Serrapeptase (Serratiopeptidase)

Serratia E15 (originally) / fermentation-derived
Evidence Level
Limited
2 Clinical Trials
5 Documented Benefits
2/5 Evidence Score

Serrapeptase is a proteolytic enzyme originally isolated from bacteria that live in the silkworm gut (Serratia), and now produced by fermentation. It has been sold for decades in Japan and parts of Europe, in some countries as a prescription drug rather than a supplement. The human research cited on this page was done in people with a diagnosed problem: a 1990 placebo-controlled trial in ear, nose and throat inflammation, and a 2021 trial in people recovering from impacted wisdom tooth surgery. The claim that it breaks down damaged tissue while sparing healthy tissue comes from laboratory work, not from people. A bigger unresolved question sits underneath all of it: serrapeptase is a protein, and whether a useful amount survives stomach acid and gets absorbed intact is still genuinely disputed, which is why capsules are enteric coated.

Studied Dose Products typically supply 10 to 60 mg a day, most often 10 to 30 mg, labelled as 20,000 to 80,000 enzyme units. Unit systems differ between brands, so the same milligram is not the same activity.
Active Compound Serrapeptase (serratiopeptidase, serralysin-family metalloprotease).

Benefits

Sinusitis and Upper Respiratory Inflammation

The only trial cited here is a 1990 multicentre, double-blind, placebo-controlled study in people being treated for acute or chronic inflammation of the ear, nose and throat, where symptoms such as pain, secretion, blockage and swelling improved more with the enzyme than with placebo. That study is now 35 years old, was run in patients under medical care rather than healthy people, and has not been repeated in a modern large trial. Thinning mucus and breaking down inflammatory proteins is the proposed explanation, and it comes from laboratory work, not from anything measured in those patients.

Post-Surgical Edema and Pain

The evidence cited here is one randomized controlled trial from 2021 in adults having impacted wisdom teeth surgically removed, where the enzyme group had less swelling and pain after the operation. No orthopedic surgery trial is cited on this page. Recovering from oral surgery under dental care is a specific medical situation and does not tell you what the supplement does for everyday aches or puffiness in a healthy person.

Fibrocystic Breast Disease

This claim traces back to an older study in women with a diagnosed breast condition, but that study is not among the references on this page. It reaches the page second hand, through a 2017 review, and it has not been replicated. Breast pain or lumps are a reason to see a doctor for a proper diagnosis, not something to self-treat with a supplement.

Carpal Tunnel Symptoms (No Trial Cited Here)

A small study is sometimes quoted for this, but no such trial appears in this page's reference list, so treat it as unverified rather than as weak-but-real evidence. Carpal tunnel syndrome is a medical diagnosis, and it is managed with wrist splinting, medication, steroid injections or surgery. Serrapeptase is not a substitute for that care.

Arterial Plaque (Untested Marketing Theory)

The idea that serrapeptase dissolves arterial plaque is a marketing story built on what the enzyme does to proteins in a test tube. There is no study in people showing it changes plaque, heart attacks, strokes or any other heart outcome. Treat it as an untested theory, not as a reason to take the product for your heart.

Mechanism of action

1

Protein-Breaking Activity (Laboratory Finding)

In laboratory testing the enzyme breaks down proteins involved in inflammation and clotting, such as fibrin and bradykinin. The often repeated claim that it attacks only damaged tissue and leaves healthy tissue untouched comes from that lab work and from product marketing, not from anything measured in people taking capsules.

2

Bradykinin Reduction

Bradykinin is a major inflammatory mediator causing pain, edema, vasodilation. In the laboratory serrapeptase breaks bradykinin down, and that is the proposed explanation for the reduced swelling and pain seen in the ENT and dental surgery trials. Nobody has confirmed it by measuring bradykinin in people taking the supplement.

3

Mucolytic Activity

Laboratory studies show it can break apart the proteins that make airway mucus thick, which is the proposed reason it has been tried for congestion. None of the references on this page tested it in lung conditions such as bronchitis or COPD.

4

Stomach Acid, Enteric Coating and the Absorption Question

Serrapeptase is a protein, and stomach acid destroys proteins, which is why capsules are usually enteric coated to hold the enzyme until it reaches the intestine. The larger unsettled question is whether an intact enzyme of this size is then absorbed into the bloodstream in amounts that could do anything, and that has never been convincingly shown. It is the main reason to stay cautious about every claim on this page, and it is why a product without an enteric coating is unlikely to be worth taking at all.

Clinical trials

1
Serrapeptase for Chronic Sinusitis

Multicentre, double-blind, randomized trial versus placebo in people with acute or chronic inflammation of the ear, nose and throat, published in the Journal of International Medical Research in 1990.

193 patients being treated for acute or chronic ear, nose and throat inflammation.

Symptoms such as pain, secretion, blockage and swelling improved more with the enzyme than with placebo. The limits matter: this is a 1990 study in patients under medical care, no modern trial of similar size has repeated it, and it says nothing about what the supplement does for a healthy person.

2
Serrapeptase for Post-Surgical Edema

Randomized controlled trial of serratiopeptidase after surgical removal of impacted third molars (wisdom teeth), published in BMC Oral Health in 2021.

Adults having impacted wisdom teeth surgically removed.

Swelling and pain after the operation were lower in the serratiopeptidase group. This is a single trial in one narrow surgical setting, so it does not show that the supplement reduces everyday swelling or pain in healthy people.

Side effects and drug interactions

Common Potential side effects

GI distress (nausea, abdominal pain, diarrhea).
Possible bleeding risk: the enzyme acts on proteins involved in clotting, so stopping it well before any planned surgery is sensible.
Skin reactions, allergic reactions rare.
Lung inflammation (pneumonitis): rare but documented, with case reports of eosinophilic and interstitial pneumonia. This is the most serious harm reported with serrapeptase. Stop taking it and get medical help if you develop a new cough, breathlessness or fever.
Coughing up blood (rare).
Liver enzyme elevation (rare).
Japanese regulators withdrew approval for some medical uses after later, more rigorous trials failed to show a benefit. That is a strong reason to keep expectations modest.

Important Drug interactions

Anticoagulants (warfarin, DOACs) — theoretical bleeding risk; monitor.
Antiplatelet drugs (aspirin, clopidogrel) — additive bleeding risk.
NSAIDs — additive bleeding risk and additive anti-inflammatory effects.
Antibiotics: serrapeptase has long been promoted as helping antibiotics reach infected tissue, but none of the studies cited here tested that, so treat it as unproven.
Other proteolytic enzyme supplements (bromelain, papain, nattokinase) — additive effects; unclear clinical relevance.

Frequently asked questions about Serrapeptase (Serratiopeptidase)

What is serrapeptase?

Serrapeptase is a protein-digesting enzyme first found in bacteria living in the silkworm gut, and it is now made by fermentation. It is taken on an empty stomach and sold for easing swelling and thinning mucus. The human research cited here is limited to a 1990 trial in ear, nose and throat inflammation and a 2021 trial after wisdom tooth surgery, both in people with a medical problem.

What is serrapeptase used for?

It is used for proposed anti-inflammatory and mucus-thinning effects, such as supporting sinus and respiratory comfort and post-surgical swelling. The supporting research is mostly older or small, so claims should be viewed cautiously.

When should I take serrapeptase?

It is taken on an empty stomach, typically 30 minutes before or a couple of hours after meals, so it is not simply used up digesting a meal. Enteric-coated forms are meant to survive stomach acid, though how much of the intact enzyme actually reaches the bloodstream is still disputed.

Is serrapeptase safe?

Short-term use is usually tolerated, but long-term safety data are thin, and there are rare case reports of lung inflammation (pneumonitis) that required medical attention. It may have a blood-thinning effect, so avoid it with anticoagulants or before surgery, and check with your doctor before use.

What is the recommended dosage of Serrapeptase?

The clinically studied dose is Products typically supply 10 to 60 mg a day, most often 10 to 30 mg, labelled as 20,000 to 80,000 enzyme units. Unit systems differ between brands, so the same milligram is not the same activity. Always follow the product label and check with a healthcare provider for personal advice.

Is Serrapeptase safe, and does it have side effects?

For most healthy adults, Serrapeptase is well tolerated at studied doses. Reported effects can include: GI distress (nausea, abdominal pain, diarrhea). Possible bleeding risk: the enzyme acts on proteins involved in clotting, so stopping it well before any planned surgery is sensible. It may also interact with some medications. Serrapeptase is not right for everyone, so check with a healthcare provider first if you are pregnant or breastfeeding, have a medical condition, or take prescription medication.

Does Serrapeptase interact with any medications?

Possible interactions include: Anticoagulants (warfarin, DOACs) — theoretical bleeding risk; monitor. Antiplatelet drugs (aspirin, clopidogrel) — additive 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 clinical trials and 3 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(3 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 The Journal of International Medical Research. 1990;18(5):379-88. doi: 10.1177/030006059001800506.PubMedUsed to support: 1990 multicentre, double-blind randomized trial versus placebo in patients with acute or chronic ear, nose and throat inflammation. It is the only cited support for the ear, nose and throat benefit, it is 35 years old, and it was run in diagnosed patients rather than healthy users.
  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: Randomized controlled trial demonstrating serratiopeptidase reduced post-surgical swelling and pain following impacted third molar surgery; backs 'Post-Surgical Edema and Pain'.
  3. Tiwari M The role of serratiopeptidase in the resolution of inflammation Asian Journal of Pharmaceutical Sciences. 2017;12(3):209-215. doi: 10.1016/j.ajps.2017.01.003.PubMedUsed to support: A 2017 narrative review, not a new trial. It summarizes what other authors have reported about serratiopeptidase, including older breast and surgical work, so it cannot count as direct evidence for any of those uses. The original breast study it describes is not cited on this page.