practice)
Severe hepatic or renal impairment where metabolism/excretion is critically compromised

🔬 Mechanism of Action

The combination exerts a multi-targeted anti-inflammatory and anti-edema effect. Bromelain and Trypsin-Chymotrypsin break down inflammatory mediators (bradykinin, histamine), fibrin deposits, and exudative proteins, reducing edema and improving tissue permeability. Rutoside reduces capillary fragility and permeability by inhibiting hyaluronidase and prostaglandin synthesis, thereby stabilizing vascular endothelium. Together, they enhance fibrinolysis, reduce blood viscosity, and improve microcirculation at the site of injury.

🤕 Side Effects

Mild gastrointestinal discomfort (heartburn, nausea, epigastric pain)
Diarrhea or loose stools
Allergic skin reactions (rash, itching, urticaria) in sensitive individuals

🤰 Special Populations

Pregnancy: Category C: Animal reproduction studies have not been conducted. Not recommended during pregnancy due to the lack of adequate and well-controlled studies. The fibrinolytic action may theoretically increase risk of bleeding.

Driving: Dizziness has been reported rarely. Patients should be cautioned about operating machinery or driving if they experience dizziness.

🔄 Drug Interactions

Warfarin, Acenocoumarol	Increased anticoagulant effect and risk of bleeding due to antiplatelet and fibrinolytic activity of enzymes and rutoside.	Major
Aspirin, Clopidogrel, NSAIDs (e.g., Diclofenac)	Additive risk of gastrointestinal irritation and bleeding.	Moderate
Antibiotics (especially Tetracyclines, Amoxicillin)	Bromelain may increase absorption and serum levels of certain antibiotics, potentially increasing both efficacy and toxicity.	Moderate
Chemotherapeutic agents (e.g., 5-Fluorouracil, Vinca alkaloids)	Bromelain may enhance absorption and cytotoxicity; use only under strict supervision.	Major
Sedatives (e.g., Benzodiazepines, Barbiturates)	Theoretical increased sedation; limited clinical data.	Minor

🔁 Alternatives to Alfapsin Forte

Same composition (Bromelain (90mg) + Rutoside (100mg) + Trypsin Chymotrypsin (50000AU)), different brands:

Chymoral Forte Erazon Forte Enzoheal Forte Chymocare Forte