Evigrade
DrugsCosmetic ingredientsCalculatorsInteractionsEvigrade SkinEvigrade Meds ↗
ConditionsJournalMethodologyPro for practitioners
ESRU

Boswellia

Botanical supplement, gum resin of Boswellia serrata (Indian frankincense), standardised by AKBA (acetyl-11-keto-beta-boswellic acid); popular iHerb «joint health» category

ATC code: M01AX-BOSWELLIA

Brand names – supplements: 5-Loxin, AprèsFlex, Life Extension 5-LOXIN Advanced, BoswellinSupplements are not tested in clinical trials and are not registered as medications.

Updated · Methodology

Indications

B

Knee osteoarthritis

Adjunct

Boswellia is an over-the-counter herbal extract. The Yu meta-analysis (BMC Complement Med Ther 2020) pooled 7 RCTs with 545 participants: in knee osteoarthritis, boswellia extracts (100–250 mg AKBA-standardised per day, 4–24 weeks) reduced VAS pain by a mean 17 mm and improved WOMAC versus placebo. The effect is comparable to weak NSAIDs in small samples. The double-blind RCT by Sengupta (Arthritis Res Ther 2008) with 5-Loxin 100 mg/day for 90 days showed a clinically meaningful pain reduction by day 7. 2019 mentions boswellia conditionally for knee osteoarthritis as an option when NSAIDs are contraindicated, not as first line. Standard care under 2022 and OARSI 2019 is exercise, weight control, paracetamol or topical NSAIDs, with oral NSAIDs in short courses if needed. If boswellia is considered instead of NSAIDs because of gastritis or cardiovascular risk, discuss with a doctor – the extract is generally well tolerated but interacts with warfarin and lowers some drugs via CYP3A4.

Sources

  1. BMC Complement Med Ther (Yu et al.): Efficacy and safety of Boswellia serrata extract in patients with osteoarthritis of knee: a systematic review and meta-analysis (2020)
  2. Arthritis Res Ther (Sengupta et al.): A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee (2008)
  3. Phytomedicine (Kimmatkar et al.): Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee: a randomized double blind placebo controlled trial (2003)
  4. NICE: Osteoarthritis in over 16s: diagnosis and management (NG226) (2022)

ICD-10: M17 · ICD-11: FA01

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Superfoods and adaptogens (marketing category)

Not recommended

Boswellia is actively marketed as a «universal anti-inflammatory for everything» – joints, gut, asthma, eczema, autoimmune disease, oncology, Alzheimer disease and even «brain rejuvenation». The actual evidence base is limited to knee osteoarthritis and a few small RCTs in Crohn disease and ulcerative colitis without confirmation in large studies. For asthma, eczema, rheumatoid arthritis and oncology, in vitro and animal data are not backed by quality human RCTs. in 2010 rejected all boswellia health claims. AESAN classifies the product as a complemento alimenticio without therapeutic indication. The «anti-inflammatory for everything» idea is marketing, not clinical: 5-lipoxygenase suppression is a narrow pathway, while inflammation in different diseases runs through different mechanisms and requires targeted therapy (DMARDs in rheumatoid arthritis, inhaled corticosteroids in asthma, biologics in Crohn disease). If boswellia was bought for «inflammation in general» or instead of prescribed treatment, discuss with a doctor – real diagnoses are treated with drugs of proven efficacy, not a plant resin.

Sources

  1. EFSA NDA Panel: Scientific Opinion on the substantiation of health claims related to Boswellia serrata gum resin (2010)
  2. BMC Complement Med Ther (Yu et al.): Efficacy and safety of Boswellia serrata extract in patients with osteoarthritis of knee: a systematic review and meta-analysis (2020)
How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Boswellia is a gum resin tapped from the bark of Boswellia serrata, native to India, Pakistan, Yemen and the Horn of Africa. Its main active molecules are pentacyclic triterpenic acids, particularly AKBA (acetyl-11-keto-beta-boswellic acid). In vitro and animal studies show AKBA inhibits 5-lipoxygenase and lowers leukotriene (LTB4) production – an anti-inflammatory mechanism that does not overlap with NSAIDs or COX inhibitors. Market standardised extracts include Boswellin (40–65% total boswellic acids), 5-Loxin (30% AKBA) and AprèsFlex (20% AKBA with improved bioavailability). in 2010 rejected all boswellia health claims – not for lack of data but because the cause-and-effect relationship did not meet EU criteria. AESAN classifies the product as a complemento alimenticio without therapeutic indication. In India, Ayurveda has used boswellia (shallaki) for joint pain for centuries.

Safety

Contraindications

  • Known hypersensitivity to Boswellia serrata
  • Warfarin or DOAC therapy – increased bleeding risk
  • Severe hepatic impairment
  • Co-administration with CYP3A4 substrates (statins, immunosuppressants, some oncology drugs) – plasma-level monitoring needed

Serious adverse effects

  • Bleeding amplification when combined with anticoagulants and antiplatelet drugs
  • Severe allergic reactions in sensitised users (rare)

Common adverse effects

  • Gastrointestinal discomfort, heartburn, nausea
  • Diarrhoea in the first days of use
  • Skin rash in predisposed users

Pregnancy: can you take Boswellia?

Boswellia safety in human pregnancy has not been studied in RCTs. Traditional Ayurveda classed the product as an emmenagogue and contraindicated it in pregnancy because of potential uterine stimulation. EMA and EFSA have set no safe dose for pregnant women. AEMPS and AESAN advise against supplements without therapeutic indication during pregnancy.

Breastfeeding: can you take Boswellia?

Lactation safety has not been studied in RCTs. No data on transfer of boswellic acids into human milk. Boswellia supplements are not justified during lactation.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Check interaction with another drug

Opens the checker prefilled with this drug. Pick the second one from your regimen.

Open checker

Summary of a multi-drug list →

Medicine list: everything you take in one place →

Frequently asked

What is Boswellia used for?

Boswellia is evaluated for the following indications with varying evidence strength: Knee osteoarthritis (evidence tier B), Superfoods and adaptogens (marketing category) (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Boswellia?

Common side effects of Boswellia (≥ 1 in 100): Gastrointestinal discomfort, heartburn, nausea, Diarrhoea in the first days of use, Skin rash in predisposed users. See the Safety section for uncommon and serious reactions.

Is Boswellia safe during pregnancy?

Boswellia safety in human pregnancy has not been studied in RCTs. Traditional Ayurveda classed the product as an emmenagogue and contraindicated it in pregnancy because of potential uterine stimulation. EMA and EFSA have set no safe dose for pregnant women. AEMPS and AESAN advise against supplements without therapeutic indication during pregnancy.

Is Boswellia compatible with breastfeeding?

Lactation safety has not been studied in RCTs. No data on transfer of boswellic acids into human milk. Boswellia supplements are not justified during lactation.

Who should not take Boswellia?

Boswellia is contraindicated in: Known hypersensitivity to Boswellia serrata; Warfarin or DOAC therapy – increased bleeding risk; Severe hepatic impairment; Co-administration with CYP3A4 substrates (statins, immunosuppressants, some oncology drugs) – plasma-level monitoring needed. Full list in the Safety section.

Other drugs in this group

Celecoxib, Dexketoprofen, Diclofenac, Etoricoxib, Glucosamine + Chondroitin, Lornoxicam, Stinging nettle leaf, Glucosamine