Zinc Carnosine (Polaprezinc): The Gut and Mouth Lining Research


Most of the carnosine research on this site is about carnosine that travels through the blood to muscle and brain. Zinc carnosine is a different story. It is a compound made by binding zinc to L-carnosine, and its main uses are local: on the lining of the stomach, the small intestine and the mouth. In Japan it is a prescription medicine for stomach ulcers, known by the generic name polaprezinc. In other countries it is sold as a supplement. This page goes through what the compound is, how researchers think it works, and what the human trials found for gut injury, Helicobacter pylori infection, mouth sores during cancer treatment, taste loss and zinc deficiency, with the numbers that went against it as well as the ones that went for it.


Table of Contents

  1. What Polaprezinc Is
  2. How It Is Thought to Work
  3. The Painkiller Gut-Permeability Study
  4. Stomach Ulcers and Small-Bowel Injury
  5. Helicobacter pylori Add-On Trials
  6. Mouth Sores During Cancer Treatment
  7. Taste Disorders and Low Zinc
  8. Safety: Copper, Stomach Upset and Animal Data
  9. What Is Not Known
  10. Key Research Papers
  11. Connections
  12. Featured Videos

What Polaprezinc Is

Polaprezinc is the generic name for the zinc complex of L-carnosine. A 2021 review describes it as a white or yellowish-white crystalline powder with the formula C9H14N4O3Zn. It is almost insoluble in water but dissolves in dilute hydrochloric acid, the kind of acid found in the stomach. The same review states that polaprezinc is an anti-ulcer drug that was first approved in Japan in 1994.

A chemistry review by researchers who worked on the compound describes its structure: each zinc ion binds one carnosine molecule (a 1:1 complex), and the units link up into a long chain, a polymer. They describe it as the first drug taken by mouth in which zinc plays an essential role, and they classify it as a "membrane protection type" anti-ulcer drug.

Because the compound is about 22% zinc by weight (worked out from its formula), a 75 mg dose of polaprezinc carries roughly 17 mg of zinc. This matters when reading the trials: some report the dose as milligrams of polaprezinc (75 mg, 150 mg, 300 mg) and others as milligrams of zinc (17 mg, 34 mg, 68 mg).

In clinical practice in Japan, polaprezinc has also been used as a zinc replacement therapy for people with low zinc, according to a 2020 analysis of its trials. The medicine approval described here is Japanese. The 2007 British study described below calls zinc carnosine "a health food product".

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How It Is Thought to Work

Several mechanisms are proposed. They come from different kinds of evidence, and most of them come from cells and animals, not from people.

None of these mechanisms has been shown to be the reason for any result in people. They are explanations researchers propose for the human findings below.

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The Painkiller Gut-Permeability Study

The most quoted human study of zinc carnosine and the gut lining is a small British trial published in 2007. Indomethacin is a strong prescription painkiller from the nonsteroidal anti-inflammatory drug family, and drugs of this family are known to make the small intestine leakier. The researchers used it on purpose as a way to injure the gut in healthy people.

The same paper included the cell and rodent experiments listed in the section above. The authors concluded that zinc carnosine "stabilises gut mucosa" at concentrations likely to be found in the gut, and that further studies are warranted.

Limits that are visible in the paper itself: the trial had 10 people, it tested a short, deliberate injury in healthy volunteers rather than a disease, and it measured a laboratory marker rather than symptoms. The paper's competing-interest statement notes that extended health claims for zinc carnosine were under consideration by the U.S. Food and Drug Administration and that one author gave evidence at that hearing. The Sources and Supplements page summarises the same trial in its list of carnosine forms.

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Stomach Ulcers and Small-Bowel Injury

Polaprezinc's approved use in Japan is stomach ulcers. Two human trials show how it has been compared.

Against another lining-protecting drug

A 2022 multicentre, double-blind trial in China enrolled 224 people with stomach ulcers at 10 centres. One group took polaprezinc and the other took rebamipide, a different drug that protects the stomach lining. After 8 weeks, ulcer healing confirmed by gastroscopy was rated effective in 81.48% of the polaprezinc group and 74.31% of the rebamipide group (P = 0.1557, not a significant difference). Symptom improvement and side effects were similar in the two groups. The trial had no placebo group, so it shows that the two drugs performed alike, not how either compares with no treatment.

Long-term low-dose aspirin

Daily low-dose aspirin can injure the small intestine. A 2013 pilot trial in Japan used capsule endoscopy (a swallowed camera) to find 20 long-term aspirin users who already had small-bowel injury. They were randomised to polaprezinc 150 mg a day for 4 weeks or no added treatment. In the polaprezinc group, the median number of reddened areas and erosions or ulcers fell significantly; in the untreated group it did not change significantly. The trial was small, had no placebo and was open to both patients and doctors.

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Helicobacter pylori Add-On Trials

Helicobacter pylori is the stomach bacterium behind most stomach ulcers. The usual treatment combines an acid-blocking drug with two antibiotics, often called triple therapy. As resistance to antibiotics has grown, cure rates have fallen, and polaprezinc has been tested as an extra, non-antibiotic ingredient.

The 2022 meta-analysis

A 2022 systematic review and meta-analysis pooled 3 randomised trials with 396 people: 199 received polaprezinc plus triple therapy and 197 received triple therapy alone. Counting everyone who was randomised (intention to treat), the odds of clearing the infection were about twice as high with polaprezinc (odds ratio 2.01, 95% confidence interval 1.27 to 3.21). Counting only those who completed treatment, the odds ratio was 2.65 (1.55 to 4.54). Total side effects did not differ (odds ratio 1.06, 0.55 to 2.06). The authors wrote that "the evidence is still scarce, and larger trials are needed to confirm or refute our findings."

The largest single trial

A 2017 multicentre trial in 11 Chinese cities gave 14 days of triple therapy (omeprazole, amoxicillin and clarithromycin) alone or with polaprezinc at 75 mg or 150 mg twice daily. Of the 303 people who completed it, infection was cleared (intention to treat) in 77.0% with 75 mg, 75.9% with 150 mg and 58.6% with triple therapy alone. The higher dose did not clear more infections than the lower one, but it had more side effects (5.1% against 2.8% for 75 mg and 1.9% for triple therapy alone). No serious adverse events occurred. The paper states that the study was sponsored by a manufacturer of polaprezinc.

Newer trials

In all of these trials polaprezinc was an add-on to antibiotics. No trial in this set tested polaprezinc alone as a treatment for the infection.

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Mouth Sores During Cancer Treatment

Oral mucositis is the painful inflammation and ulceration of the mouth lining caused by chemotherapy and radiotherapy. Zinc carnosine has been given for it as mouthwashes, lozenges and thick suspensions that coat the mouth. The site's chamomile mouthwash page covers another approach studied for the same problem.

The 2026 meta-analysis

A 2026 systematic review and meta-analysis gathered 8 studies with 544 patients. Six of the studies were not randomised and had moderate or serious risk of bias. Under one statistical model (common effect), zinc carnosine was linked to fewer cases of severe mucositis, grade 3 or higher (odds ratio 0.48, 95% confidence interval 0.32 to 0.72). Under the random-effects model, which allows for differences between studies, the result was no longer statistically significant (odds ratio 0.44, 0.18 to 1.06). Results for grade 2 or higher were similar. On the GRADE scale used to rate evidence, the certainty was low for mucositis and very low for healing of the mouth lining. Only one study suggested better healing of surgical wounds in the mouth. No serious adverse events were reported.

Two transplant trials that disagreed

A smaller mouthwash trial

A 2026 single-blind randomised trial in Italy treated 42 cancer patients who already had mucositis. Those using a zinc-L-carnosine mouthwash four times a day for 30 days had less moderate and severe mucositis at 15 and 30 days (from 61% at the start to 14%), while the control group, who rinsed twice a day with water and sodium bicarbonate, got worse. The two groups did not rinse the same number of times, and the trial was small.

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Taste Disorders and Low Zinc

Zinc is needed for normal taste, and the site's page on zinc deficiency and loss of taste and smell covers the wider evidence. Polaprezinc has been studied in Japan both for taste loss and for raising low blood zinc.

The taste trial

A 2009 double-blind, placebo-controlled multicentre trial randomised 109 people with taste disorders of no known cause, including some with low blood zinc, to placebo (28 people) or polaprezinc providing 17 mg (27), 34 mg (26) or 68 mg (28) of zinc a day for 12 weeks. The group on 68 mg of zinc had a significant improvement in taste sensitivity compared with placebo; the abstract does not report a significant improvement for the 17 mg or 34 mg groups. The most common side effects were a rise in blood triglycerides and alkaline phosphatase, a fall in blood iron, and some stomach and gut complaints, none of them serious.

A 2023 meta-analysis of all zinc forms for taste disorders (12 randomised trials, 938 people; polaprezinc was one of the forms) found that taste improved more often with zinc than with control (relative risk 1.38, 95% confidence interval 1.16 to 1.64). The doses in these trials were 17 mg to 86.7 mg of zinc a day for three to six months.

Raising blood zinc: a dose-response analysis

A 2020 analysis pooled the individual patient data from 4 randomised placebo-controlled trials of polaprezinc in people with low zinc, at doses of 75 mg, 150 mg and 300 mg a day.

Kidney dialysis patients

Low zinc is common in people on long-term hemodialysis. Two Japanese randomised trials compared polaprezinc (34 mg of zinc a day) with zinc acetate (50 mg of zinc a day). In the first (91 patients, 2020), zinc acetate raised blood zinc faster, and blood copper fell significantly with zinc acetate but not with polaprezinc at 3 months. In the second (75 patients followed for a year, 2023), blood zinc was higher with zinc acetate for the first 12 weeks but the same from week 16 to week 52, and side effects that required a lower dose, including copper deficiency, were significantly more frequent with zinc acetate.

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Safety: Copper, Stomach Upset and Animal Data

Zinc and copper compete for absorption, and taking extra zinc for a long time can drain the body's copper. The site's page on zinc-induced copper deficiency covers this in detail. Polaprezinc is a zinc medicine, and the same risk appears in its own records.

The copper blood-count picture is covered on the site's page on copper deficiency, anemia and low white cells. Copper deficiency can look like a bone-marrow disease, as in the 2020 case.

Other side effects reported in the trials above:

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What Is Not Known

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Key Research Papers

  1. Mahmood A, FitzGerald AJ, Marchbank T, Ntatsaki E, Murray D, Ghosh S, Playford RJ. Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes. Gut. 2007;56(2):168-75. PubMed PMID: 16777920
  2. Mahmoud A, Abuelazm M, Ahmed AAS, Abdalshafy H, Abdelazeem B, Brašić JR. Efficacy and Safety of Polaprezinc-Based Therapy versus the Standard Triple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2022;14(19):4126. PubMed PMID: 36235778
  3. De Francesco P, Vescovi P, Pedrazzi G, Giovannacci I. Protective and Healing Effects of Zinc L-Carnosine on the Oral Mucosa: A Systematic Review and Meta-Analysis. Dent J (Basel). 2026;14(7):408. PubMed PMID: 42505716
  4. Furihata K, Tsuchikawa M, Miwa T, Naito Y, Oba K, Sakagami M. Efficacy and Safety of Polaprezinc (Zinc Compound) on Zinc Deficiency: A Systematic Review and Dose-Response Meta-Analysis of Randomized Clinical Trials Using Individual Patient Data. Nutrients. 2020;12(4):1128. PubMed PMID: 32316581
  5. Li M, Sun Z, Zhang H, Liu Z. Recent advances on polaprezinc for medical use (Review). Exp Ther Med. 2021;22(6):1445. PubMed PMID: 34721687
  6. Matsukura T, Tanaka H. Applicability of zinc complex of L-carnosine for medical use. Biochemistry (Mosc). 2000;65(7):817-23. PubMed PMID: 10951100
  7. Efthymakis K, Neri M. The role of Zinc L-Carnosine in the prevention and treatment of gastrointestinal mucosal disease in humans: a review. Clin Res Hepatol Gastroenterol. 2022;46(7):101954. PubMed PMID: 35659631
  8. Ohkawara T, Nishihira J, Nagashima R, Takeda H, Asaka M. Polaprezinc protects human colon cells from oxidative injury induced by hydrogen peroxide: relevant to cytoprotective heat shock proteins. World J Gastroenterol. 2006;12(38):6178-81. PubMed PMID: 17036391
  9. Qin Y, Naito Y, Handa O, Hayashi N, Kuki A, Mizushima K, Omatsu T, Tanimura Y, Morita M, Adachi S, Fukui A, Hirata I, Kishimoto E, Nishikawa T, Uchiyama K, Ishikawa T, Takagi T, Yagi N, Kokura S, Yoshikawa T. Heat shock protein 70-dependent protective effect of polaprezinc on acetylsalicylic acid-induced apoptosis of rat intestinal epithelial cells. J Clin Biochem Nutr. 2011;49(3):174-81. PubMed PMID: 22128216
  10. Meng F, Zhu S, Gong M, Tao H, Wang W, Wang G. Heat shock protein 70 is involved in polaprezinc driven cell protection against Helicobacter pylori-induced injury. Int J Med Microbiol. 2023;313(3):151582. PubMed PMID: 37285706
  11. Shen W, Zhao X, Han Z, Miao Y, Huang H, Zhang Z, Dong L, Nie Y, Li H, Ni R. Efficacy and safety of polaprezinc in the treatment of gastric ulcer: A multicenter, randomized, double-blind, double-dummy, positive-controlled clinical trial. Med Eng Phys. 2022;110:103860. PubMed PMID: 35999163
  12. Watari I, Oka S, Tanaka S, Aoyama T, Imagawa H, Shishido T, Yoshida S, Chayama K. Effectiveness of polaprezinc for low-dose aspirin-induced small-bowel mucosal injuries as evaluated by capsule endoscopy: a pilot randomized controlled study. BMC Gastroenterol. 2013;13:108. PubMed PMID: 23826914
  13. Tan B, Luo HQ, Xu H, Lv NH, Shi RH, Luo HS, Li JS, Ren JL, Zou YY, Li YQ, Ji F, Fang JY, Qian JM. Polaprezinc combined with clarithromycin-based triple therapy for Helicobacter pylori-associated gastritis: A prospective, multicenter, randomized clinical trial. PLoS One. 2017;12(4):e0175625. PubMed PMID: 28407007
  14. Ibrahim N, El Said H, Choukair A. Zinc carnosine-based modified bismuth quadruple therapy vs standard triple therapy for Helicobacter pylori eradication: A randomized controlled study. World J Clin Cases. 2022;10(1):227-235. PubMed PMID: 35071521
  15. Wu D, Li X, Li T, Xie W, Liu Y, Tan Q, Wu W, Sun Z, Chen T, Jiang H, Li J, Qin J, Zhao Y, Chen W. The Effect of Quadruple Therapy with Polaprezinc or Bismuth on Gut Microbiota after Helicobacter pylori Eradication: A Randomized Controlled Trial. J Clin Med. 2022;11(23):7050. PubMed PMID: 36498624
  16. Kitagawa J, Kobayashi R, Nagata Y, Kasahara S, Ono T, Sawada M, Ohata K, Kato-Hayashi H, Hayashi H, Shimizu M, Itoh Y, Tsurumi H, Suzuki A. Polaprezinc for prevention of oral mucositis in patients receiving chemotherapy followed by hematopoietic stem cell transplantation: A multi-institutional randomized controlled trial. Int J Cancer. 2021;148(6):1462-1469. PubMed PMID: 32984946
  17. Nakagaki M, Kennedy GA, Gavin NC, Butler J, Clavarino A, Whitfield K. A randomised trial of topical polaprezinc to prevent oral mucositis in patients undergoing haematopoietic stem cell transplantation (ToPaZ study). Support Care Cancer. 2023;32(1):44. PubMed PMID: 38112867
  18. Togni L, Sparabombe S, Mascitti M, Barlattani A, Isola G, Lo Russo L, Santarelli A. Zinc-L-carnosine mouthwash in oral mucositis patients: a single-blind, randomized, controlled trial. Minerva Dent Oral Sci. 2026;75(4):263-272. PubMed PMID: 41855025
  19. Sakagami M, Ikeda M, Tomita H, Ikui A, Aiba T, Takeda N, Inokuchi A, Kurono Y, Nakashima M, Shibasaki Y, Yotsuya O. A zinc-containing compound, Polaprezinc, is effective for patients with taste disorders: randomized, double-blind, placebo-controlled, multi-center study. Acta Otolaryngol. 2009;129(10):1115-20. PubMed PMID: 19037756
  20. Mozaffar B, Ardavani A, Muzafar H, Idris I. The Effectiveness of Zinc Supplementation in Taste Disorder Treatment: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Nutr Metab. 2023;2023:6711071. PubMed PMID: 36937245
  21. Okamoto T, Hatakeyama S, Konishi S, Okita K, Tanaka Y, Imanishi K, Takashima T, Saitoh F, Suzuki T, Ohyama C. Comparison of zinc acetate hydrate and polaprezinc for zinc deficiency in patients on maintenance hemodialysis: A single-center, open-label, prospective randomized study. Ther Apher Dial. 2020;24(5):568-577. PubMed PMID: 31794152
  22. Kumagai E, Furumachi K, Kurihara A, Hosokawa K, Hosohata K, Takai S. Zinc Acetate Hydrate Supplementation versus Polaprezinc Supplementation for Improving Hypozincemia in Hemodialysis Patients: A Randomized Clinical Trial. Int J Nephrol. 2023;2023:2403755. PubMed PMID: 37840640
  23. Koi S, Arai K, Nogami A, Toma H, Yamamoto M, Miura O, Nagao T. [Impaired hematopoiesis due to copper deficiency in a hemodialysis patient supplemented with zinc]. Rinsho Ketsueki. 2020;61(10):1487-1491. PubMed PMID: 33162445
  24. Kadoya H, Uchida A, Kashihara N. A Case of Copper Deficiency-Induced Pancytopenia With Maintenance Hemodialysis Outpatient Treated With Polaprezinc. Ther Apher Dial. 2016;20(4):422-3. PubMed PMID: 26948531
  25. Yamaguchi I, Shibata K, Takei M, Matsuda K. Changes in tissue contents of zinc, copper and iron in rats and beagle dogs treated with polaprezinc. J Toxicol Sci. 1996;21(3):177-87. PubMed PMID: 8887886

PubMed Topic Searches

  1. PubMed: polaprezinc
  2. PubMed: polaprezinc and Helicobacter pylori eradication
  3. PubMed: zinc carnosine and oral mucositis
  4. PubMed: polaprezinc and copper deficiency
  5. PubMed: zinc carnosine and intestinal permeability

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Connections

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