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NexoBrid

anacaulase-bcdb
Used for Wound Care
Used for Wound Care

NexoBrid (anacaulase or anacaulase-bcdb) is a topical medication FDA-approved to get rid of damaged skin from second- and third-degree burns wounds in adults. It contains a mixture of enzymes (proteins) from pineapple plants that help to remove dead skin tissue. NexoBrid (anacaulase) is applied onto the burn wound by a healthcare professional (HCP), left on for 4 hours, then removed along with the dead skin tissue. If needed, another NexoBrid (anacaulase) treatment can be given 24 hours after the first. Common side effects of this medication are itching and fever.

Reviewed by:
reviewer
Ally Tsai, PharmD
reviewer
Kristianne Hannemann, PharmD
Last reviewed on July 17, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is NexoBrid (anacaulase)?

What is NexoBrid (anacaulase) used for?

How NexoBrid (anacaulase) works

NexoBrid (anacaulase) contains a mixture of enzymes (proteins) from the pineapple plant. It breaks down dead skin tissue caused by a burn. The removal of dead skin tissue allows for new, healthy skin to grow in its place to help wounds heal.

Drug Facts

Common BrandsNexoBrid
Drug ClassEnzyme
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of NexoBrid (anacaulase)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Other Side Effects

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious allergic reactions: hives, itchy skin, rash, facial swelling, or trouble breathing

Source: DailyMed

pros-and-cons

Pros and cons of NexoBrid (anacaulase)

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Pros

Wells well removing dead skin tissue removed after application

Lowers the rate of surgery and blood loss after a burn wound

Able to remove dead skin tissue within 4 hours

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Cons

Application can lead to serious injury to surrounding skin

Not for chemical burns, or burns near medical devices (e.g., pacemakers, implants) and important body organs

Contains bromelain (a protein in pineapples), so not a safe option if you have an allergy to any pineapples or papayas

pharmacist-tips

Pharmacist tips for NexoBrid (anacaulase)

pharmacist

  • You'll typically receive NexoBrid (anacaulase) at a wound clinic or a hospital. This medication needs to be given by a HCP with the right tools and techniques to lower the risk of side effects.

    • NexoBrid (anacaulase) is available as a topical powder. It needs to be mixed with a gel before application. Your HCP will make sure that you receive this medication within 15 minutes after mixing.

      • Once NexoBrid (anacaulase) is applied to your burn wound, your care team will leave it on for 4 hours. Before your treatment, ask your care team what are some appropriate activities you can bring to help you pass the time.

        • Treatment with NexoBrid (anacaulase) can be painful. Typically, your care team will give you medication to help ease pain and discomfort at least 15 minutes before the application. Let your care team know if you experience pain during treatment.

          • Your care team will also give you a topical ointment, like Vaseline, to protect the skin outside of the treatment area and a topical antibiotic to prevent infection from the procedure.

            • You might need a second application of NexoBrid (anacaulase) 24 hours after the first application. Make sure to plan for some extra time for your procedure for the HCP to check how your wound is doing.

              faqs

              Frequently asked questions about NexoBrid (anacaulase)

              What is the active ingredient in NexoBrid (anacaulase)?
              NexoBrid (anacaulase) is a topical medication containing a mixture of enzymes (proteins) that's placed on your skin. It breaks down dead skin tissue caused by a burn within 4 hours. As a result, new and healthy skin can grow back faster. One of the active ingredients in NexoBrid (anacaulase) is bromelain, an enzyme extracted from pineapple plants. Let your care team know if you've a history of allergies to pineapples or papayas (which can cross-react with pineapples) before receiving this medication.
              How long does it take for NexoBrid (anacaulase) to work?
              One treatment of NexoBrid (anacaulase) takes about 4 hours. This medication will start to work before then, but your HCP will leave in on the skin for 4 hours for maximum benefit. After 4 hours, your care team will carefully scrape off the dead skin from the application area. If the burn area is larger or if you have multiple burn wounds, they might give you a second treatment 24 hours later.
              How well does NexoBrid (anacaulase) work for burn wounds?
              A study showed that 94% people who received NexoBrid (anacaulase) were able to have most of the dead tissue removed from burn wounds after treatment, compared to only 4% who received placebo. In addition, people who received NexoBrid (anacaulase) in this study were also less likely to need surgical procedures afterwards in comparison to people who received standard burn care. If you have any questions about whether NexoBrid (anacaulase) is right for you, follow up with your care team for more information.
              Does NexoBrid (anacaulase) help with swelling?
              NexoBrid (anacaulase) has some anti-inflammatory effects, so it might help with swelling. But the main way NexoBrid (anacaulase) works is by breaking down dead skin tissue caused by a burn, which allows for new, healthy skin to grow in its place to help wounds heal. Make sure you follow up with your care team regularly after treatment with NexoBrid (anacaulase). They can let you know if your burn is healing properly.
              When was NexoBrid (anacaulase) FDA-approved?
              NexoBrid (anacaulase) was FDA-approved in December of 2022. According to the FDA, it can only be given by a HCP with the right tools and techniques to lower the risk of serious infections.
              Who should be careful about getting NexoBrid (anacaulase) treatment?
              People with burns in certain body areas, such as the face or groin, or have medical conditions, such as diabetes, heart, or lung injury, might not be able to get treated with NexoBrid (anacaulase). This medication hasn't been well-studied in certain types of burns or medical conditions. In addition, NexoBrid (anacaulase) might raise the risk of bleeding in people with blood problems or taking blood thinners (e.g., Eliquis (apixaban), warfarin (Coumadin)). Get medical attention right away if you have any signs of bleeding: black, red, or tarry stools; vomiting blood; unexplained bruises; bruises that get bigger; or bleeding that won’t stop.
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              warings-icon

              What are the risks and warnings for NexoBrid (anacaulase)?

              NexoBrid (anacaulase) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Serious allergic reaction

              • Risk factors: Allergy to pineapples or bromelain | Allergy to papayas or papain

                Tell your healthcare team before treatment with NexoBrid (anacaulase) if you've been told you have an allergy to pineapples, bromelain (a type of protein in pineapple), papayas, or papain (a type of protein in papaya). Many of the enzymes found in NexoBrid (anacaulase) are from pineapples (which can cross-react with papayas). Watch out for signs and symptoms of allergic reactions, such as swelling, rash, itchy skin, or trouble breathing. Get medical attention right away if you have these signs and symptoms.

                risk-warning

                Severe pain

                Treatment with NexoBrid (anacaulase) can cause serious pain. At least 15 minutes before application, your care team will provide pain management to help ease and control the pain. Let your care team know as soon as possible if you experience pain during application.

                risk-warning

                Serious skin injury

                • Risk factors: Applying this medication in areas with medical devices | Applying this medication near important body organs

                  NexoBrid (anacaulase) shouldn't be used in areas with medical devices, such as implants or pacemakers. It should also not be used near important body organs. Treatment with NexoBrid (anacaulase) can potentially expose them underneath the skin, which can be life-threatening. In order to prevent serious skin injury, your care team will protect the skin around the application area with an ointment similar to Vaseline.

                  risk-warning

                  Bleeding risk

                  • Risk factor: History of blood problems

                    NexoBrid (anacaulase) might raise the risk of bleeding in people with blood problems or taking blood thinners (e.g., Eliquis (apixaban), warfarin (Coumadin)). Get medical attention right away if you have any signs of bleeding: black, red, or tarry stools; vomiting blood; unexplained bruises; bruises that get bigger; or bleeding that won’t stop.

                    dosage

                    NexoBrid (anacaulase) dosage forms

                    Typical dosing for NexoBrid (anacaulase)

                    NexoBrid contains 8.8% anacaulase. It's only available as a topical medication that's given by a HCP. Your HCP will determine how much NexoBrid (anacaulase) you need based on your body surface area (BSA), which takes into account your weight and height.

                    NexoBrid (anacaulase) can only be used to treat areas up to 20% BSA between 2 applications.

                    • Adults: After cleaning and prepping the affected area, your care team will apply a layer of NexoBrid (anacaulase) 3 mm thick to cover the burn area. They'll cover the treated area with a dressing, then leave the medication on for 4 hours. After that, your care team will carefully scrape off the dead skin from the application area. If not all of the dead skin can be removed, you have multiple wounds, or the affected area(s) is more than 15% BSA, they might give you a second treatment 24 hours later.

                    contraindications-icon

                    NexoBrid (anacaulase) contraindications

                    Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because NexoBrid (anacaulase) will not be safe for you to take.
                    alternatives

                    What are alternatives to NexoBrid (anacaulase)?

                    There are a number of medications that your doctor can prescribe in place of NexoBrid (anacaulase). Compare a few possible alternatives below.
                    NexoBrid (anacaulase)
                    Used for:
                    View Prices
                    Santyl (collagenase)
                    Used for:

                    • Removal of damaged or burned skin

                    $327.52 Lowest GoodRx priceView Prices
                    Silver sulfadiazine (SSD)
                    Used for:

                    • Prevention and treatment of infections caused by second- and third-degree burns

                    $6.42 Lowest GoodRx priceView Prices

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                    References

                    Best studies we found

                    American Academy of Allergy, Asthma and Immunology. (n.d.). Cross-reactivity defined.

                    Manna, B., et al. (2023). Wound Debridement. StatPearls.

                    National Center for Complementary and Integrative Health. (2020). Bromelain.

                    View All References (5)

                    Shoham, Y., et al. (2023). Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes. International Wound Journal.

                    Shoham, Y., et al. (2023). Early Enzymatic Burn Debridement: Results of the DETECT Multicenter Randomized Controlled Trial. Journal of Burn Care & Research.

                    U.S. Food & Drug Administration. (2024). Drug Trials Snapshot: NEXOBRID.

                    Vericel Corporation. (2022). Vericel announces FDA approval of NexoBrid for the treatment of severe thermal burns in adults. Globe Newswire.

                    Vericel Corporation. (2023). Nexobrid- anacaulase-bcdb kit [package insert]. DailyMed.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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