In the U.S.—

In Canada—

• Chemonucleolytic, herniated lumbar intervertebral disk therapy

Chymopapain (KYE-moe-pa-pane ) is injected directly into a herniated (``slipped'') disk in the spine to dissolve part of the disk and relieve the pain and other problems caused by the disk pressing on a nerve. Before you receive chymopapain, you will be given an anesthetic (either a general anesthetic to put you to sleep or a local anesthetic).

Very rarely, use of chymopapain may cause serious side effects, including paralysis of the legs or death. Another dangerous side effect of chymopapain injection is a severe allergic reaction called anaphylaxis. This side effect occurs in less than 1% of the patients receiving the medicine, but it occurs more often in women than in men. Before receiving chymopapain, you should discuss its use, and the possibility of anaphylaxis or other serious side effects, with your doctor.

Chymopapain injections are given only in a hospital, usually in an operating room, by your surgeon. This medicine is available in the following dosage form:

Parenteral
• Injection (U.S. and Canada)

In deciding to use a medicine, the risks of receiving the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For chymopapain, the following should be considered:

Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to chymopapain, papaya, meat tenderizer, contact lens cleaning solutions, beer, or iodine. Also tell your doctor if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy—Studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding—It is not known whether chymopapain passes into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are receiving this medicine and who wish to breast-feed should discuss this with their doctor.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of chymopapain in children with use in other age groups.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of chymopapain in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your doctor if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

• Allergic reaction to papaya or
• Previous chymopapain injection—Increased risk of serious allergic reactions

• Diseases of the back (spine), muscles, or nerves or
• High blood pressure (hypertension) or
• Stroke or bleeding in the brain (or if any member of your family has ever had these problems) or
• Surgery of the back—The chance of side effects may be increased

Dosing—

The dose of chymopapain will be different for different patients and must be determined by your doctor.

Along with its needed effects, a medicine may cause some unwanted effects. Very rarely, use of chymopapain has caused serious side effects, including paralysis of the legs or death. Also, this medicine may cause dangerous allergic reactions, especially in women.

Although not all of the following side effects may occur, if they do occur they may need medical attention. Tell your health care professional if any of the following side effects occur:

• Rare
  • Abdominal or stomach cramps or pain;  changes in facial skin color;  constipation (severe) ;  convulsions (seizures);  decreased or uncontrolled urination;  fast or irregular breathing;  headache (sudden, severe, and continuing) ;  hot skin;  pain, tenderness, swelling and/or skin color changes of the leg or foot;  puffiness or swelling of the eyelids or around the eyes;  runny nose;  shortness of breath, troubled breathing, tightness in chest, or wheezing;  skin rash, redness, hives, or itching;  swelling of abdomen or stomach ;  uncontrolled bowel movements;  vomiting;  weakness in legs (severe) or problems with moving legs 
  
  

Other side effects may occur that usually do not need medical attention. Pain and muscle spasms in the lower back may last for several days after you have received this medicine. Stiffness or soreness in the back may last for several months. Other side effects may go away after a short time. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Back pain, stiffness, or soreness;  muscle spasms in lower back 
  
  

• Less common or rare
  • Cramps, pain, or mild weakness in legs;  decreased sensitivity to pain;  dizziness;  feeling of burning in lower back;  foot drop;  headache;  nausea;  numbness or tingling in legs or toes 
  
  

Some side effects may not appear until several days or weeks after you have received chymopapain. Check with your doctor as soon as possible if any of the following side effects occur within 1 month after you have received this medicine:

• Back pain or muscle weakness (sudden and severe);  skin rash, hives, or itching 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.