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Q. What is the conversion of 10 mg of serrapeptase to international units?
   A. As far as I can tell, 10 mg is equivalent to about 20,000 iu... but I am not 100 percent certain yet, it seems there is no major consensus yet on this dosing equivalency.

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Comment and review
Serrapeptase has some clinical potential, however much more research is needed before we determine what clinical role this enzyme has in medicine. In the meantime, only use it under medical supervision until more studies determine the full spectrum of side effects and benefits.

Medical conditions where serrapeptase has been studied
Chronic airway lung disease
Chronic ear, nose or throat disorders
Carpal tunnel syndrome
Jaw pain and swelling after dental surgery
Certain cases of edema after an operation or injury.

Review article - Int J Surgery. 2013. Serratiopeptidase: a systematic review of the existing evidence.
Serratiopeptidase is being used in many clinical specialties for its anti-inflammatory, anti-edemic and analgesic effects. It is even being promoted as a health supplement to prevent cardiovascular morbidity. The existing scientific evidence is insufficient to support its use as an analgesic and health supplement. The data on long-term safety of this enzyme is lacking. Evidence based recommendations on the analgesic, anti-atherosclerotic efficacy, safety and tolerability are needed.

Serrapeptase side effects - caution, safety, risk, danger, reports from users, adverse effects
A review of the medical literature indicates rare cases of pneumonitis or allergic skin reactions. As with any supplement or medicine, rare cases of other side effects are possible. Over the past severeal years we have had individuals who have mentioned side effects, some were minor aches and pains after taking it daily for a few weeks and some more serious reactions. We suggest limiting to one tablet or capsule a day and taking at least 2 or three days off each week until we find out whether these cases were just coincidence or true side effects from serrapeptase. Have approval by your doctor before use.

Q. I just received my order and was wondering if this natural enzyme is something you take every day, or for a certain amount of time and take some time off and then take again. I am just concerned about toxic effects from serrapeptase taking everyday?
   A. Since little human research is available in the West, it is preferable to take breaks from use until we learn more about the full clinical effects. At this time we don't have full knowledge of potential serrapeptase allergic reactions, side effects, cautions or dangers, and how it interacts with medicines and other supplements. We also don't have a full understanding of which medical conditions it is most effective for.

Testimonials regarding adverse reactions
I ordered a bottle of serrapeptase enzyme for the purpose of removing plaque from my coronary arteries. After taking one serrapeptase tablet on an empty stomach, eight hours later I experienced stomach upset and nausea which lasted for nearly 24 hours. Since this nausea could have been caused by something else, I waited a couple days before taking another pill.  The results were the same. My nausea was so bad that I was unable to eat my usual lunch.
    A. This is the first report we have had of nausea and gastrointestinal symptoms associated with this enzyme.

Cough
After taking serrapeptase for approx. one week I developed a very disturbing deep and unusual cough while attending my college alumni homecoming weekend. The cough seriously irritated my lungs and bronchial tubes, and was uncomfortable enough that I left the campus a day earlier than planned. I had no other related symptoms of any kind, and I am not a smoker. I started investigating online to see and found research that said that an unusual form of pneumonia could develop in elderly users. I am in my middle 70's. Since after a week to 10 days after stopping the pills, the cough slowly disappeared without any discernible after-effects.

My wife has rheumatiod arthritis. She has recently started taking 2 80,000 iu serrapeptase pills. She has severe side affects to methotrexate and salazopyrin is now ineffective, though she still takes a low dose. She has developed a mild, catchy dry cough over the last week since she started the serrapeptase, though symptoms of the disease seems to be starting to ease off a little. Is this a cause for concern, or could the cough be put down to a temporary bug? She has been taking this supplement for about a week.
   A. We have had other users report cough symptoms. 

Diarrhea and vomiting
I have lymphedema; my right arm is larger than my left. Serrapeptase is listed as a remedy on some web sites. The first time I got dry heaves and terrible diarrhea. Not realizing it was the med, I took it again and got dry heaves and diarrhea again. Still, nobody could believe such a side effect. Yes, I stupidly took it a third time. Now, there is no doubt that I cannot take serrapeptase. Within half an hour I was vomiting.

I tried serrapeptase last night at a 40,000U dose. Nausea and vomiting this morning (nothing in stomach). Last time I took this was over a month ago, and I did not have the nausea and vomiting initially, but I did develop it after about 7 days of use. Recently diagnosed with IPF. Father died from idiopathic pulmonary fibrosis.

Pain and aches
One MD prescribed a low dose of prednisone (15 mg) for a several weeks for a diagnosis of polymyalgia rheumatica. My shoulders, and hips ached and especially after doing some light exercise. Because of the side effects of prednisone I read about (suppressed immune system), I contacted an alternative health care person who prescribed 6 caps containing 120,000 units of enzymatic activity. The third night I had dull aching pain in my hips, lower back and knees along with extreme fatigue. I quit taking it on the fourth day and am feeling a little better. It appears from your recommended dose of 20,000 that I was taking too high a dose and my body couldn't tolerate it.

I started taking 40,000 units serrapeptase twice daily to clean my arteries. After 3 weeks I noticed that my veins looked abnormal when I took a pill, but I thought it was just something temporary. One morning I woke up with a slight painful feeling in my right ankle. When I stood up I had a strange sensation in both of my legs, I could not really stand or walk, and my veins looked extremely large when I was standing. I stopped taking serrapeptase that morning, and since my condition did not improve for two days, I went to a vein doctor who examined me and said that I have varicose vein. I also see spider veins in the area under my ankles.

I have a really weak immune system and took 160,000 iu of serrapetase in one day. The idiot that sold the stuff to me said to follow the instructions on the bottle, 80,000 3 times a day! I took the first pill and nothing happened.. but when I took the second I felt like I was going to die, my chest tightened, I couldn't breath and felt so weak, I could hardly walk.

Q. I have had a chat with my doctor. He said the risk with using this enzyme is that when it breaks up arterial plaque into smaller bits, then the loosen plague can make it's way into smaller arteries and cause blockages. He also mentioned that if these smaller pieces end up moving into your brain then it can potentially cause a stroke. Please indicate if you are of a different opinion? I am really keen on using this product as a preventative measure, but obviously not at the risk of causing problems elsewhere.
   A. I am not aware of any studies that have shown these medical problems to occur and I would be interested in reviewing such studies if your doctor can provide the references.

Q. I was taking serrapeptase on an empty stomach successfully for 3 months. It gave me surprising relief from inflammation-related pain (overuse injuries). Upon switching brands, it began to cause nausea and vomiting, up to 8 hours after taking it. I took a break for a couple of weeks, switched back to my previous brand, but after a week of taking it with no side effects, the vomiting began again. Apparently I have developed a sensitivity for this product? I cannot find any reference to this on the internet and am wondering if you have any information? I had been recommending serrapeptase to my friends, but now I am wondering if it is perhaps a dangerous product.
   A. Perhaps the dosage needed is less than you require, and perhaps it is a good idea to not take it every day or to take 2 days off a week. Another option is to try it with a little bit of food in the stomach.

Q. As a few others have noted, I also stopped taking serrapeptase due to joint and muscle pain that made it painful to walk, move my arms....don't know how long it will take to completely eliminate it from my system.

Q. Have heard good things about the use of serrapeptase for reducing inflammatory conditions in the body for various chronic conditions, for everything from arthritis to cancer. Should one stop using such a supplement before surgical or dental procedures and if so how far in advance. Since this is a proteolytic enzyme should one be careful about taking it with other digestive enzymes or blood thinners?
   A.  It would be prudent to stop its use a week or so before surgery. Its interactions with other enzymes and blood thinners are not fully understood yet.

Q. I am a medical resident and have read your post about serrapeptase and there were several questions and comments about dosages. It is clear that many are taking dosages that are way too high and as such are causing some side effects, mainly muscle and joint pain. Let me remind you that one of or maybe the western medical pioneer of that enzyme Dr. Hans Nieper, used usually a dosage of 3 x 5mg per day. Beats the hell out of me how we in north America wound up with tablets of 10 to 15 times that dosage.

Q. Is it safe to take SerraGold if your on Coumadin warfarin? SerraGold contains high-potency Serrapeptase combined with a blend of proteolytic enzymes.
   A. I would not suggest combining SerraGold with Coumadin since the risk of bleeding has not been well studied with the combination.

Q. I just finished reading your readers' comments about their personal experiences with taking serrapeptase and want to add mine. Thank you for posting your collection of reader comments (and your cautionary statement); without them I would not been made aware of the enzyme's possible side effects, such as joint pain. This different viewpoint has caused me to consider modifying my dosage schedule with this enzyme. I have been taking 240, 000 CPU (Arthur Andrew Medical) every 6 hours since my bout of cellulitis (over 2 months ago). I took it with a prescribed antibiotic (not at the same time, but on a staggered schedule, and always on empty stomach) to facilitate the action of the antibiotic. The thinking behind this method was that the enzyme would break down the infecting bacteria's outer membrane, or "biofilm," allowing the antibiotic to more easily block the bacteria's action. Because of my diagnosed paroxysmal atrial fibrillation, I continued to take the enzyme at the same rate to protect myself from the ever present threat of cardiovascular events due to this condition, such as stroke. I am also taking another enzyme, nattokinase, on a different schedule (every 12 hours) for this cardiovascular protection - very important to me, since I have declined to take prescribed blood thinners with their many known side effects.Regarding your readers' comments, I take them with a grain of salt, because, though I value the compelling circumstantial evidence they offer, their statements cannot be considered as strong as those from scientific studies; users' feedback usually do not take into consideration all of the complicating factors (general health, dietary habits, lifestyle, use of probiotics and prebiotics, concurrent morbidities, medical histories, etc) that could be acting behind reported symptoms. As far as I know no studies (RCTs) have shown serrapeptase to have adverse effects. There is an ongoing study of nattokinase, in its last phases, but I have not yet noticed any published conclusions. Regarding the "joint pain" mentioned above, for the last month I have persistent should and arm pain that I had thought was precipitated by over-vigorous exercise using my arms. I had been practicing Dr. Joseph Mercola's NO Dump exercise that he has published as an online video, in which he personally demonstrates. I suspect that the NO Dump exercise aggravated my shoulder joints leading to inflammation and soreness. The symptoms may have been magnified by my existing cervical spondylosis that I speculate involve some kind of little known, or possibly unknown, interaction between cervical nerve roots and their corresponding dermatomes in my shoulder. However, your reader reports of joint pain associated with taking serrapeptase has prompted me to try reducing my serrapeptase dosage rate to see if I get a reduction of my shoulder pain.

Vomiting side effect, acid reflux?
I read with interest your page about serrapeptase benefits and side effects. I have Lyme Disease and some co-infections and my naturopathic doctor put me on a high dose of this to break up bacterial biofilms --120,000spu, twice a day (I take Doctor's Best). He wanted me to take 500 mg (Nutrimedix, I believe). WebMD uses mg also for measure. I think the serrapeptase may have improved my chronic cough of 12 years, but I started noticing lightheadedness and increasing acid reflux until I woke up in the middle of the night, with vomiting that felt like acid and mucous coming up. I checked several of my supplements and managed to find your site, which I found very helpful, since I could find no official side effects. I went off the product and the acid reflux is improving. I may use a lower dose. Thought I'd add to your information.

Serrapeptase dosage, amount to take
This natural enzyme is a relatively new supplements compared to vitamins A, B, C etc. The long term benefits and side effects are not yet fully understood. I prefer being cautious and erring on the side of taking less rather than more until several more years pass and I have a clearer understanding of the benefits and risks.

Benefits of Serrapetase

Alzheimer's disease
Hum Exp Toxicol. 2013. Serrapeptase and nattokinase intervention for relieving Alzheimer's disease pathophysiology in rat model. These enzymes may have a therapeutic application in the treatment of AD.

Carpal tunnel syndrome
A preliminary trial of serratiopeptidase in patients with carpal tunnel syndrome.
J Assoc Physicians India. 1999.
Twenty patients with carpal tunnel syndrome were evaluated clinically. After baseline electrophysiological studies, these patients were given serrapeptase 10 mg twice daily with initial short course of nimesulide. Clinical and electrophysiological reassessment was done after 6 weeks. Sixty five percent of serrapeptase cases showed significant clinical improvement which was supported by improvement in electrophysiological parameters. Recurrence was reported in four cases. Serrapeptase therapy may proved to be a useful alternative mode of conservative treatment. Larger study may be further helpful to establish the role of serrapeptase in carpal tunnel syndrome. Serratiopeptidase therapy showed no significant side effects.

Chronic lung disease and mucus
Effect of the proteolytic enzyme serrapeptase in patients with chronic airway disease.
Respirology. 2003.
We investigated the effect of 30 mg/day on sputum properties and symptoms in patients with chronic airway diseases. After 4 weeks of treatment, sputum weight in the morning, percentage solid component, viscosity and elasticity of sputum, sputum neutrophil count, frequency of coughing and frequency of expectoration significantly decreased.

Jaw pain and swelling after dental surgery
Effect of the proteolytic enzyme serrapeptase on swelling, pain and trismus after surgical extraction of mandibular third molars.
Int J Oral Maxillofac Surg. 2008.
Twenty-four healthy individuals with symmetrically impacted mandibular third molars underwent surgical removal in a prospective, intra-individual, randomized, double-blind, cross-over study. Teeth were removed in 2 sessions by the same surgeon. At each session, one third molar was removed under local anaesthesia via a buccal osteotomy. All patients received a combination of either serrapeptase 5mg or placebo tablets and 1000 mg paracetamol tablets at either the 1st or 2nd operation in accordance with the randomization plan. There was a significant reduction in the extent of cheek swelling and pain intensity in the serrapeptase group at the 2nd, 3rd and 7th postoperative days, but no significant difference in mean maximal interincisal distance was found between the 2 groups.

J Clin Exp Dent. 2015. Comparison of clinical efficacy of methylprednisolone and serratiopeptidase for reduction of postoperative sequelae after lower third molar surgery. Surgical removal of mandibular third molars results in some degree of post-operative pain, swelling and trismus. These can be controlled by proper administration of local anesthesia, careful bone removal, minimal trauma to adjacent soft tissues and administration of methylprednisolone and serratiopeptidase drugs. The aim of the present study was to compare the efficacy of methylprednisolone and serrapeptase in controlling post-operative pain, swelling and trismus after surgical removal of impacted mandibular third molars. We conclude that methylprednisolone affords better pain relief while serrapeptase exerts better anti-inflammatory and anti-swelling effects in the post-operative period. Synergistic combinations of these two drugs would however prove to be more effective when extensive post-operative sequelae are expected. Key words: Methylprednisolone, serratiopeptidase, pain, swelling, trismus, third molar.

Serrapeptase or serratiopeptidase research study
Intestinal absorption of serrapeptase in rats.
Biotechnol Appl Biochem. 1994.
Serrapeptase in the plasma was determined after its oral administration (100 mg/kg) to rats. The peak concentration was observed between 30 min and 2 h after administration. These results indicate that orally administered serrapeptase was absorbed from the intestinal tract and transferred into the circulation in an enzymically active form.

Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo.
University of Naples, Italy.
J Int Med Res. 1990.
The efficacy and tolerability of serrapeptase were evaluated in 193 subjects suffering from acute or chronic ear, nose or throat disorders. After 4 days' treatment significant symptom regression was observed in treated patients. There was also a significant reduction in symptoms after 8 days for patients in both treatment groups but the response was more marked in those patients receiving the active drug. It is concluded that serrapeptase has anti-inflammatory, anti-edemic and fibrinolytic activity and acts rapidly on localized inflammation.

A case of pneumonitis due to serrapeptase
Nihon Kyobu Shikkan Gakkai Zasshi. 1989.
A 69-year-old man was treated with serrapeptase for 16 days because of common cold, then fever, nonproductive cough and dyspnea developed and chest X-ray revealed diffuse fine granular shadows in bilateral lung fields. Once the administration was halted, symptoms, chest X-ray abnormalities and laboratory data improved markedly. Microscopic examination of transbronchial lung biopsy showed interstitial pneumonia. Both leukocyte migration inhibition test and sensitized hemagglutination test were positive for serrapeptase.

The treatment of breast engorgement with Serrapeptase (Danzen): a randomised double-blind controlled trial.
Singapore Med J. 1989.
We evaluated an anti-inflammatory enzyme drug Danzen ( Takeda Chemical Industries ) on 70 patients complaining of breast engorgement. Serrapeptase was noted to be superior to placebo for improvement of breast pain, breast swelling and induration and while 85% of the patients receiving serrapeptase had "Moderate to Marked" improvement, only 60% of the patients receiving placebo had a similar degree of improvement.

A case of serratiopeptidase-induced subepidermal bullous dermatosis.
Br J Dermatol. 1999.

Reduction of postoperative swelling. Objective measurement of swelling of the upper ankle joint in treatment with serrapeptase -- a prospective study
Fortschr Med. 1989.
Using a quantitative standardized procedure, the swelling of the ankle produced by supination trauma was measured. In the 66 patients with fresh rupture of the lateral ligament treated surgically at our Department between December 1986 and April 1987, a prospective study of the effect of serrapeptase (Aniflazym) on post-operative swelling and pain was carried out in 3 randomized groups of patients. In the group receiving serrapeptase, the swelling had decreased by 50% on the third post-operative day, while in the other two control groups (elevation of the leg, bed rest, with and without the application of ice) no reduction in swelling had occurred at that time. Decreasing pain correlated for the most part with the reduction in swelling. Thus, the patients receiving the test substance more rapidly became pain-free than did the control groups. On the basis of these results, serrapeptase would appear to be an effective preparation for the post-operative reduction of swelling, in comparison with the classical conservative measures, for example, the application of ice.

The effect of an orally administered proteolytic enzyme on the elasticity and viscosity of nasal mucus.
Arch Otorhinolaryngology. 1988.
We have evaluated the effect of serrapeptase on the elasticity and viscosity of the nasal mucus in adult patients with chronic sinusitis. It was administered in a dose of 30 mg/day orally for 4 weeks. Nasal mucus was collected from the nasal cavities of each patient before and 4 weeks after the start of the medication. Serrapeptase reduced the viscosity but not the elasticity of the nasal mucus.

Testimonial by email
I have started taking this enzyme after having it recommended by a chiropractor friend. I have had type 1 diabetes for over 22 years, have macular edema and also a heart rhythm abnormality for which I have been treated with a synchronising pace-maker. I thought you might be interested I my experience. I initially started using 80,000 unit tablets one a day. I upped this to 3 times a day and found this too much as it made me feel weak and breathless. I have now reduced this back to one a day but I think I may get weaker tabs and split the dose. Anyway, what I thought might be of interest is that within a few days of starting the treatment, I am finding my sight improving. Mostly this relates to improvement in colour perception but my floaters also seem less pronounced and some of the fading is reducing. I still have macular distortion but hopefully this might improve too with time.

I never thought that pain in my joints was being caused by taking sarrapeptase. But I did want to put my two cents in on this subject. I did not have joint pain before taking Sarrapeptase. And I don't have any joint pain now. I had taken them before and stopped because it was causing me to cough. Both that time and this time it appears to thin the mucus so much it causes it to run down my throat into my lungs hence the cough. But I started taking it again for repeated boils in my left armpit. It went to work immediately. I felt tingling in the boil. Over night it went from a quarter size to a nickel size two days later a pea size. Then gone completely. I did have pain in my finger joints one knee and one hip. Yes it was painful to walk and use my hands. But I didn't think it was caused by the serrapeptase. Anyway I kept taking 40,000 two times a day and the pain eventually went away. I believe there was an issue with those joints and the Sarrapeptase was dealing with it. I also believe that when the serrapeptase has finished it work in your body removing everything unnatural in the body it collects in the mucus for disposal and unfortunately cause lung issues. So I'm done with my body maintenance and the serrapeptase goes back up on the self until I need it again. The first time I took Sarrapeptase I was taking 120,000 and it also along with the cough caused skin discoloration on my for arms which went away with time. I do believe that the lower dosage the better. All in all this is an amazing enzyme. That I will use when needed for ever.

Emails and questions
Q. Can serrapeptase cause adverse reactions when taking meds for high blood pressure such as Norvasc and Avapro? Because my mom takes those and they really afflict her badly. And what is the ideal serrapeptase dosage for me to take for chronic sinusitis. I've had that all my life. I need relief and not drugs.
   A. Serrapeptase has been used in Japan but very little in the US so we really don't know much about the ideal dosage or what conditions it is likely to benefit, or how it interacts with medicines.

Q. My father has found benefit using serrapeptase for his leg claudication. He can now walk twice as far, but still not much, about 400m, but he is 81! I wonder if serrapeptase breaking down plaque. Does it reduce blood pressure?
   A. I am still not sure how much of an influence it has on blood pressure.

Q. I began taking Serrapeptase, 30,000 IU from a company other than Physician Formulas, one a day, approximately 2.5 months ago. I am taking no prescription drugs, but am taking various vitamin and herbal supplements. There were no apparent side effects but nor did I notice any noticeable change in my general wellbeing. My brief history: I have been diagnosed with GERD which had its onset 3 years ago after a 2-day bout with food poisoning. Because I did not want to remain on Nexium 40 mg/day for the rest of my life, I changed my diet and began researching vitamin and herbal supplements to replace the foods I could no longer tolerate. The only other conditions I had/have were:
Very mild elevated B/P - corrected
Very mild hypothyroid - supplemented with Thyroforce
Very mild elevated cholesteol - treated with increase in exercise and barely any fat in diet.
Mild osteoarthritis which, like the GERD, flares up and wanes with changes in the weather. Flares not only result in more GERD symptoms but, when severe, feel like flu - achy all over.
     I added the serrapeptase supplement because local promotions said it would improve digestion, clean plaque out of arteries, etc. Although I did not make any association at first, for the past month or so I began to have increasing pain in leg muscles and knee / ankle joints. Muscles became really tight and this progressed to the point where I could hardly walk and stairs were almost impossible. Spider veins worsened in number. I had physiotherapy which did not afford much improvement and the only thing that helped was a hot shower and massage with A535 liniment. I could not figure out what was going on until I sat down and made notes about chronology. What was startling was that symptoms began to improve dramatically during the past three days, which coincided with the fact that I had run out of serrapeptase and had not been able to go to my usual natural nutrition store for a new supply. Working back the chronology, there it was - the problem had commenced shortly after starting the serrapeptase. I have looked at the data available online and there seems to be no reference to similar side effects....so it's over to you. Is this possible? Obviously, there are other things I could mention, but I don't want to make this any longer than it is already. If you could throw any light on this situation, it would be much appreciated.
   A. Thank you for your email, it is quite interesting. This is the first report we have had regarding a possible link to these kinds of symptoms. It is difficult to say whether they are related or coincidence, but it is certainly should no be discounted. Serrapeptase has not been used in this country for prolonged periods and hence we do not know the short term and longer term serrapeptase side effects as well as we do for other vitamins and herbs. As a rule, we often recommend taking breaks from supplements, and this is one of the reasons we do so. Perhaps the dosage of the serrapeptase was too high for you, the serrapeptase that Physician Formulas sells is 20,000 units. Or perhaps it interacted negatively with the other herbs or supplements you are taking, or perhaps this particular serrapeptase product was contaminated with a toxin. You may wish to contact the manufacturer directly. Please keep us updated.

Follow Up Serrapeptase side effect ?
     Q. it has been many weeks since we discussed my experience with side effects possibly due to my use of serrapeptase, discontinued at the time I first wrote to you. Eight days ago, I restarted the product taking a single, 30,000 IU capsule of serrapeptase. This time, because I am prone to very early waking, I used that to good effect by taking the capsule on waking and then nothing else for at least an hour. I did that following receipt of the results of my annual check-up - all clear as a bell - BP, ECG, Thyroid, cholesterol, BUN, glucose all within normal limits, although BP is higher at age 71 than it was when I was in my fifties. The three 'conditions' that remain symptomatic are the intermittent episodes of right-sided cramping pain which present like gallstones - not confirmed on ultrasound and blood tests. The other two are GERD - which I now keep under control with diet, Tums and the occasional Pariet - and osteoarthritis, which is painful or not largely in response to the weather and which is deforming some finger-joints and causing pain and 'catching' in the left knee. For the first few days, I had no adverse side-effects at all. Then, with gradually-increasing intensity, I began to experience increased swelling and discomfort in most joints - hands, knees and feet. Walking became extremely uncomfortable, just as it did previously. In short, the condition I most hoped to improve appears to be worsened by taking the product. I have not taken serrapeptase this morning and, unfortunately, it looks as though I'm out of luck in the future. That's really too bad, as it sounded so promising.

Q. I tried serrapeptase swallowed as a pill and did not notice much effect on me. Then I tried it under the tongue, and so far I have very good results. I have noticed a sharp decline in my post-op inflammation. It is impossible to tell if this is a direct result of the neutraceutical or the result of being almost six weeks recovered from back surgery. Please note that using this product of yours under the tongue is like chewing sandpaper. If it proves to be beneficial you may want to reformulate it in such a way to be gentler to tender tissue.
   A. This is interesting. We have no idea if it works better under the tongue or how safe it is to take it this way.

Q. I saw on your web site that there is at least one other person who has had a negative experience with this enzyme. I too was disappointed and shocked as it caused me extreme muscle and joint pain after two weeks. And it sounded like a product that could have really helped me. I took 2 caps serrapeptase (40,000 units each) on an empty stomach one hour before breakfast. I did this for about three weeks. After I stopped the serrapeptase I did notice some improvement, but it has been a week since then, and I'm still in a lot of pain, joints and muscles.
   A. We find this strange since this potential serrapeptase side effect has not been mentioned in the medical literature, yet you are the second person who has reported it to us in the past 3 years. We will keep monitoring this potential serrapeptase side effect. Perhaps the dosage was too high.

Q. I was reading your website in search of anyone with side effects from taking serrapeptase. I just turned 50 and was recently diagnosed with osteoarthritis in my lumbar spine. Otherwise I am perfectly healthy. After taking 60,000IU twice daily for a week, I noticed some intermittent swelling in my hands and a "fullness" in my head. I decided to get my blood pressure checked and it was about 150/90 when it has always been about 115/70. This continued for another few days when my doctor suggested stopping the serrapeptase for 2 weeks. I did this and the swelling left after a couple of days and my blood pressure returned to normal. Three days ago I resumed the serrapeptase at 1/2 the dosage (60,000IU/day) and the swelling and elevated blood pressure (146/92) have returned. Unfortunately, my back improved significantly both times I was on the serrapeptase. Is it possible that the swelling and blood pressure are a side effect of some positive effect the serrapeptase is having and would go away eventually?
   A. This is the first we have heard of serrapeptase influencing blood pressure, but it may be possible since the full side effect profile of serrapeptase is not yet known. However, it does appear that the side effects could be dosage related, so we suggest using only 20,000 units a day and taking 2 or 3 days off each week, or using the serrapeptase every other day.

Q. I thought I'd let you know my experiences with serrapeptase (Serralone 400mg per capsule). I started using it in the hope that it would help reduce the appearance of my varicose veins (I am only 32). As it is also an anti-inflammatory I thought it may also help with my adult acne as my infections are prone to being very swollen and red. Well, it seems to have certainly helped with the acne swelling, my spots are not as inflamed and angry looking but I have developed an awful lot of spider/thread veins that I never had before and I didn't notice and difference to my varicose veins. I have stopped taking it now as I am worried about the thread vein situation worsening.

Q. I have looked through the previous newsletter articles but can find nothing on serrepeptase. Are you able to advise serrapeptase dosage and length of time that you consider safe to take the supplement (I have been taking it for chronic sinus infection as well as osteoarthritis and ankylosing spondilytis) and what sort of breaks you consider best.
   A. The reason we do not have specific dosages and length of use is because there are hardly any human studies that can give us these answers. Hence, until we know more, we feel it is best to take frequent breaks and discuss with your doctor on further details. Your doctor may wish to read this page on serrapeptase.

Q. I refer to a category of systemic enzymes which are fibrolytic —  fibrolytic enzymes break down fibrin and reduce or prevent scarring. Examples of these are serrapeptase and nattokinase. So, more precisely, could a fibrolytic enzyme like serrapeptase possibly reduce the fibrosis in an inflammation damaged esophagus (as in eosinophilic esophagitis) or an inflammation-damaged airway, as seen in asthma? Both undergo eosinophilic inflammation and with time, remodeling which includes fibrosis.
   A. We really do not know, there is so little research done with serrapeptase, hopefully we will know more in the next few years.

Q. Are there any studies saying whether or not serrapeptase would be helpful in costochondritis? Also, why would spider veins be a symptom of serrapeptase use?
   A. I am not sure why spider veins are related to the use of serrapeptase. I have not seen research regarding serrapeptase and costochondritis.

Q. I have read a lot about serrapeptase from your website and I am wondering how it will help with scar tissues formed after myomectomy surgery of six years ago.  I read in your website that only little research has been done on serrapeptase and edema which I interpret to mean scar tissues; is this correct.
   A. Edema is fluid accumulation in tissues, it is not a scar. We don't have any research on serrapeptase and post myomectomy scar formation.

Hello, and greetings from Paris. I just came across your great website and was particularly interested by the reports about serrapeptase side-effects. I am considering to start taking Neprinol or Vitalzym for my fibroid problem. While reading the ingredient list of both supplements I noticed that they don't give the exact amount of serrapeptase included in their formula. All they say is that one tablet contains 500mg or 15000 units of their mix of enzymes. How is one to know the amount of serrapeptase included in that blend? I am worried that if I adhere to their recommended dosage my intake of serrapeptase might be too high. On the other hand, I am really interested in reducing the size of my fibroid. Do you think it would be an option to take your recommended dose of 20000 units/day of serrapeptase alone without the other enzymes? I can get serrapeptase here in France without a prescription.
   It is best to ask the manufacturers of Neprinol or Vitalzym regarding the dosage of the serrapeptase in their products. As to serrapeptase and fibroids, we have not seen such research yet, and you may consider reading about fibroids on this website.

How is serrapeptase manufactured? Do they kill silkworms to do it? I have several friends who are interested in a product but they are all vegetarians.
   It is made by specific bacteria found in the gut of silkworms and these bacteria "digest" their cocoons. That is the extent of our knowledge, the exact steps are not revealed to us by the manufacturer.

I have visited a few websites, and came across yours. You seem to cast some doubt on the use of this supplement, in regards to the amount a person should take. I went to another site and found out that it has been used for at least 25 years, with NO side effects. It has been used in Europe, and Asia, doctors prescribing and using it to treat patients with major problems. I would tend to use this supplement, then use some prescription drugs, with major side effects, as we have seen in the past few years, especially with arthritis drugs.
   There is a lot of information published on serrapeptase and other supplements on the internet. It is up to the consumer to decide which web site they find the most reliable and honest. We still have a lot to learn about its full benefits and risks.

I'm adding to your data re joint/muscle pain side effects - I ordered the enzyme from Nutri-Health - object was relief of sciatic pain from traumatic injury of several years ago, on the theory that the nerve might be irritated by scar tissue. Total relief after 48 hours (4 doses of 20,000), but I continued it for a few more days to see if it would help with knee pain from torn meniscus. Overall achiness and finally real pain kept increasing to the point that I was finding it difficult to move when I found your site with the few references that matched my experience. I recovered from that effect after 2 days and stayed off the enzyme for a couple of weeks. Last week I tried it again to be certain and within 2 days began the pain once again. This time I have stopped the serrapeptase for good. There is probably no interaction involved as I take no prescription drugs, but do take many antioxidants and other supplements that reduce inflammation. However, I do test positive for rheumatoid arthritis although I am symptom-free through a strict diet.

Does it desolve kidney cysts?
    I have not seen any studies regarding the role of serrapeptase in kidney cysts.

Is it okay to take a Wobenzym supplement together with a serrapeptase enzyme product?
    Not much is known about the effects or results of combining serrapeptase enzyme with Wobenzym supplement, therefore I suggest not taking them the same day.

Will serrapeptase dissolve scar tissue, as some claim? Also, I ordered some serrapeptase tablets that are 80,000 units. They made my blood pressure go up.
    As of 2017, I am not aware of any human studies regarding the dissolving of scar tissue with the use of serrapeptase supplements. The use of serrapeptase pills and research regarding this product is quite new and I suggest using lower dosages until more information is available.

Greetings from Cambridge, England. It may be useful if I responsibly recount my serendipitous experience. Around two years back a colleague suggested I try a few low-power daily capsules to see whether sharp big-toe joint pain might be alleviated. Gout it resembled but gout it was NOT, as my general practitioner doctor discovered to his puzzlement when the standard uric acid lab test came back negative--nonetheless, stomach-irritating anti-inflams were offered with commiserations. I opted to try serrapeptase pills instead and found that the inflammation subsided quickly and with no stomach discomfort. An unexpected side-effect, however, was that dead-tissue collagen growths in my hands (bi-lateral Dupuytren's contractures) began to itch and tingle, and over the next couple of weeks finger dexterity loosened up noticeably. Background info: Two senior UK hand-surgeons, one of them US qualified, had advised against excision and z-plasty in my case as growths were judged aggressive and advanced, likely to recur within five years of surgery. I was encouraged to await availability of Santyl collagenase injection therapy (undergoing phase 3 trials and FDA control at Stoneybrook, Detroit, and elsewhere). 'Delay surgery as long as possible! Try and wait', said the surgeons. (And Phase 3 is not yet done.) Bent ring fingers have straightened up considerably as a result of my taking enteric coated serrapeptase, 30,000 iu each day over the last two years. The growths are visibly and palpably retreating, and I can now press my palms flat on a table top. Maybe the cords will wither away or snap and dissolve as I nowadays flex fingers to degrees which were impossible before. Presumably my lymph system is perforce processing a lot of dissolved dead tissue, unhealthy material, and this may well be a debilitating strain on the body's daily attempts to achieve homeostasis. I imagine that rises in temperature and occasional flu-like symptoms might be triggered when my body needs to rid itself of unwanted solutions. General practitioners seem puzzled and skeptical. They say nothing. A very senior hospital specialist treating chronic pain knows the enzyme and its use in state regulated medicine in Germany and Japan (for fibroids, blocked arteries, etc.), and has no reservations whatever about my using serrapeptase. I realise that this does not add up to longterm controlled trials and verifiable findings. Obviously I am pleased to get my hands back into better shape and fitness for purpose, but perhaps I am at risk as we do not know if longterm damage elsewhere in the body can result from bioactive agents taken extensively. I see a parallel with the Santyl collagenase enzymatic injection trials, taking the original enzyme from the King crab, I hear, not the silkworm as in serrapeptase, but the Santyl approach is a targeted, more topical and contained treatment.

I just purchased serrapaptase for my knee pain. Two doctor have recommended double knee replacement. I have already been through the arthroscopic surgery and the Synvisc injections and a vitamin / supplement program which consists of the following: D-ribose Magnesium COQ 10 L-Carnitine Quercitin Boswellia N-acetyl cysteine Fish oil. Anyway, I hope that it works for me and I will keep you posted.

I have a friend that is reluctant to use this enzyme because she is taking the highest known prescription for inflammation. Is there any research in regards to the safety of a person using anti-inflammatory drugs?
   Not that I am aware of.

Has any research been done to support the use to mitigate the damage done by Giant Cell arteritis? I have GCA and it has 100% clogged the major artery (segmental occlusion of the left subclavian artery) to my left arm. I’m wondering if this product might open it again.
   As of 2017 a search on Medline did not reveal such research in terms for giant cell arteritis treatment .

Last month I had a severe inflamation in my mouth to my throat, partly because of my allergy. I was already feverish and coughing so hard. I remembered from my research about serrapeptase that it is also good for inflamation, so I placed 3 tablets in my mouth in the morning (I did not swallow). In my surprised, in the afternoon the inflamation subside. I took another 3 tablets in the afternoon, and another before i sleep. The next day, in the morning, the inflamation in my mouth were totally gone. Since I could still feel a little on the lower part of my throat, I continue to take 2 tablets 2x a day with an empty stomach. Until now, I did not feel any side effects. In fact, I did not anymore feel the pain in my stomach due to symtom of myoma. I Have a lot of sickness actually. I have hypothyroidism, cysts, kidney stone, arteries problems and others. I just take natural medicine / supplements and my health is getting better compare 6 months ago. I continue researching in the internet other supplements that i could add to my daily maintenance and i found this serrapeptase in another web.

What is the fibrinolytic activity of this enzyme? I purchased Neprinol and was wondering whether I should take it.
   We are not aware of human studies that have evaluated the specific fibrinolytic activity of serrapeptase although it may have some. It is nattokinase that is often mentioned for its fibrin breakdown activity. Any company that sells serrapeptase and claims it has a specific fibrinolytic activity must provide you with published studies in reputable journals of their particular product and whether what they claim about their product is true in terms of its fibrin dissolving properties. As far as we know Neprinol is a mix of several enzymes, not just one.

Q. My daughter has EDS Ehlers Danlos syndrome, and following an operation to remove an ovarian cyst has had ongoing pain. She has had numerous tests to rule out blockages etc and the view seems to be the pain is caused by adhesions.Apparently further surgery to remove the adhesions is only likely to produce MORE adhesions. We came across Serrapeptase which claims to dissolve adhesions. However we are worried that it might also dissolve collagen and as you know collagen production is faulty in EDS patients. Do you have any advice / links to any research please?
   A. As of 2018 I do not have experience in this area but I will look out for such research.

Q. There is a website where the proprietor claims to have taken 240,000 I.U. of serrapeptase daily for the past 13 years, and has taken doses as high as 2,000,000 I.U. He discusses his experience and has also written a book entitled, The Miracle enzyme is serrapeptase. I, personally, have been using Doctor's Best at 40,000 I.U. and the suggested use states, "Take 1 capsule up to 3 times daily without food." I use the product off and on. I am going to contact this Robert Redfern as well as Doctor's Best to see if they have any answers for me.
   A. Although it is possible a minority of users may tolerate these high amounts, most people would have untoward reactions to these massive dosages.

Different misspellings that have been seen include serapeptase and sierrapeptase

Other products online
Doctor's Best, Best Serrapeptase, 90 Veggie Caps
Buy Serrapeptase 40,000 units
The silkworm has serrapeptase (also known as Serratio Peptidase or serratiopeptidase), a proteolytic enzyme. This enteric coated serrapeptase product is of the highest quality available. It is manufactured by a FDA approved facility.

Serratiopeptidase, isolated from the microorganism Serratia E15,  is naturally present in the silkworm intestine which allows the emerging moth to dissolve its cocoon. Clinical use in Europe and Asia spans over twenty five years.

Buy Serrapeptase supplement

Suggested use: The label says one to three serrapeptase tablets a day, but we suggest you limit your use to one tablet daily or every other day until more research is available. Do not exceed 4 tablets a week until more research is published. We don't suggest using more than 40,000 units since the benefits and risks on this high dose are not clearly understood. Discuss with your doctor regarding its use before self-medicating.

Supplement Facts: Serrapeptase
   SerratioPeptidase (40,000 units enteric coated granules)

Have approval by your doctor before use.

Testimonial received in 2018
I would like to report my experience with serrapeptase (Drs. Best, 40,000 SPU). I have allergies and still find that I seem to have more mucus than the average person my age, 73. Serrapeptase has done nothing to change this in any way. I doubt it would help with a cold in my case. I found one huge benefit, in my case. I think I had a 2-3" circle of peripheral artery disease in my left calf. If I sleep on my left side with my right leg laying on top of the left effected leg, this would cause mild pain in the effected area. This area is also where the greatest concentration of weight was located. I took the serrapeptase on and off for a couple of months, and this was no longer an issue. I also used to be a beer drinker, and would occasionally get small ischemic strokes. This also stopped. This stopped when I stopped the beer. I have had absolutely no adverse reactions to the serrapeptase. My gut, however, has always been to take the product for a month or two and then lay off for months.