1. Clinical Overview
Trypsin Chymotrypsin is a proteolytic enzyme preparation derived from bovine pancreas, standardized to contain 50000 Anti-inflammatory Units (AU). It is a systemic anti-inflammatory, anti-edematous, and fibrinolytic agent used primarily to reduce inflammation, swelling, and pain associated with trauma and post-operative conditions. It works by breaking down necrotic tissue, fibrin clots, and exudates, thereby facilitating healing.
| Onset | Duration | Bioavailability |
|---|---|---|
| Within 2-4 hours of oral administration. | Approximately 8-12 hours. | Oral bioavailability is low (<10%) due to degradation in the GI tract. Enteric-coated tablets are designed to release the enzymes in the intestine for absorption. |
2. Mechanism of Action
Trypsin and Chymotrypsin are serine endopeptidases that hydrolyze peptide bonds in proteins and polypeptides. Systemically, they reduce inflammation by: 1) Breaking down fibrinogen, fibrin clots, and necrotic tissue, improving microcirculation and reducing edema. 2) Modulating inflammatory cytokines (e.g., reducing TNF-α, IL-6) and promoting the release of anti-inflammatory mediators. 3) Reducing capillary permeability and leukocyte migration to the site of injury. 4) Facilitating the drainage of protein-rich exudates.
3. Indications & Uses
- Traumatic Swelling and Inflammation (e.g., sprains, fractures, contusions)
- Post-operative Edema and Inflammation (e.g., following dental, orthopedic, or general surgery)
- Phlebitis and Thrombophlebitis (adjunct therapy)
4. Dosage & Administration
Adult Dosage: 1 tablet (50000 AU) three to four times daily. For severe conditions, an initial dose of 2 tablets three times daily for the first 2-3 days may be used, followed by maintenance dose.
Administration: To be taken on an empty stomach, at least 1 hour before or 2 hours after meals, with a full glass of water. Do NOT crush, chew, or break the enteric-coated tablet. Swallow whole.
5. Side Effects
Common side effects may include:
- Gastrointestinal discomfort (dyspepsia, nausea)
- Diarrhea or loose stools
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Anticoagulants (Warfarin, Acenocoumarol, Dabigatran, etc.) | May potentiate anticoagulant effect, increasing risk of bleeding. | Major |
| Antiplatelet drugs (Aspirin, Clopidogrel) | Increased risk of bleeding due to additive effects. | Moderate |
| Other Proteolytic Enzymes (Papain, Bromelain) | Additive therapeutic and adverse effects. | Moderate |
| Antibiotics (Tetracyclines, Aminoglycosides) | Theoretical interaction - enzymes may affect absorption. Separate administration by 2-3 hours. | Minor |
7. Patient Counselling
- DO take the tablet on an empty stomach (1 hr before or 2 hrs after food).
- DO swallow the tablet whole with water. Do not crush or chew.
- DO inform your surgeon/dentist about taking this medicine before any procedure.
- DO complete the full course as prescribed.
- DONT take it with meals as it will reduce effectiveness.
- DONT take if you are allergic to beef or bovine products.
8. Toxicology & Storage
Overdose: No specific reports of acute overdose in humans. Theoretical symptoms may include severe gastrointestinal upset (nausea, vomiting, diarrhea), increased bleeding tendency, and allergic reactions.
Storage: Store below 30°C. Protect from moisture and light. Keep out of reach of children. Do not use after the expiry date printed on the pack.