Chymopapain (injection)

Chymopapain, which is derived from the papaya fruit, is used to treat herniated or dislocated discs in the patient’s spine.

Overview

Chymopapain is a proteolytic enzyme, meaning it can break down various different kinds of bonds through a variety of different mechanisms. The medicine itself is derived from the papaya fruit, which contains the proteolytic enzyme. The enzyme is also found in a variety of different plants and animals.

The medicine acts by being injected directly into a herniated disc, specifically dissolving part of the disc to relieve pressure it may be putting on nerves. Injections of chymopapain are usually delivered after the application of local anaesthetic.

Sale of chymopapain was discontinued in the US on 27 January 2003, when the manufacturer, Abbott Laboratories, discontinued global distribution. While the FDA deem the product to be safe and classify it as a drug that was discontinued for reasons other than effectiveness or safety concerns, there is no form of chymopapain presently approved by the FDA for sale in the US. While sold, chymopapain was sold under under the brand name Chymodiactin.

Conditions treated

  • Herniated or bulging discs

Type of medicine

  • Proteolytic agent

Side effects

Chymopapain can come with some serious adverse side effects related to it, including paralysis or even death. Patients who begin to experience any of the following side effects should contact their doctor immediately.

  • Abdominal pain
  • Stomach cramping
  • Flushing, reddening, or other coloration changes in the patients face.
  • Constipation
  • Convulsions
  • Seizures
  • Changes to urinary patterns
  • Incontinence
  • Rapid or labored breathing
  • Irregular breathing patterns
  • Wheezing
  • Tightness in the patient’s chest
  • Severe headache
  • Persistent headache
  • Hot skin
  • Pain and or swelling of the extremities, especially the patients ankles
  • Puffiness or swelling under the patient’s eyes or in their eyelids
  • Runny nose
  • Rash
  • Hives
  • Itching
  • Swelling or bloating of the abdomen or stomach
  • Vomiting
  • Weakness in the legs
  • Difficulty moving the legs

The following side effects may be signs of severe side effects. Patients who begin to experience any of the following side effects after receiving a chymopapain injection should seek medical attention immediately.

  • Sudden and severe pain in the lower back
  • Sudden and severe weakness in the lower back
  • The combination of skin rash, hives, or itching

Not all side effects necessitate medical attention. Many are the symptoms of the body’s adaptation to or handling of the sudden influx of medicine. Patients who experience any of the following symptoms should contact their doctor to find out how to mitigate or lessen the side effects.

  • Back pain
  • Burning sensation in the lower back
  • Stiffness or soreness in the back
  • Leg cramps
  • Leg pain
  • (Mild) weakness in the legs
  • Dizziness
  • Foot drop
  • Headaches
  • Nausea
  • Numb or tingling legs

This is not necessarily a complete list of side effects. Patients who begin to experience any new or worsening symptoms should contact their doctor immediately. Patients can report new side effects to the FDA at 1 800 FDA 1088 or at www.fda.gov/medwatch.

Dosage

The dosage of chymopapain will vary widely from patient to patient, depending on the condition being treated and what is necessary to treat it. Patients should accurately describe their symptoms and experiences to their doctor, which will enable them to most accurately determine the proper dose for the patient.

In most cases, chymopapain injections will be preceded by the use of a local anaesthetic.

When it was available, Chymodiactin came in vials of 10,000 IUs of chymopapain per vial. The doctor or other medical professional would then determine how much of the vial would be necessary to treat the patient’s condition.

Interactions

Drugs can interact with each other in a patient’s body in a variety of unique ways. Before receiving any treatment or taking any new medication, patients should consult with their doctor. Patients should provide their doctor with a complete list of all drugs, medications and supplements that they are taking, to ensure their doctor is best able to help them.

Some drugs can interact negatively with different diets or foods. Patients should consult with their doctor before receiving a new treatment or taking a new medicine. Patients should make sure their doctor properly understands their dietary habits so they are best able to help the patient.

No specific drugs have been identified to interact with chymopapain injections.

This is not necessarily a complete list of interactions. Patients should look to their doctor to determine which drugs may or may not interact with any treatment they plan to receive.

Warnings

Chymopapain is considered a Class C drug in terms of pregnancy. This means that there is insufficient evidence to determine whether or not it is harmful to human fetuses. Patients who are pregnant should exercise caution when considering receiving a chymopapain injection. Patients who are pregnant and require a chymopapain injection should consult with their doctor to determine the best way to proceed.

Additionally, there is no conclusive evidence to determine whether or not chymopapain is excreted through breast milk or whether or not it is harmful to breastfeeding children. Patients who are breastfeeding should exercise caution when considering receiving a chymopapain injection.

Some patients, especially women, have been known to have serious allergic reactions to chymopapain. Patients who begin to experience the signs of an allergic reaction should contact their doctor or seek medical attention immediately. Symptoms of an allergic reaction can include:

  • Hives
  • Rash
  • Itching
  • Anaphylaxis
  • Swelling of the throat, possibly causing breathing problems

Patients who are allergic to papaya should exercise caution when considering receiving a chymopapain injection. In almost all cases, patients who are allergic to papaya will be advised against receiving a chymopapain injection. Patients should seek guidance from their doctor.

Patients who have previously received a chymopapain injection should be aware that they are at a significantly higher risk of serious allergic reaction. Patients should exercise caution when considering receiving a second or third chymopapain injection and patients who have received a chymopapain injection and now require another injection should seek guidance from their doctor.

Patients with existing back conditions, such as scoliosis, nerve pain, pulled muscles and so on, should exercise caution when considering receiving a chymopapain injection, as back problems can complicate chymopapain injections. Patients with back problems should seek guidance from their doctor.

Patients who have high blood pressure, are at serious risk of stroke, or have already suffered a stroke should exercise caution when considering receiving a chymopapain injection. These conditions can increase the risk that the patient suffers serious side effects. Patients with high blood pressure, who have had a stroke, or who are at risk of stroke should look to their doctor for guidance when considering receiving a chymopapain injection.

Patients who have had back surgery should exercise caution when deciding whether or not to receive a chymopapain injection. Patients who have previously had a back surgery are typically at a higher risk of experiencing serious adverse side effects. Patients who have previously undergone back surgery should look to their doctor for guidance.

Chymopapain has not been studied in pediatric or geriatric patients groups. The safety of chymopapain to these groups has not been established. However, there is no present indication that pediatric or geriatric patients will suffer any specific age-related effects.

In some cases, patients who received a chymopapain injection have reported resurgent back pain. Whether or not the new pain is the result of the chymopapain injection (either by causing it or failing to treat the pain permanently) or an unrelated occurrence has not been established. The FDA continues to deem chymopapain an effective treatment for herniated discs.

Chymopapain is injected directly into the patient's spine, and will dissolve part of the patient’s spinal disc. Patients should be aware that any procedure involving their spine carries the risk of paralysis or other serious nerve disorders. Patients should ensure they receive the highest caliber of healthcare possible to minimize risk of paralysis or other nerve disorders.

This is not necessarily a complete list of warnings. Patients should look to their doctor to fully describe the risks associated with receiving a chymopapain injection.

Storage

Patients should not be tasked with storing chymopapain. The chymopapain should be supplied by their doctor or other healthcare provider.

Summary

Chymopapain is notable in that it can rapidly treat hernias and bulging discs, conditions that would otherwise require extended amounts of therapy or full blown surgery. Patients have reported their pain was relieved quickly and they rapidly regained function in their lower back and legs. With that said, the risks are considerable, not just from the drug itself but from the fact that a destructive enzyme is being unleashed on the spine, which is uncomfortably close to the vital spinal cord. Risk of paralysis and death are present.

Patients in the US, fortunately or unfortunately, do not have to worry about the risks or rewards associated with receiving a chymopapain injection. The product was discontinued in 2003 by Abbott Laboratories and has not been produced by any other company since then.