Nattokinase

Common Name(s): Flite Tabs, Natto-K, Natto, NattoMax, Natural Super Kinase – Spray Dried(NSK-SD), Vein Caps, Cardiokinase, Fermented soybeans, Nattokinase, Subtilisin NAT, Subtilisin natto

Medically reviewed by Drugs.com. Last updated on Jul 22, 2021.

Clinical Overview

Use

Nattokinase is promoted for use as a fibrinolytic agent; however, clinical trials are currently lacking to support this use. There is no substantial evidence that nattokinase lowers blood pressure in hypertension. Nattokinase has been used with pycnogenol for the prevention of deep vein thrombosis (DVT) in long airline flights.

Dosing

Clinical studies to guide safe and effective dosing are lacking. Nattokinase 100 mg (equivalent to 2,000 fibrin units [FU]) taken up to 3 times a day, has been used in some studies.

Contraindications

Avoid nattokinase in patients with ischemic stroke, peptic ulcer, and coagulation disorders, as well as pre- and post-surgery.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

Interactions

Nattokinase has pharmacologic effects that could increase the risk of bleeding with anticoagulants and antiplatelet agents. High concentrations of vitamin K₂ in natto can reduce the international normalized ratio (INR) with warfarin; this may also occur with nattokinase supplements if vitamin K₂ is not removed during the production process.

Adverse Reactions

Small short-term trials evaluating the effect of nattokinase reported no adverse reactions. There is a theoretical risk of bleeding, based on a case report of acute cerebellar hemorrhage in a patient with a history of ischemic stroke. Thrombosis was reported after substitution of nattokinase for warfarin in a patient with a mechanical aortic valve. Rare cases of late-onset anaphylaxis with natto have been attributed to poly (gamma-glutamic acid), a product of the fermentation process that may be present in nattokinase supplements.

Toxicology

Nattokinase was nonmutagenic in the Ames test and a cell-based chromosomal aberration study in manufacturer studies. The median lethal dose (LD₅₀) in a rodent study was more than 1,000 mg/kg.

Source

Nattokinase is a fibrinolytic enzyme found in natto, a traditional Japanese food. It is produced by Bacillus subtilis (also called Bacillus natto or Bacillus subtilis natto) during the fermentation process that turns boiled soybeans into natto. Similar fibrinolytic enzymes are found in other traditional fermented foods, including chungkook-jang in Korea, douchi in China, thua nao in Thailand, and tempeh in Indonesia.1, 2 Fermentation technology is used to manufacture nattokinase supplements that are formulated into powders, pills, and capsules, alone or with other ingredients.2, 3

History

The fermentation of soybeans is a common traditional Asian and African culinary practice. Natto is a traditional Japanese food that has been consumed for at least 1,000 years. It is usually served as breakfast with rice, on toast, or as sushi; it is also available as an ice cream flavor. Traditionally, it has been used for heart conditions, to relieve fatigue, and as an antiberiberi agent. In the 1980s, researchers investigating food substances for thrombolytic properties isolated the enzyme nattokinase from natto.1, 3, 4 The first commercial nattokinase product was marketed in Japan in 1998.5 Although it has been marketed as a dietary supplement in ma...