Boswellia belongs to supplements with a generally favorable safety profile, but "natural" does not mean "suitable for everyone". There are conditions and situations in which intake should be postponed or agreed with a doctor. The editorial team has systematized the contraindications and precautions, relying on clinical data and review sources.
Absolute restrictions
An absolute contraindication is a confirmed allergy to boswellia or other components of the product. If a rash, itching or swelling previously occurred after contact with frankincense - in the form of an ointment, essential oil or smoke - the supplement should not be taken orally.
People allergic to other plant resins, in particular myrrh from the same Burseraceae family, should also be careful because of possible cross-sensitivity. In such cases it is advisable to consult an allergist.
The same category can include people who previously developed signs of liver injury while taking boswellia supplements. A repeat intake in such a situation is unacceptable.
Finally, one should not take products whose composition is not fully disclosed: if you cannot verify exactly what and in what dose is contained in the capsule, the risks cannot be assessed either.
Pregnancy, lactation and children
The safety of boswellia during pregnancy and breastfeeding has not been studied in controlled trials. In traditional medicine there are mentions of a possible effect of the resin on pelvic blood circulation, although there is no scientific confirmation of this. In the absence of data, the general principle of caution means avoiding the supplement.
The same applies to the pregnancy-planning period if a woman is taking any supplements without agreement with an obstetrician-gynecologist. It is better to discuss with the doctor the full list of products you are taking.
As for children and adolescents, there are very few clinical data. Individual studies in inflammatory bowel disease or asthma in childhood do not provide grounds for independent use. The supplement can be given to children only as prescribed by a doctor.
For young athletes who complain of pain in the joints or tendons, examination is the priority: during growth such symptoms may be a manifestation of apophysitis or other conditions that require load adjustment rather than supplements.
Conditions requiring caution
There is a number of conditions in which intake is possible only after consulting a doctor. The editorial team has compiled them into a table.
| Condition | Why caution is needed | Recommendation |
|---|---|---|
| Liver diseases | Isolated reports of hepatotoxicity of boswellia supplements | Only with a hepatologist's consent, monitoring of liver function tests |
| Gastritis, peptic ulcer disease, GERD | The most common side effects are gastrointestinal | Take with food, monitoring, consultation with a gastroenterologist |
| Autoimmune diseases | Possible effect on immune processes, interaction with therapy | Discuss with a rheumatologist or other treating physician |
| Blood clotting disorders | Theoretical effect on platelet aggregation, data contradictory | Avoid without a doctor's approval |
| Planned surgery | Uncertain effect on bleeding and anesthesia | Inform the surgeon, usually discontinue in advance |
It is especially important not to replace prescribed treatment of chronic inflammatory diseases - rheumatoid arthritis, Crohn's disease, ulcerative colitis, asthma - with boswellia. Although boswellia has been studied in these conditions (for example, Gerhardt et al., 2001; Gupta et al., 1998), the evidence is insufficient to replace standard therapy.
Discontinuing basic drugs on one's own in favor of a supplement can lead to an exacerbation of the disease with serious consequences. If you are interested in boswellia as an addition, discuss it with your doctor.
Medication use and interactions
Laboratory studies have shown that boswellia extracts can inhibit some cytochrome P450 enzymes (Frank and Unger, 2006) and also affect transport proteins. In humans the clinical significance of these effects has not been established, but changes in drug concentration are theoretically possible.
The most attention should be paid to drugs with a narrow therapeutic window, when even a small change in concentration matters. These include some anticoagulants, immunosuppressants after transplantation, antiepileptic drugs, and certain antiarrhythmic drugs.
- Anticoagulants and antiplatelet agents - theoretical risk of enhanced action and bleeding.
- Immunosuppressants - possible changes in metabolism and effect on the immune response.
- NSAIDs - summation of gastrointestinal side effects, difficulty assessing the effect.
- Any drugs with a narrow therapeutic window - risk of a change in concentration.
A practical rule: if you take prescription drugs constantly, tell your doctor or pharmacist about your intention to start taking boswellia, even if you consider the supplement harmless.
Sport and special situations
Boswellia itself is not on the WADA Prohibited List. However, for athletes undergoing doping control there is a risk of supplement contamination with prohibited substances, which the IOC consensus on dietary supplements warns about (Maughan et al., 2018). So it is worth choosing products with independent certification.
People preparing for planned surgical interventions, in particular arthroscopy or joint replacement, should inform the surgeon and anesthesiologist about all supplements. Usually they are recommended to be discontinued in advance.
If joint pain is accompanied by swelling, redness, fever or arose after an injury, diagnosis is needed. A supplement should not mask symptoms that require treatment.
Elderly people who take many drugs at the same time are especially sensitive to interactions. For them, a doctor's consultation before starting intake is especially important.
Editorial conclusions
Boswellia should not be taken in case of allergy to it or related resins, during pregnancy and breastfeeding, and for children - only as prescribed by a doctor.
People with liver diseases, gastrointestinal tract diseases, autoimmune conditions, blood clotting disorders, and before surgery need a prior consultation.
Particular attention is required for the combination with anticoagulants, immunosuppressants and other drugs with a narrow therapeutic window.
We also recommend reading our articles "Side effects of Boswellia", "How to take Boswellia: dosage, timing, duration" and "Boswellia: what it is and how it works".
References
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Boswellia. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases.
- Frank A, Unger M. Analysis of frankincense from various Boswellia species with inhibitory activity on human drug metabolising cytochrome P450 enzymes using liquid chromatography mass spectrometry after automated on-line extraction. J Chromatogr A. 2006;1112(1–2):255–262.
- Gerhardt H, Seifert F, Buvari P, et al. Therapy of active Crohn disease with Boswellia serrata extract H 15. Z Gastroenterol. 2001;39(1):11–17.
- Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res. 1998;3(11):511–514.
- Ammon HPT. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006;72(12):1100–1116.
- Yu G, Xiang W, Zhang T, et al. Effectiveness of Boswellia and Boswellia extract for osteoarthritis patients: a systematic review and meta-analysis. BMC Complement Med Ther. 2020;20(1):225.
- Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–455.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
