Written by Ellen McDonell, Gabriele Dennert and the CAM-Cancer Consortium.
Updated September 11, 2018

Boswellia spp

Is it safe?

Adverse effects

Several of the above mentioned clinical investigations reported the presence or absence of side effects of Boswellia extracts 4,17-18,20,34. In 134 cancer patients receiving BAs, 11 cases of possible adverse effects were reported: nausea/emesis WHO III (one patient), skin rash WHO II (two patients), diarrhoea WHO I/II (six patients), gastrointestinal pain (two patients), loss of appetite and heartburn (six patients). In the former three patients with nausea/emesis and skin rash, Boswellia administration had to be terminated.


Pregnancy and lactation; nothing is known about teratogenicity and possible effects of Boswellia extracts on breast-fed infants. There is no information available on mutagenic effects of Boswellia extracts in women and men or long-term carcinogenicity.

Further known contraindications are any previous allergic reactions to Boswellia extracts or components of these extracts.


Findings of an in vitro study of extracts of various Boswellia spp. showed minor inhibitory effects on the CYP enzymes 1A2 und 2D5 as well as a moderate inhibition of the enzymes 2C8, 2C9, 2C19, and 3A4 32. Another in vitro study showed a concentration-dependent modulation of P-glycoprotein function in various cell systems; the degree of P-GP inhibition varied with the type of Boswellic acid studied.

Inhibition of P-GP at the blood brain barrier in humans seems unlikely, as the Boswellian acid plasma levels following oral administration are lower than the concentrations used in vitro. On the other hand, inhibitory effects on the P-GP of the intestinal mucosa are conceivable as a result of the higher intraluminal concentrations of Boswellic acids upon oral application 33.

In general, although these results may suggest inhibitory effects of Boswellia components on CYP450 enzymes and P-glycoprotein, they represent merely anecdotal evidence based on cell systems thus precluding any firm conclusions as to the clinical relevance of potential interactions.

Citation Ellen McDonell, Gabriele Dennert, CAM-Cancer Consortium. Boswellia spp [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Boswellia-spp. September 11, 2018.


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