Home Ingredients Serrapeptase (Serratiopeptidase)
Anti-Inflammatory

Serrapeptase (Serratiopeptidase)

Serratia sp. E-15 (fermentation-derived enzyme)
Evidence Level
Limited
2 Clinical Trials
2 Documented Benefits
2/5 Evidence Score

Serrapeptase (serratiopeptidase) is a protein-digesting enzyme first isolated from Serratia bacteria found in silkworms, and now made by fermentation. It has long been used in Japan and Europe as an anti-inflammatory medicine for swelling after surgery and for ear, nose and throat complaints; in the US it is sold as a dietary supplement. The human evidence is thin: one placebo-controlled trial in people with ear, nose or throat inflammation, and a few trials after wisdom tooth removal in which it eased swelling and jaw stiffness but not pain. A systematic review judged most of these studies to be of poor quality and found long-term safety data lacking. Little is known about how much active enzyme is absorbed from the gut, and rare cases of drug-induced lung inflammation have been reported.

Studied Dose A wisdom tooth surgery trial used 10 mg three times a day for 5 days. That trial's authors describe a usual adult dose of 10 mg three times a day (range 15 to 60 mg a day) and a recommended course of about 1 week.
Active Compound Serrapeptase (serratiopeptidase, serralysin-family metalloprotease).

Benefits

Ear, nose and throat swelling and discomfort

In a multicentre, double-blind trial of 193 people with acute or chronic ear, nose or throat disorders, two tablets three times a day for 7 to 8 days eased the symptoms measured faster and more than placebo, with similar tolerability. It is one older trial in people under medical care, and its summary does not give the tablet strength.

Supported by Trial 1

Swelling and jaw stiffness after wisdom tooth removal

In a placebo-controlled trial of 133 adults after impacted wisdom tooth surgery, 10 mg three times a day for 5 days, taken with paracetamol, gave wider mouth opening and about 2 to 3 mm less swelling on a jaw-line measure on days 4 and 5, but pain did not differ. A drug company funded the trial. A review pooling five small trials also reported less jaw stiffness.

Supported by Trial 2

Mechanism of action

1

Protein breakdown in inflamed tissue (laboratory finding)

In laboratory and animal work the enzyme breaks down fibrin and other proteins in inflammatory fluid and reduces the leakiness of small blood vessels caused by bradykinin, histamine and serotonin. These effects have not been measured directly in people taking it by mouth.

2

Absorption from the gut

Serrapeptase is a large protein. A review describes it as absorbed from the digestive tract, but less is known about how much active enzyme crosses the gut wall in people.

Clinical trials

1
Serrapeptase for Ear, Nose and Throat Inflammation
PubMed

Multicentre, double-blind, randomized, placebo-controlled trial; two tablets three times a day for 7 to 8 days. (Mazzone et al. 1990, J Int Med Res)

193 people with acute or chronic ear, nose or throat disorders.

Symptoms improved faster and more with the enzyme than with placebo at days 3 to 4 and 7 to 8, and tolerability was similar. The abstract does not give the tablet strength.

2
Serrapeptase After Wisdom Tooth Surgery
PubMed

Single-centre, double-blind, randomized, placebo-controlled trial; 10 mg three times a day for 5 days, both groups also taking paracetamol. Funded by Hayat Pharmaceutical Company. (Tamimi et al. 2021, BMC Oral Health)

133 adults (mean age 23) who completed the study after surgical removal of an impacted lower wisdom tooth.

Mouth opening was wider on days 4 and 5 (32.1 vs 27.3 mm on day 4). A jaw-line swelling measure rose about 2 mm less on day 4 (2.9 vs 5.0 mm) and about 3 mm less on day 5 (0.9 vs 3.7 mm) than with placebo. Pain scores did not differ, and no side effects were recorded.

Side effects and drug interactions

Common Potential side effects

Lung inflammation (pneumonitis): rare case reports describe drug-induced pneumonitis and eosinophilic pneumonia, one with coughing up blood; both people improved after the enzyme was stopped, one with steroid treatment. Stop taking it and get medical help if a new cough, breathlessness or fever develops.
Long-term safety has not been studied well; a systematic review found safety and tolerability data lacking.
Possible bleeding risk: the enzyme breaks down fibrin, a clotting protein, so stopping it before planned surgery is sensible.

Important Drug interactions

Anticoagulants (warfarin, DOACs): theoretical added bleeding risk because of its fibrin-dissolving activity; ask your doctor before combining.
Antiplatelet drugs (aspirin, clopidogrel): theoretical added bleeding risk.
NSAIDs: possible added bleeding risk.
Antibiotics: a review reports that it can enhance the activity of some antibiotics; whether this matters for people taking it as a supplement is not known.
Other protein-digesting enzyme supplements (bromelain, papain, nattokinase): overlapping effects; clinical relevance unclear.

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Frequently asked questions about Serrapeptase (Serratiopeptidase)

What is serrapeptase?

Serrapeptase is a protein-digesting enzyme first found in Serratia bacteria from silkworms and now made by fermentation. It is sold for easing swelling. The human trials are few and small, mostly in people with ear, nose and throat problems or after wisdom tooth surgery.

What does the research show?

One placebo-controlled trial found faster relief of ear, nose and throat symptoms, and trials after wisdom tooth removal found less swelling and jaw stiffness but no less pain. A systematic review rated most serrapeptase studies as poor quality.

Does serrapeptase clear arterial plaque?

No study in people has shown that. The idea comes from its protein-digesting activity in the laboratory. A systematic review concluded that the evidence does not support its use as a health supplement for heart health.

Is serrapeptase safe?

Short courses were well tolerated in trials, but long-term safety data are lacking, and rare cases of lung inflammation have been reported. Because it breaks down a clotting protein, check with your doctor if you take blood thinners or have surgery planned.

What is Serrapeptase used for?

Serrapeptase is researched primarily for Anti-Inflammatory. In a multicentre, double-blind trial of 193 people with acute or chronic ear, nose or throat disorders, two tablets three times a day for 7 to 8 days eased the symptoms measured faster and more than placebo, with similar tolerability.

What is the recommended dosage of Serrapeptase?

The clinically studied dose is A wisdom tooth surgery trial used 10 mg three times a day for 5 days. That trial's authors describe a usual adult dose of 10 mg three times a day (range 15 to 60 mg a day) and a recommended course of about 1 week. Always follow the product label and check with a healthcare provider for personal advice.

Does Serrapeptase interact with any medications?

Possible interactions include: Anticoagulants (warfarin, DOACs): theoretical added bleeding risk because of its fibrin-dissolving activity; ask your doctor before combining. Antiplatelet drugs (aspirin, clopidogrel): theoretical added bleeding risk. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Serrapeptase?

NutraSmarts rates the evidence for Serrapeptase as Limited (2 out of 5). It is backed by 2 study summaries and 7 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(7 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. Mazzone A, Catalani M, Costanzo M, Drusian A, Mandoli A, Russo S, Guarini E, Vesperini G. Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo. J Int Med Res. 1990;18(5):379-88. doi: 10.1177/030006059001800506.PubMedUsed to support: Multicentre, double-blind, randomized, placebo-controlled trial in 193 people with acute or chronic ear, nose or throat disorders. Two tablets three times a day for 7 to 8 days reduced symptoms faster and more than placebo, with similar tolerability.
  2. Tamimi Z, Al Habashneh R, Hamad I, Al-Ghazawi M, Roqa'a AA, Kharashgeh H. Efficacy of serratiopeptidase after impacted third molar surgery: a randomized controlled clinical trial. BMC Oral Health. 2021;21(1):91. doi: 10.1186/s12903-021-01451-0.PubMedUsed to support: Double-blind, placebo-controlled trial in 133 adults after impacted lower wisdom tooth surgery. 10 mg three times a day for 5 days with paracetamol gave wider mouth opening and a smaller rise in facial swelling on days 4 and 5; pain did not differ. Funded by Hayat Pharmaceutical Company.
  3. Sivaramakrishnan G, Sridharan K. Role of Serratiopeptidase After Surgical Removal of Impacted Molar: A Systematic Review and Meta-analysis. J Maxillofac Oral Surg. 2018;17(2):122-128. doi: 10.1007/s12663-017-0996-9.PubMedUsed to support: Systematic review and meta-analysis of five randomized trials after impacted molar removal. Serratiopeptidase improved jaw stiffness (trismus) more than corticosteroids, with no difference in swelling versus corticosteroids; too few studies for other comparisons.
  4. Bhagat S, Agarwal M, Roy V. Serratiopeptidase: a systematic review of the existing evidence. Int J Surg. 2013;11(3):209-17. doi: 10.1016/j.ijsu.2013.01.010.PubMedUsed to support: Systematic review of 24 clinical studies. The evidence for serratiopeptidase as an anti-inflammatory and pain reliever comes from studies of poor methodology, the evidence is insufficient to support its use as an analgesic or health supplement, and long-term safety data are lacking.
  5. Tiwari M. The role of serratiopeptidase in the resolution of inflammation. Asian J Pharm Sci. 2017;12(3):209-215. doi: 10.1016/j.ajps.2017.01.003.PubMedUsed to support: Narrative review describing serratiopeptidase as an enzyme from Serratia E15 found in silkworms, its proposed actions in inflamed tissue (reduced vessel leakiness caused by bradykinin, histamine and serotonin; breakdown of exudate proteins), and its use in Japan and Europe. Not new trial evidence.
  6. Sasaki S, Kawanami R, Motizuki Y, Nakahara Y, Kawamura T, Tanaka A, Watanabe S. [Serrapeptase-induced lung injury manifesting as acute eosiniphilic pneumonia]. Nihon Kokyuki Gakkai Zasshi. 2000;38(7):540-4..PubMedUsed to support: Case report: an 84-year-old man who had taken serrapeptase for 3 months developed fever, cough, coughing up blood and acute eosinophilic pneumonia; a lymphocyte stimulation test was positive for serrapeptase and he recovered with corticosteroids.
  7. Hirahara K, Saitoh T, Terada I, Uno K, Nagai A, Kioi S, Arakawa M. [A case of pneumonitis due to serrapeptase]. Nihon Kyobu Shikkan Gakkai Zasshi. 1989;27(10):1231-6..PubMedUsed to support: Case report: a 69-year-old man developed interstitial pneumonitis after 16 days of serrapeptase; symptoms and chest X-ray improved markedly once the enzyme was stopped.