NexoBrid
NexoBrid (anacaulase or anacaulase-bcdb) is a topical gel that's FDA approved to remove damaged skin from severe thermal burns in adults and children. It contains a mix of enzymes (proteins) from pineapple plant stems that help break down and remove dead skin tissue. A healthcare professional will apply the gel and leave it on for 4 hours to clear burned tissue while protecting healthy skin. Common side effects include itching and fever.
What is NexoBrid (anacaulase)?
What is NexoBrid (anacaulase) used for?
- Remove dead skin tissue from severe thermal burns
How NexoBrid (anacaulase) works
NexoBrid (anacaulase) contains a mixture of enzymes (proteins) from pineapple plant stems. It works by breaking down dead skin tissue caused by a burn. Removing the dead tissue allows new, healthy skin to grow so your wound can heal.
Drug facts
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
Adults:
- Itching (15%)
- Fever (12%)
- Worsening of wound (9%)
- Lower red blood cell count (6%)
- Vomiting (5%)
- Trouble sleeping (5%)
Children:
- Itching (13%)
- Fever (10%)
- Vomiting (7%)
Less Common Side Effects
Adults:
- Urinary tract infection
- Fast heart rate
- Rash
- Infections
- Bed sore
- Scar
- Bruises
Children:
- Nausea
- Constipation
- Common cold symptoms
- Rash
- Infections
NexoBrid (anacaulase) 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
Pros and cons of NexoBrid (anacaulase)
Pros
- Wells well at removing dead skin tissue in burn wounds
- FDA approved for both children and adults
- Works within 4 hours
Cons
- Must be applied by a healthcare professional
- Not for all burn types (e.g. chemical or electrical)
- Allergy risk for those sensitive to pineapple or papayas
Pharmacist tips for NexoBrid (anacaulase)
- You’ll usually receive NexoBrid (anacaulase) at a burn unit or hospital. This medication must be given by a healthcare professional who has the right training and tools.
- Before you get NexoBrid (anacaulase), your care team will also use a topical ointment, like Vaseline, to protect the skin around the treatment area.
- Once NexoBrid (anacaulase) is applied to your burn wound, your care team will leave it on for 4 hours. After that, they will scrape off any dead skin tissue to help your wound heal.
- Treatment with NexoBrid (anacaulase) can be painful. Your care team will usually give you pain-reliever at least 15 minutes before the application.
- You might need a second application of NexoBrid (anacaulase) about 24 hours after the first one. This is only done if your care team thinks you need more treatment.
- NexoBrid (anacaulase) can cause allergic reactions, including serious allergic reactions like anaphylaxis. Tell them right away if you notice trouble breathing, swelling, dizziness, or hives.
Common questions about NexoBrid (anacaulase)
Yes. NexoBrid (anacaulase) was first approved by the FDA for adults in December 2022. It was later approved for children in August 2024.
A healthcare professional will apply NexoBrid (anacaulase) directly to your burn and then cover it with a dressing. The gel stays on your skin for 4 hours so it can break down the dead tissue. After that, your care team will remove the dressing and gently scrape off the dead skin to help your wound heal.
NexoBrid (anacaulase) is made by Vericel Corporation.
NexoBrid (anacaulase) icontains a mix of enzymes (proteins) that breaks down dead skin tissue from a burn. One of the ingredients is bromelain, an enzyme taken from pineapple plant stems. Tell your care team if you’ve ever had an allergy to pineapples or papayas (which can cross-react with pineapples) before receiving this medication.
One treatment of NexoBrid (anacaulase) takes about 4 hours. This medication starts working as soon as it's applied, but your care team will leave it on your skin for the full 4 hours so it can work best. After that, they will carefully scrape away the dead skin from the treated area.
A clinical study showed that 94% of people who received NexoBrid (anacaulase) had most of the dead tissue removed from their burn wounds after treatment, compared to only 4% who received a placebo. People treated with NexoBrid (anacaulase) were also less likely to need surgery afterward compared to those who received standard burn care.
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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.
Serious allergic reaction
- Risk factors: Allergy to pineapples or bromelain | Allergy to papayas or papain
Serious allergic reactions, including anaphylaxis, have been reported in people using NexoBrid (anacaulase). The enzymes in NexoBrid (anacaulase) come from pineapples, and these can cross-react with papayas. Tell your care team if you're allergic to pineapples, bromelain (an enzyme in pineapple), papayas, or papain (an enzyme in papaya). Watch for signs of allergic reactions, such as swelling, rash, itchy skin, or trouble breathing. Get medical help right away if you notice any of these symptoms.
Blood clotting problems
- Risk factor: History of blood clotting problems | Also taking blood thinners | Low platelet counts | Peptic ulcers | Sepsis
NexoBrid (anacaulase) might raise your risk of bleeding if you have blood clotting problems or if you take blood thinners like Eliquis (apixaban) or warfarin. Get medical attention right away if you have any signs of bleeding like black or tarry stools, vomiting blood, unexplained bruises, bruises that get bigger, or bleeding that won’t stop.
NexoBrid (anacaulase) dosage
Typical dosage for NexoBrid (anacaulase)
NexoBrid (anacaulase) is applied to your skin by a healthcare professional. Your dose is based on your body surface area (BSA), which takes into account your weight and height.
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Adults: The typical dose is a 3 mm-thick layer applied to a burn area up to 15% of your BSA. The area will be covered with a dressing, and the medication will stay on for 4 hours. After that, your care team will gently scrape off the dead skin from the treated area.
- If all of the dead skin can't be removed, if you have multiple wounds, or if your burn covers more than 15% BSA, you might receive a second treatment 24 hours later.
- For both applications together, the total treated area can't be more than 20% of your BSA.
-
Children
- 6 years and older: The typical dose is a 3 mm-thick layer applied to a burn area up to 15% of your child's BSA. The area will be covered with a dressing, and the medication will stay on for 4 hours. After that, their care team will gently scrape off the dead skin from the treated area.
- Less than 6 years old: The typical dose is a 3 mm-thick layer applied to a burn area up to 10% of your child's BSA. The area will be covered with a dressing, and the medication will stay on for 4 hours. After that, their care team will gently scrape off the dead skin from the treated area.
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.
