Chymotrypsin

Usage

Chymotrypsin is primarily prescribed to reduce inflammation and swelling associated with various conditions, including:

• Post-surgical wounds and traumatic injuries
• Abscesses and ulcers
• Bronchitis, asthma, and other respiratory conditions where it helps loosen mucus.

Pharmacological Classification: Proteolytic enzyme, anti-inflammatory agent.

Mechanism of Action: Chymotrypsin is a proteolytic enzyme that catalyzes the hydrolysis of proteins into smaller peptides. It acts by breaking down proteins involved in the inflammatory process, reducing swelling, pain, and promoting tissue repair.

Alternate Names

Chymotrypsin, α-chymotrypsin, Chymotrypsin Alfa.

Brand Names: Chymoral Forte, Alfapsin, Decsir Forte, Zymor AP, Chymar, Marochym-200, Chymolife, Valumoral, Usatrypsin.

How It Works

Pharmacodynamics: Chymotrypsin reduces inflammation by breaking down inflammatory proteins at the injury site, thereby decreasing swelling, pain, and promoting faster healing. It also helps in debridement of necrotic tissue.

Pharmacokinetics: When administered orally, chymotrypsin is absorbed in the small intestine. It bypasses the stomach’s acidic environment due to its enteric coating. Onset of action is typically within 30 minutes to an hour. Elimination pathways are not fully elucidated.

Mode of Action: Chymotrypsin cleaves peptide bonds adjacent to aromatic amino acids in proteins, including those involved in the inflammatory cascade. It does not involve receptor binding or neurotransmitter modulation.

Dosage

Standard Dosage

Adults:

Oral: 100,000 - 200,000 USP units four times daily, taken on an empty stomach, approximately 1-2 hours before meals. The duration of treatment is usually 10 days or as directed by a physician. For burn patients, a trypsin:chymotrypsin ratio of 6:1 with a combined amount of 200,000 units USP four times daily for ten days is recommended.

Children:

Pediatric dosing is not well-established and should be determined by a physician.

Special Cases:

• Elderly Patients: Dose adjustments may be necessary based on individual patient needs and organ function.

• Patients with Renal Impairment: Caution should be exercised, and dose adjustment may be required based on renal function.

• Patients with Hepatic Dysfunction: Caution should be exercised, and dose adjustment may be required based on hepatic function.

• Patients with Comorbid Conditions: Dosage adjustments should be individualized based on the specific comorbid conditions.

Clinical Use Cases:

Dosage in clinical use cases such as intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations should be individualized and determined by a physician. Specific dosage recommendations for these situations are not universally established.

Dosage Adjustments:

Dose adjustments should be made based on patient-specific factors like renal and hepatic impairment, other medical conditions, and response to therapy.

Side Effects

Common Side Effects:

• Gastrointestinal disturbances (diarrhea, nausea, vomiting, abdominal pain/discomfort).
• Allergic reactions (itching, skin rash).

Rare but Serious Side Effects:

• Severe allergic reactions (shortness of breath, swelling of the lips or throat, shock, loss of consciousness).
• Corneal swelling and inflammation (when used ophthalmically).

Long-Term Effects:

Limited data are available on the long-term effects of chymotrypsin.

Adverse Drug Reactions (ADR):

Severe allergic reactions require immediate medical intervention.

Contraindications

• Hypersensitivity to chymotrypsin.
• Severe liver or kidney impairment.
• Peptic ulcers.
• High intraocular pressure.
• Pregnancy and breastfeeding (due to limited safety data).
• Active bleeding or coagulopathies.

Drug Interactions

• Anticoagulants (warfarin, heparin, clopidogrel): Increased risk of bleeding.
• Certain antibiotics (chloramphenicol, penicillin): May alter antibiotic effectiveness.
• Alcohol: May increase the risk of gastrointestinal side effects.

Pregnancy and Breastfeeding

Safety in pregnancy and breastfeeding is not established. Avoid use unless the potential benefits outweigh the risks.

Drug Profile Summary

• Mechanism of Action: Proteolytic enzyme, reduces inflammation by breaking down inflammatory proteins.

• Side Effects: GI upset, allergic reactions. Rarely, severe allergic reactions.

• Contraindications: Hypersensitivity, severe liver/kidney disease, peptic ulcers, pregnancy, lactation.

• Drug Interactions: Anticoagulants, certain antibiotics, alcohol.

• Pregnancy & Breastfeeding: Avoid use.

• Dosage: 100,000-200,000 units four times daily.

• Monitoring Parameters: Observe for signs of allergic reaction, GI distress, and efficacy of treatment.

Popular Combinations:

Chymotrypsin is often combined with trypsin for enhanced anti-inflammatory and proteolytic effects.

Precautions

• Assess for allergies and renal/hepatic function prior to initiating treatment.
• Caution in patients with bleeding disorders.
• Avoid alcohol during treatment.
• Monitor for allergic reactions.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Chymotrypsin?

A: The standard adult dose is 100,000-200,000 USP units four times daily, taken on an empty stomach. Pediatric dosing should be determined by a physician.

Q2: What are the common side effects of Chymotrypsin?

A: Common side effects include gastrointestinal upset (diarrhea, nausea, vomiting) and allergic reactions such as skin rash and itching.

Q3: Is Chymotrypsin safe to use during pregnancy?

A: No, safety during pregnancy has not been established. Avoid use unless benefits outweigh the risks, as advised by a doctor.

Q4: What are the contraindications for Chymotrypsin?

A: Contraindications include hypersensitivity to the drug, severe liver/kidney impairment, active peptic ulcers, high intraocular pressure, and pregnancy/breastfeeding.

Q5: How does Chymotrypsin work?

A: It is a proteolytic enzyme that breaks down proteins involved in the inflammatory process, reducing swelling and pain.

Q6: Can Chymotrypsin be used in children?

A: Pediatric use should be under the guidance of a physician as the safety and efficacy are not well-established. Dosing should be adjusted according to the child’s age and weight.

Q7: What drugs interact with Chymotrypsin?

A: Anticoagulants, certain antibiotics (e.g., chloramphenicol), and alcohol can interact with Chymotrypsin.

Q8: What precautions should be taken while using Chymotrypsin?

A: Patients with liver or kidney disease should use with caution. Monitor for any signs of allergy. Avoid alcohol while taking Chymotrypsin. Contact your doctor if symptoms worsen or new symptoms appear.

Q9: Are there any long-term side effects of Chymotrypsin?

A: Limited data are available on long-term effects.

Q10: Can Chymotrypsin be used for ophthalmic purposes?

A: Yes, chymotrypsin is used in ophthalmic procedures, specifically for enzymatic zonulysis during intracapsular lens extraction. It is administered by a healthcare professional.