Usage
Trypsin-Chymotrypsin is prescribed for reducing pain and swelling associated with various inflammatory conditions, including:
- Post-operative wounds
- Traumatic injuries
- Pelvic inflammatory disease
- Episiotomies
- Intervertebral disc herniation
- Cataract surgery (administered by healthcare professionals)
- Thrombophlebitis
- Vasectomies
- Reduction of mucus viscosity and sputum formation in bronchitis, rhinitis and sinusitis.
- Ocular trauma like macular edema, black eye, hyphema, uveal tract inflammation, subconjunctival hemorrhage, extraocular trauma.
- Dental procedures, tooth extraction, periapical abscess, maxillofacial surgery.
- Fractures and dislocations
- Enhancement of antibiotic concentration at infection sites
- Burns (to reduce tissue damage)
Pharmacological Classification: Proteolytic enzyme, anti-inflammatory agent.
Mechanism of Action: Trypsin and chymotrypsin are proteolytic enzymes that break down proteins, including those involved in the inflammatory cascade. This action helps resolve swelling and edema by clearing fibrin and other inflammatory mediators, thus promoting tissue repair and reducing pain.
Alternate Names
Chymoral, Kristryp, MaroChym-200, Alpha Chymar. Combinations with other drugs also exist (e.g., with aceclofenac and paracetamol).
How It Works
Pharmacodynamics: Trypsin and Chymotrypsin work by breaking down proteins involved in inflammation. They facilitate the clearing of fibrin and other inflammatory mediators, reducing swelling and pain.
Pharmacokinetics: When administered orally, trypsin-chymotrypsin is absorbed in the small intestine. Enteric-coated formulations protect the enzymes from degradation in the stomach. The onset of action is typically within half an hour. Elimination pathways are not fully elucidated, but it is believed to be metabolized, at least partially, with any remaining drug and metabolites excreted either renally or in the bile.
Mode of Action: These enzymes act directly on proteins involved in inflammation, promoting their breakdown and removal from the affected area.
Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: Trypsin and chymotrypsin exert their effects through direct enzymatic action on proteins, not through receptor binding, enzyme inhibition of other enzymes, or neurotransmitter modulation.
Dosage
Dosage is dependent on the severity of the condition and is at the discretion of the prescribing physician.
Standard Dosage
Adults:
Initial dosage: Two tablets three times a day. After improvement, reduce to one tablet four times a day.
Children:
Safety and efficacy in children have not been established. Pediatric dosing is not well-defined and should be determined by a physician based on individual cases and with caution.
Special Cases:
- Elderly Patients: Caution is advised, and dosage adjustments may be necessary based on kidney and liver function.
- Patients with Renal Impairment: Use with caution. Dose adjustment may be required.
- Patients with Hepatic Dysfunction: Use with caution. Dose adjustment may be required.
- Patients with Comorbid Conditions: Caution is advised in patients with peptic ulcers, bleeding disorders, or those taking anticoagulants.
Clinical Use Cases
Dosage adjustments based on specific clinical use cases are not standardized and should be determined by the treating physician.
Dosage Adjustments
Adjustments should be made for renal/hepatic impairment and in patients with bleeding disorders or those taking anticoagulants.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Skin rash
- Itching
Rare but Serious Side Effects
- Allergic reactions (itching, shortness of breath, swelling of lips/throat, shock, loss of consciousness)
- Corneal swelling (with ophthalmic use)
- Increased intraocular pressure (with ophthalmic use)
Long-Term Effects
Long-term effects are not well-documented.
Adverse Drug Reactions (ADR)
Severe allergic reactions require immediate medical attention.
Contraindications
- Hypersensitivity to trypsin, chymotrypsin, or any component of the formulation.
- Severe hepatic impairment
- Severe renal impairment
- Active peptic ulcer
- High vitreous pressure
- Bleeding disorders or concomitant use of anticoagulants
Drug Interactions
- Anticoagulants (e.g., warfarin, heparin, clopidogrel): Increased risk of bleeding.
- Antibiotics (e.g., penicillin, chloramphenicol): Increased risk of gastrointestinal side effects.
- Herbal supplements: Potential for increased effects of some herbal supplements.
- Alcohol: Increased risk of side effects.
Pregnancy and Breastfeeding
Safety during pregnancy and breastfeeding has not been established. Avoid use unless the potential benefits outweigh the risks, as determined by a physician.
Drug Profile Summary
- Mechanism of Action: Proteolytic enzymes that break down proteins involved in inflammation.
- Side Effects: Nausea, vomiting, diarrhea, allergic reactions.
- Contraindications: Hypersensitivity, severe liver/kidney impairment, peptic ulcer, high vitreous pressure.
- Drug Interactions: Anticoagulants, antibiotics.
- Pregnancy & Breastfeeding: Avoid use unless benefits outweigh risks.
- Dosage: Variable, depending on the condition.
- Monitoring Parameters: Observe for signs of allergic reactions and gastrointestinal distress.
Popular Combinations
Trypsin-chymotrypsin is sometimes combined with aceclofenac and paracetamol for enhanced pain relief and anti-inflammatory effects.
Precautions
- Screen patients for allergies and relevant medical conditions.
- Monitor for signs of allergic reactions and gastrointestinal adverse effects.
- Caution advised in patients with hepatic/renal impairment, bleeding disorders, and those taking anticoagulants.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Trypsin Chymotrypsin?
A: The dosage varies depending on the condition and its severity. Adults may initially take two tablets three times a day, reducing to one tablet four times a day after improvement.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, abdominal pain, skin rash, and itching.
Q3: Is Trypsin Chymotrypsin safe during pregnancy?
A: Safety during pregnancy and breastfeeding has not been established. It’s best to avoid use unless a physician determines that the potential benefits outweigh the risks.
Q4: Can I take Trypsin Chymotrypsin with blood thinners?
A: Concurrent use with anticoagulants like warfarin, heparin, and clopidogrel should be avoided due to the increased risk of bleeding.
Q5: What conditions is Trypsin Chymotrypsin used to treat?
A: It’s used to reduce pain and swelling associated with various conditions, including post-surgical wounds, trauma, inflammation, and certain ocular and dental procedures.
Q6: Are there any drug interactions I should be aware of?
A: Yes, it can interact with anticoagulants and antibiotics, potentially increasing the risk of side effects. Inform your doctor about all medications you are taking.
Q7: How should Trypsin Chymotrypsin be taken?
A: Tablets should be swallowed whole with water, preferably on an empty stomach, approximately one to two hours before meals.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the time for your next dose. Do not double the dose to catch up.
Q9: What are the signs of an allergic reaction to Trypsin Chymotrypsin?
A: Watch for itching, shortness of breath, swelling of the lips or throat, and any signs of shock. Seek immediate medical attention if these occur.
Q10: How long does it take for Trypsin Chymotrypsin to work?
A: The onset of action is typically within half an hour.
