Boswellia (Frankincense)

• Osteoarthritis (knee/hand): Research suggests standardized Boswellia serrata extracts may modestly reduce pain and improve function versus placebo; supported by multiple randomized trials and meta-analyses (evidence: moderate). Effects sometimes detectable within 1–4 weeks, with continued improvement over 2–3 months.
• Inflammatory bowel disease (ulcerative colitis): Small randomized trials indicate Boswellia may improve symptoms and induce remission at rates similar to mesalamine in some studies; overall data are limited and heterogeneous (evidence: emerging to moderate).
• Asthma: Small randomized trials suggest improvements in symptoms and reduced attacks, likely via 5-lipoxygenase/leukotriene pathway inhibition; larger, modern trials are lacking (evidence: emerging).
• Peritumoral/cerebral edema (adjunct): A small randomized, placebo-controlled pilot trial in brain-tumor patients receiving radiotherapy found Boswellia reduced MRI-measured edema and allowed steroid reduction in some cases; confirmatory studies needed (evidence: emerging).
• Rheumatoid or other inflammatory arthritides: Some small studies and mechanistic data suggest symptom relief, but robust clinical evidence is limited (evidence: emerging).
• Mechanistic/biomarker effects: Boswellic acids (e.g., AKBA) inhibit 5-lipoxygenase and may reduce leukotriene synthesis and inflammatory markers; clinical translation varies by condition (evidence: moderate for mechanism, variable for outcomes).

• Common: Gastrointestinal upset (nausea, diarrhea, abdominal discomfort, heartburn/reflux), reported in a minority of users in trials; headache; mild dizziness; skin rash/itching.
• Less common: Dry mouth, constipation, fatigue.
• Rare but important: Elevations in liver enzymes or liver injury have been reported rarely; hypersensitivity reactions (including to resinous/fragrance products); potential increased bruising/bleeding (theoretical antiplatelet effect).
• Dose-related effects: GI complaints are more likely at higher doses.
• Overall tolerability in trials was generally similar to placebo for short-term use (weeks to a few months).

These are commonly used ranges in studies; optimal dosing varies by individual and condition.

• Standardized Boswellia serrata gum resin extracts (typically 30–65% boswellic acids): 300–500 mg, 2–3 times daily for osteoarthritis and general inflammation in trials spanning 4–12 weeks.
• High-AKBA extracts (e.g., 5-Loxin ~30% AKBA): 100–250 mg/day in divided doses improved knee osteoarthritis outcomes over 1–3 months in RCTs.
• Enhanced bioavailability extracts (e.g., Aflapin): about 100 mg/day used in some osteoarthritis trials.
• Ulcerative colitis trials: ~300–350 mg three times daily for 6–8 weeks.
• Asthma trials: ~300 mg three times daily for 6 weeks.
• Cerebral edema (adjunct in radiotherapy): up to ~4.2 g/day in divided doses short-term in a pilot RCT. Always consult a clinician for individualized guidance, especially when taking other medications or managing chronic conditions.

• Pregnancy: Avoid—insufficient safety data and theoretical uterine/bleeding effects.
• Breastfeeding: Avoid—insufficient safety data.
• Bleeding disorders or active bleeding: Use only with medical supervision due to possible antiplatelet effects.
• Before surgery or invasive dental procedures: Discontinue 1–2 weeks prior to reduce bleeding risk (conservative precaution).
• Concomitant anticoagulant or antiplatelet therapy (e.g., warfarin, DOACs, aspirin, clopidogrel): Increased bleeding risk—medical supervision advised.
• Liver disease or history of drug-induced liver injury: Use cautiously; consider baseline and periodic liver function monitoring.
• Allergy to Boswellia/frankincense, Burseraceae family resins, or fragrance resins: Contraindicated.
• Children/adolescents: Limited data—use only with clinician guidance.
• Concurrent strong CYP3A4/P-gp substrate medications with narrow therapeutic index (e.g., calcineurin inhibitors): Use cautiously and monitor drug levels (based on in vitro data; clinical relevance uncertain).