Meta Information
ID:boswellia
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/dietary/high-fat-meal
Target name:
Meal Containing Fat
Severity:
major
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The active compounds in Boswellia, boswellic acids, are fat-soluble and require dietary fat for proper absorption into the bloodstream, which can increase bioavailability by several fold.
Actionable advice:
Boswellia should be taken with a meal that contains healthy fats like olive oil, avocado, or nuts.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
As compared to the fasted state (treatment A), the administration of BSE-018 concomitantly with a high-fat meal (treatment B) led to several-fold increased areas under the plasma concentration-time curves as well as peak concentrations of beta-boswellic acid (betaBA), 11-keto-beta-boswellic acid (KbetaBA) and acetyl-11-keto-beta-boswellic acid (AKbetaBA).
Label source:
PubMed: Planta medica (2004)
Source url:
Exact phrase from label:
However, absorption of both is increased more than twice when taken together with a high-fat meal.
Label source:
PubMed: Advances in experimental medicine and biology (2016)
Action type:
informational_none
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The safety of Boswellia during pregnancy is not established. Traditionally, it has been associated with emmenagogue effects (stimulating menstrual flow), which could pose a risk to pregnancy.
Actionable advice:
Boswellia should not be used during pregnancy.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
Boswellia is also used as a stimulant, to increase urine flow, and for stimulating menstrual flow.
Label source:
Anecdotal: RxList
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if boswellic acids are excreted into breast milk or what their potential effects on a nursing infant might be.
Actionable advice:
Boswellia should be avoided while breastfeeding due to a lack of safety data.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
But there isn't enough reliable information to know if Boswellia serrata is safe to use in larger amounts as medicine when pregnant or breast-feeding.
Label source:
Anecdotal: WebMD
Action type:
avoid
Target id:
/procedure/surgery
Target name:
Surgery
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
336
Hours after target:
null
Description:
Boswellia may possess mild antiplatelet (blood-thinning) properties, which could increase the risk of excessive bleeding during and after surgical procedures.
Actionable advice:
Boswellia should be discontinued at least 2 weeks before any scheduled surgery.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
BSAE and BSWE at 3 mg dwt/mL completely inhibited ADP induced platelet aggregation and activities were comparable to 20 μg/mL of heparin.
Label source:
PubMed: Journal of ethnopharmacology (2011)
Source url:
Exact phrase from label:
Together, our study unravels the complex agonizing and antagonizing properties of boswellic acids on human platelets in pharmacologically relevant preparations of B. serrata gum extracts and prompts for careful evaluation of the safety of such extracts as herbal medicine in cardiovascular risk patients.
Label source:
PubMed: Planta medica (2017)
Source url:
Exact phrase from label:
The promising effect of B. serrata and BA can be attributed to its antioxidant, anti-inflammatory, immunomodulatory, cardioprotective, anti-platelet aggregation, antibacterial, antifungal, and broad antiviral activity.
Label source:
PubMed: Inflammopharmacology (2021)
Action type:
avoid
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Boswellia may have mild antiplatelet effects that can be additive with medications like warfarin, clopidogrel, or aspirin, theoretically increasing the risk of bruising and bleeding.
Actionable advice:
It is important to consult a doctor before combining Boswellia with blood-thinning medications; increased monitoring may be necessary.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CI=confidence interval ND=not determined There were approximately four times as many major bleeding episodes in the two groups receiving warfarin than in the group receiving aspirin alone.
Label source:
Action type:
monitor
Target id:
/class/immunosuppressants
Target name:
Immunosuppressant Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
As an immunomodulator, Boswellia could potentially interfere with the action of drugs designed to suppress the immune system, such as cyclosporine or tacrolimus.
Actionable advice:
Boswellia is best avoided with immunosuppressant therapy unless approved by a prescribing physician.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
1. We have previously shown that 11-keto boswellic acids (11-keto-BAs), the active principles of Boswellia serrata gum resins, activate p38 MAPK and p42/44(MAPK) and stimulate Ca(2+) mobilisation in human polymorphonuclear leucocytes (PMNL).
Label source:
PubMed: Coupling of boswellic acid-induced Ca2+ mobilisation and MAPK activation to lipid metabolism and peroxide formation in human leucocytes. (PMID 14691050)
Action type:
avoid
Target id:
/condition/bleeding-disorders
Target name:
Bleeding Disorders
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Due to its potential antiplatelet effects, Boswellia may increase bleeding risk in individuals with pre-existing conditions like hemophilia or von Willebrand disease.
Actionable advice:
This is best used with caution, and it is important to talk to a hematologist for those with a diagnosed bleeding disorder.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
BSAE and BSWE at 3 mg dwt/mL completely inhibited ADP induced platelet aggregation and activities were comparable to 20 μg/mL of heparin.
Label source:
PubMed: Journal of ethnopharmacology (2011)
Source url:
Exact phrase from label:
Together, our study unravels the complex agonizing and antagonizing properties of boswellic acids on human platelets in pharmacologically relevant preparations of B. serrata gum extracts and prompts for careful evaluation of the safety of such extracts as herbal medicine in cardiovascular risk patients.
Label source:
PubMed: Planta medica (2017)
Source url:
Exact phrase from label:
The promising effect of B. serrata and BA can be attributed to its antioxidant, anti-inflammatory, immunomodulatory, cardioprotective, anti-platelet aggregation, antibacterial, antifungal, and broad antiviral activity.
Label source:
PubMed: Inflammopharmacology (2021)
Action type:
informational_none
Target id:
/class/nsaids
Target name:
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Although they work on different inflammatory pathways, concurrent use of Boswellia and NSAIDs (e.g., ibuprofen) could theoretically increase the risk of gastrointestinal irritation or bleeding.
Actionable advice:
Caution may help when combining with NSAIDs for long durations; it is worth monitoring for any stomach discomfort.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
5.15 Disseminated Intravascular Coagulation (DIC)
6 ADVERSE REACTIONS
Reference ID: 5482829
FULL PRESCRIBING INFORMATION
WARNING: RISK OF SERIOUS CARDIOVASCULAR AND GASTROINTESTINAL
EVENTS
Cardiovascular Thrombotic Events
• Nonsteroidal anti-inflammatory drugs (NSAIDs) cause an increased risk of serious
cardiovascular thrombotic events, including myocardial infarction, and stroke, which
can be fatal.
Label source:
Action type:
monitor
Target id:
/class/cyp3a4-substrates
Target name:
Drugs Metabolized by CYP3A4
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
In vitro studies suggest Boswellia may inhibit the CYP3A4 enzyme, which could slightly increase levels of medications metabolized by this pathway, such as some statins or calcium channel blockers.
Actionable advice:
If you take multiple medications, ask your pharmacist if any are sensitive CYP3A4 substrates before starting Boswellia.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Monitor for symptoms of hypotension and edema
when amlodipine is co-administered with CYP3A4 inhibitors.
Label source:
Action type:
separate
Target id:
/class/cyp2c9-substrates
Target name:
Drugs Metabolized by CYP2C9
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Some evidence indicates Boswellia might inhibit the CYP2C9 enzyme, potentially raising concentrations of drugs like warfarin or certain oral diabetes medications.
Actionable advice:
Exercise caution and consult your doctor if taking medications metabolized by CYP2C9, particularly those with a narrow therapeutic index.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CYP2C9, a polymorphic enzyme, is likely to be the principal form of human liver CYP450 that modulates the in vivo anticoagulant activity of warfarin.
Label source:
Action type:
informational_none
Target id:
/class/p-glycoprotein-substrates
Target name:
P-glycoprotein (P-gp) Substrate Drugs
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Boswellia may inhibit the P-glycoprotein (P-gp) efflux pump in the gut, which could increase the absorption and blood levels of certain drugs like digoxin or fexofenadine.
Actionable advice:
This potential interaction is worth keeping in mind when taking medications known to be P-gp substrates.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Therefore, drugs that induce/inhibit P-glycoprotein have the potential to alter digoxin
pharmacokinetics.
Label source:
Action type:
informational_none
Target id:
/intervention/curcumin
Target name:
Curcumin
Severity:
minor
Interaction type:
synergistic
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Boswellia (inhibiting the 5-LOX pathway) and Curcumin (inhibiting COX and NF-κB pathways) target different aspects of the inflammatory cascade, potentially offering broader anti-inflammatory effects when combined.
Actionable advice:
Consider taking Boswellia and Curcumin together for complementary anti-inflammatory support.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
boswellic acid combined with curcumin ^^ were reported useful in patients with osteoarthritis although data are conflicting
Label source:
Anecdotal: MSKCC
Action type:
informational_none
Target id:
/class/chemotherapy-radiation
Target name:
Chemotherapy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Boswellia can interfere with drug-metabolizing enzymes (e.g., CYP3A4) and transporters (P-gp), which can unpredictably alter the concentration, efficacy, and toxicity of chemotherapy drugs.
Actionable advice:
Boswellia should not be taken during chemotherapy unless specifically directed and monitored by an oncologist.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
the same chemotherapy alone.
Label source:
Action type:
avoid