This tablet contains a combination of two proteolytic enzymes Typsin and Chymotrypsin having anti- inflammatory properties. Trypsin Chymotrypsin mixture (6:1) is a protolytic enzyme obtained by controlled activation of zymogens form in the glands. Both enzymes function within the intestine to help break down large protein molecules that we ingest in the foods we eat. Without these both enzyme-aided digestions, it would be unable to get the essential amino acids required for tissue building and repair. Because these two enzymes break down proteins, they classified as proteases.
Proteases refer to a group of enzymes whose catalytic function is to hydrolyze peptide bonds of proteins. They are also called proteolytic enzymes or proteinases. Proteolytic enzymes have the ability to carry out selective modification of proteins by limited cleavage such as activation of zymogenic forms of enzymes, blood clotting and lysis of fibrin clots, and processing and transport of secretory proteins across the membranes. Their use in medicine is gaining more and more attention because several clinical studies are indicating their applications in oncology, inflammatory conditions, blood rheology control and immune regulation. These are also used in crucial biological processes such as regulation of metabolism, enzyme modification, photogenecity, complement system, apoptosis pathways, invertebrate prophenoloxidase activating cascade etc.
Proteolytic enzymes have been widely used as anti-inflammatory agents. Trypsin chymotrypsin mixture is used as NSAID.

Trypsin-Chymotrypsin is the co-crystal of Chymotrypsin and Trypsin:
Trypsin-Chymotrypsin is the co-crystal of Chymotrypsin and Trypsin so it has the properties of both. The activity of hydrolyzing casein is as much as Chymotrypsin. But the activity of its Chemotrypsin to hydrolyze N-Benzoyl-L-tyrosine ethyl ester (BTEE) is three times higher than Chemotrypsin.The activity of hydrolyze ester bond similar to that of Trypsin. It is stable when dry and easy to be inactivated in solutions. The optimum pH is 7.0-8.0.
This is a purified mixture of proteolytic enzymes trypsin and chymotrypsin. It has anti- inflammatory, anti-exudative (reduces swelling) and mucolytic (breaks down bronchial secretion) effects. During the inflammatory process, in tissue there is hampered blood circulation and lymph flow. The trypsin and chymotrypsin, with their proteolytic activity at the site of the pathological process, tear a long polypeptide chains in less suitable for resorption. Disappearance of the edema, exudate and hematoma, leads to normalizing of locally disturbed blood circulation and lymph flow. 
Chymotrypsin is a proteolytic enzyme. Chymotrypsin is secreted by the pancreas as the inactive proenzyme chymotrypsinogen. Chymotrypsin is a serine endopeptidase that preferentially cleaves peptide bonds on the carboxyl side of amino acids with bulky hydrophobic residues, particularly tyrosine, tryptophan, phenylalanine and leucine. Chymotrypsin is effective in reducing soft tissue inflammation especially associated with trauma.
Trypsin is a serine endopeptidase that catalyzes the cleavage of peptide bonds on the carboxyl side of either arginine or lysine. Trypsin (Protease) is secreted by the pancreas as the pro-enzyme and converted to the active form in small intestine, catalyzes different enzymes important for the process of protein digestion. Clinically, Trypsin (Protease) is effective to treat symptoms of pancreatitis or other various digestive disorders.
Oral administration of enteric coated tablets containing proteolytic enzymes of plant and animal origin may stabilize or probably enhance a variety of physiological and immunological processes even in healthy consumers.
Oral administration of enteric coated tablets containing proteolytic enzymes may stabilize or probably enhance a variety of physiological and immunological processes even in healthy consumers.

Indications:
  • This drug is used to treat different types of muscle and joint injuries, accompanied by swelling
  • For the management of edema associated with dental procedures (e.g. swelling of the tooth or swelling of the gums) and inflammation
  • For reduction of edema associated with surgical wounds and sinusitis
  • Used to treat ulcerative colitis, hay fever, pulmonary edema and shortening of labor
  • Used to treat sciatica
  • It can be taken after hysterectomy (uterus removal)
  • Treatment of hematomas
  • After surgical trauma
  • Used to treat necrotic tissue
  • It is used to treat pelvic inflammatory diseases
  • It is also used to treat chronic respiratory diseases

Mechanism of Action:
The physiological function of the Trypsin and Chymotrypsin in digestion of proteins is well known, their action being to split proteins into amino acids and peptides. These enzymes have been demonstrated to be effective therapeutics in reducing inflammation and edema when properly administered. It is theorized that trypsin functions as a depolymerase at the site of inflammation to reverse the fibrogen-fibrin reaction responsible for the inflammation. As the porosity of the protein network wall is increased, the inter-cellular fluid is released, hydrostatic pressures are reduced, capillaries open, and circulation in the local area is restored. Thus the anti-inflammatory action of trypsin is a direct result of its facilitating drainage from the inflamed area by lysis of fibrin plugs in the lymphatics and capillaries about the inflammatory lesion. Both trypsin and chymotrypsin can be absorbed through the walls of the ileum, more particularly, the lower /s on the small intestine. 
Trypsin and chymotrypsin are unique in that they will increase tissue permeability and thus actually facilitate their own absorption. Thus, if this proteolytic action is protected by the device of formulation in a suitable enteric coated tablet, this action will ensure passage through the intestinal mucosa and hence into the blood stream where the therapeutic activity will be manifested.
Trypsin Chymotrypsin mixture when consumed in unprotected form is destroyed by acidic environment in the stomach. However, enteric coating tablet, enable the enzyme to pass through the stomach unchanged, and be absorbed in the intestine.

Precautions:
This tablet should be avoided in patients allergic to trypsin or chymotrypsin or other similar enzymes.
Symptoms of an allergy can include:
  • skin rash
  • redness of the skin
  • itching of the skin
  • swelling of the throat, tongue and face
  • trouble breathing

Side Effects:
Nausea, vomiting, abdominal pain, bloating, blood in the urine, allergy.

Drug Interactions:
  • Alcohol
  • Chloramphenicol

Contraindication:
This tablet must not be used in case of known hypersensitivity to its active ingredients. The preparation must not be used by patients with severe inborn or gained coagulation disorders. (E.g- hemophilia, severe liver damage, dialyzed patients).

Pregnancy and Lactation:
Administration of Combination tablet during pregnancy and breastfeeding is not recommended.

Storage:
Store in a cool and dry place, away from direct sunlight.