Boswellia and medications.
Boswellia is in the Distil supplement database, evidence Grade B. The page below lists every medication we have explicitly assessed it against.
Boswellia, standardised to its active boswellic acid AKBA, is proposed to work through 5-lipoxygenase inhibition, a different anti-inflammatory route to curcumin's NF-kB pathway and omega-3's prostaglandin effects, which is why the three are often combined. Doses are 100 to 250mg of AKBA at 30 to 40 percent strength, or 900 to 1,200mg of standard boswellia. The Grade B evidence is strongest for osteoarthritis pain and physical function, with one well-known trial reporting improvement within a week at the higher dose. We do not recommend it for gut or bowel conditions, because a year-long placebo-controlled trial in Crohn's disease points the other way. Holtmeier and colleagues ran a 22-centre study giving Boswellia or placebo for a year to 108 people with Crohn's disease in remission, and it was stopped early because the two groups could not be told apart: 59.9 percent stayed in remission on Boswellia and 55.3 percent on placebo, with no advantage on any disease-activity or inflammation measure. Crohn's and colitis belong with a gastroenterologist in any case. Its asthma evidence does not reach the same bar: one small 1998 trial that has never been independently replicated, so asthma management belongs with a GP. It is generally very well tolerated, with mild stomach upset the main complaint. Two interaction points matter. There is a theoretical mild blood-thinning effect at high doses, so anticoagulant users should be mindful, though its antiplatelet potency is rated negligible to low, well below omega-3 or ginkgo. Separately, laboratory work on the gum resin shows it can inhibit CYP3A4, the liver and gut enzyme that clears many prescription drugs, with one study reporting the opposite effect, increased enzyme activity. Because the direction is unsettled, and because our literature search found no study of the combination in people, we treat boswellia as a do-not-combine for anyone on a drug with a narrow safe range that depends on that enzyme: the anti-rejection medicines used after a transplant, tacrolimus, ciclosporin, sirolimus and everolimus, and antiretroviral medication for HIV. Anyone in either group should keep supplement decisions with their transplant or HIV team. It pairs naturally with curcumin and omega-3 for joint and inflammation goals. A reasonable option for joint discomfort for people not on those medications.
Below are the 10 documented pairs we have explicitly assessed for Boswellia: 10 severe. The pairs cluster around 2 mechanisms: CYP-mediated metabolism and CYP3A4 inhibition. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Last reviewed 27 August 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
CYP-mediated metabolism
Severe Does Boswellia interact with Efavirenz?
Boswellia may change how quickly the body clears efavirenz, and the laboratory evidence points both ways at once, so we cannot say whether your levels would go up or down. Either direction matters, and efavirenz is less forgiving than most: a level that drifts too low may let the virus rebound and become resistant to this whole family of HIV medicines, while a level that drifts too high tends to bring on dizziness, vivid dreams and mood changes. We treat this as a do-not-combine pair, and if you are already taking both, tell your HIV team before you change anything.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP3A4 inhibition
Severe Does Boswellia interact with Ciclosporin?
Boswellia may slow how the body clears ciclosporin and raise its blood levels, though one laboratory study suggests the opposite effect. Because the direction is unsettled and ciclosporin has to stay within a narrow range, we treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Severe Does Boswellia interact with Everolimus?
Boswellia may slow how the body clears everolimus and raise its blood levels, with one laboratory study pointing the other way. Because the direction is unsettled and everolimus has to stay within a narrow range, we treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Severe Does Boswellia interact with Sirolimus?
Boswellia may slow how the body clears sirolimus and raise its blood levels, with one laboratory study pointing the other way. Because the direction is unsettled and sirolimus has to stay within a narrow range, we treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Severe Does Boswellia interact with Tacrolimus?
Boswellia may slow how the body clears tacrolimus, which can push tacrolimus blood levels higher than intended. One laboratory study points the other way, toward faster clearance and levels that drift too low. Because we cannot tell which way it would go for you, we treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
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How the checker decides
Every result has a source
Each pair we have assessed is cited to a published study (PMID) or the British National Formulary, so you can read the source yourself.
Four kinds of answer
Severe, caution, no known interaction, and not yet assessed. A pair we have not assessed is never shown as clear.
- Severe
- Caution
- No known interaction
- Not yet assessed
Nothing in our data is not a clearance
When nothing in our data records a problem with a pair, the result says no known interaction at typical doses, which is not a clearance: your pharmacist or GP can check the pair against your full medical history.
A full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
£49 until 30 June 2027 · £79 from 1 July 2027.
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