10–60 mg/day on an empty stomach.
It is used for inflammation and post-surgical pain, but the evidence is scarce and of low methodological quality.
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Serrapeptase is a proteolytic enzyme originally produced by the bacterium Serratia marcescens E15, discovered in the 1970s in the intestine of the silkworm (Bombyx mori), where it takes part in dissolving the cocoon during metamorphosis; initially marketed as a medicine in Japan and several European countries for inflammatory conditions, postoperative edema, and respiratory problems with thick mucus, it moved in many markets (including Spain) into the supplement channel when it lost its pharmaceutical regulatory status, maintaining a moderate clinical-use profile supported by several small trials, mainly Japanese and European, from the 1980s and 1990s.
The proposed mechanism of action combines direct hydrolysis of fibrin and other structural proteins (fibrinolytic and anti-edema effect), reduction of inflammatory mediators (bradykinin), and reduction of the viscosity of bronchial and nasal secretions (mucolytic effect); commercial products come in capsules with an essential enteric coating so that the enzyme is not inactivated in the acidic gastric environment and reaches the small intestine, where it is absorbed.
Several small trials published in the 1970s and 1980s documented significant reductions in postoperative edema, acute inflammatory pain, and the duration of localized inflammatory processes with doses of 10-30 milligrams daily for 5-15 days; in acute and chronic sinusitis, serrapeptase has shown reductions in nasal mucus viscosity and symptomatic improvements in European studies.
In chronic bronchitis with thick secretions and in other respiratory conditions with difficult expectoration, serrapeptase acts as a mucolytic by fragmenting the proteins that give mucus its viscosity; the clinical data are limited but consistent with this traditional indication and with the enzymatic mechanism documented in vitro.
The doses studied range from 10 to 60 milligrams daily (measured in enzyme units, typically 20,000-120,000 IU/day), split into two or three doses on an empty stomach (at least 30 minutes before or 2 hours after meals) to maximize absorption; the enteric coating is essential to preserve enzymatic activity until the small intestine.
Generally well tolerated in short courses; the adverse effects described are rare and mild (digestive discomfort, occasionally skin rash); the most relevant clinical consideration is the sporadic reports of eosinophilic pneumonitis and pulmonary hypersensitivity reactions associated with prolonged use, enough to justify caution and limit the duration to short courses; people taking anticoagulants should be cautious because of a theoretical fibrinolytic effect that could increase bleeding risk; in pregnancy and breastfeeding the data are limited and avoidance is advised as a precaution; modern clinical evidence with rigorous methodology is modest, and many commercial products have lower enzymatic activity than declared because of degradation during storage, an important variability when choosing products from manufacturers with a good reputation for quality control.
Information, not medical advice. Scientific evidence reflects the quality of the studies.