MVIIIHealth The MVIII app
← Back

Research · Supplements

Serrapeptase

After wisdom tooth surgery, a meta-analysis found better mouth opening than corticosteroids and no difference in swelling, and placebo-controlled trials disagreed. Single older trials found less swelling after sinus surgery and fewer ear, nose and throat symptoms. Pain did not differ from placebo in two dental trials. Japanese case reports describe drug-induced pneumonitis.

Add to Bio HackChecked 2026-11-09
Status
Dietary supplement in the US. Not approved by the FDA as a drug for any use.
Also called
serratiopeptidase, serratio peptidase, Serratia peptidase, serralysin, Danzen, Nicolase, silkworm enzyme
Taken for
swelling, inflammation, sinusitis, ear nose and throat inflammation, pain after surgery, pain after tooth extraction, breast engorgement

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help3

Reported risks2

What people take it for, and what was found

Shown to help3

Limited

Swelling after sinus surgery

One trial found less cheek swelling than placebo for 5 days after sinus surgery.

The numbers and sources
Effect
In 174 patients after Caldwell-Luc antrotomy for chronic empyema, 10 mg three times a day around surgery gave less cheek swelling than placebo at every point up to day 5 (p < 0.01 to p < 0.05) [4].
Population
88 on serrapeptase and 86 on placebo, Japan [4].
Sources
[4]
Caveats
One trial from 1984 [4].
Limited

Ear, nose and throat inflammation

One trial found faster symptom improvement than placebo over 7 to 8 days in people with ear, nose or throat disorders.

The numbers and sources
Effect
In 193 people with acute or chronic ear, nose or throat disorders, two tablets three times a day for 7 to 8 days gave greater symptom regression than placebo after 3 to 4 days and after 7 to 8 days [5].
Population
193 participants at multiple centers [5].
Sources
[5]
Caveats
One trial. The abstract gives no effect sizes and does not split results by sinusitis [5].
LimitedStudied in women

Breast engorgement

One small trial found 86% of women with breast engorgement improved on serrapeptase against 60% on placebo over 3 days.

The numbers and sources
Effect
In 70 women with breast engorgement, 85.7% on serrapeptase and 60.0% on placebo had moderate to marked improvement over 3 days. Marked improvement was 22.9% against 2.9% (P < 0.05) [6].
Population
70 women, Singapore [6].
Sources
[6]
Caveats
One small trial from 1989 [6].

Mixed results1

Moderate

Swelling and jaw stiffness after wisdom tooth surgery

Mixed results: after wisdom tooth surgery, one trial found less jaw stiffness and swelling than placebo, and another found no effect.

The numbers and sources
Effect
A meta-analysis of 5 studies found serratiopeptidase improved trismus (limited mouth opening) more than corticosteroids (MD 4.42, 95% CI 3.84 to 5). Swelling did not differ from corticosteroids [1]. In 133 patients, serratiopeptidase with paracetamol for 5 days gave less trismus on day 4 (27.30 against 32.06 mm, P < 0.001) and less swelling (111.49 against 115.39 mm, P < 0.001) than placebo with paracetamol [2]. In 150 patients, serratiopeptidase did not show significant anti-inflammatory or analgesic action against placebo, while ibuprofen and betamethasone reduced swelling [3].
Population
Adults after surgical removal of impacted lower third molars [1][2][3].
Sources
[1], [2], [3]
Caveats
The two placebo-controlled trials disagree [2][3]. The meta-analysis authors note too few studies for other outcomes or comparators [1].

Doses studied

The sinus surgery trial gave 10 mg three times on the day before surgery, once that night and three times a day for 5 days after [4]. The ear, nose and throat trial gave two tablets three times a day for 7 to 8 days [5]. The 133-patient dental trial gave serratiopeptidase for 5 days after surgery [2].

Risks

Reported risks1

Limited

Lung injury

Case reports: three people in Japan developed pneumonia, two of them eosinophilic pneumonia, after taking serrapeptase.

The numbers and sources
Effect
An 84-year-old man who had taken serrapeptase for 3 months developed acute eosinophilic pneumonia with respiratory failure. A lymphocyte stimulation test was positive for serrapeptase [7]. A 32-year-old woman developed eosinophilic pneumonia 3 days after starting serrapeptase for pharyngitis, also with a positive test [8]. A 69-year-old man developed interstitial pneumonia after 16 days and improved after it was stopped [9].
Population
Single case reports from Japan [7][8][9].
Sources
[7], [8], [9]
Caveats
Case reports give no rate.

Mixed results1

Limited

Side effects in trials and gaps in safety data

Limited evidence: few side effects were reported in trials, but a review found safety data lacking and no long-term data.

The numbers and sources
Effect
A systematic review of 24 clinical studies found data on safety and tolerability were lacking and long-term safety data were absent [10]. Tolerance was similar to placebo in the ear, nose and throat trial [5]. No side effects were reported in the sinus surgery and breast engorgement trials [4][6].
Population
Clinical studies and trial participants [10][4][5][6].
Sources
[10], [5], [4], [6]
Caveats
The review rated the clinical studies as of poor methodology [10].

Claims tested and not found

  1. That serrapeptase relieves pain after tooth surgery. Reported pain did not differ from placebo in a 133-patient trial [2], and no significant analgesic action was seen in a 150-patient trial [3].

Sources

  1. Sivaramakrishnan G, Sridharan K. Role of Serratiopeptidase After Surgical Removal of Impacted Molar: A Systematic Review and Meta-analysis. Journal of Maxillofacial and Oral Surgery. 2018. https://doi.org/10.1007/s12663-017-0996-9
  2. Tamimi Z, Al Habashneh R, Hamad I, et al. Efficacy of serratiopeptidase after impacted third molar surgery: a randomized controlled clinical trial. BMC Oral Health. 2021. https://doi.org/10.1186/s12903-021-01451-0
  3. Chopra D, Rehan H, Mehra P, et al. A randomized, double-blind, placebo-controlled study comparing the efficacy and safety of paracetamol, serratiopeptidase, ibuprofen and betamethasone using the dental impaction pain model. International Journal of Oral and Maxillofacial Surgery. 2009. https://doi.org/10.1016/j.ijom.2008.12.013
  4. Tachibana M, Mizukoshi O, Harada Y, et al. A multi-centre, double-blind study of serrapeptase versus placebo in post-antrotomy buccal swelling. Pharmatherapeutica. 1984. https://pubmed.ncbi.nlm.nih.gov/6366808/
  5. Mazzone A, Catalani M, Costanzo M, et al. Evaluation of Serratia peptidase in acute or chronic inflammation of otorhinolaryngology pathology: a multicentre, double-blind, randomized trial versus placebo. Journal of International Medical Research. 1990. https://doi.org/10.1177/030006059001800506
  6. Kee WH, Tan SL, Lee V, Salmon YM. The treatment of breast engorgement with Serrapeptase (Danzen): a randomised double-blind controlled trial. Singapore Medical Journal. 1989. https://pubmed.ncbi.nlm.nih.gov/2688125/
  7. Sasaki S, Kawanami R, Motizuki Y, et al. Serrapeptase-induced lung injury manifesting as acute eosinophilic pneumonia. Nihon Kokyuki Gakkai Zasshi. 2000. https://pubmed.ncbi.nlm.nih.gov/11019569/
  8. Kai N, Shirai R, Hirata N, et al. A case of eosinophilic pneumonia due to Nicolase (serrapeptase) after recovery from acute eosinophilic pneumonia. Nihon Kokyuki Gakkai Zasshi. 2009. https://pubmed.ncbi.nlm.nih.gov/19348276/
  9. Hirahara K, Saitoh T, Terada I, et al. A case of pneumonitis due to serrapeptase. Nihon Kyobu Shikkan Gakkai Zasshi. 1989. https://pubmed.ncbi.nlm.nih.gov/2693781/
  10. Bhagat S, Agarwal M, Roy V. Serratiopeptidase: a systematic review of the existing evidence. International Journal of Surgery. 2013. https://doi.org/10.1016/j.ijsu.2013.01.010

Everything in the library