Drug & supplement interaction

Boswellia Serrata + Acetaminophen, Butalbital, Codeine

Acetaminophen, Butalbital, Codeine brand name: Bancap w/ Codeine.

Moderate Interaction
The bottom line Moderate

Acetaminophen, Butalbital, Codeine falls into 2 drug categories that Boswellia Serrata can interact with; the most serious is rated moderate. Theoretically, Boswellia serrata might increase the levels of CYP2D6 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Boswellia Serrata and Acetaminophen, Butalbital, Codeine

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Boswellia Serrata interacts with whole categories of medication. Acetaminophen, Butalbital, Codeine falls into 2 of those categories, so it can interact with Boswellia Serrata in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

1 of 2

Why this applies to Acetaminophen, Butalbital, Codeine

Acetaminophen, Butalbital, Codeine falls under CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES — the group Boswellia Serrata interacts with.

Theoretically, Boswellia serrata might increase the levels of CYP2D6 substrates.
In vitro research shows that Boswellia serrata gum resin inhibits CYP2D6 enzymes.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

This combination pill contains codeine, which is interesting here. Codeine is actually a prodrug, meaning your body has to convert it into morphine using an enzyme called CYP2D6 before it can relieve pain. In lab studies, Boswellia appears to block CYP2D6. If that happened in real life, less codeine would turn into morphine, so you might get weaker pain relief from this medicine.

Keep in mind this is theoretical, based only on test-tube research, not on people, so the real-world effect may be small or none at all. The acetaminophen and butalbital parts aren't really affected by this. Still, if your pain isn't well controlled, mention the Boswellia to your pharmacist or doctor.

References
  1. 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;111 PubMed
Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

2 of 2

Acetaminophen, Butalbital, Codeine also falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES.

Theoretically, Boswellia serrata might increase the levels of CYP1A2 substrates.
In vitro research shows that Boswellia serrata gum resin inhibits CYP1A2 enzymes.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for your Bancap with Codeine (acetaminophen, butalbital, and codeine). Lab studies hint that boswellia might gently slow down a liver enzyme called CYP1A2. In theory, that could let a drug cleared by CYP1A2 build up a little, which might mean stronger or longer-lasting effects.

The honest truth is this is theoretical only, based on test-tube research, not real people. On top of that, CYP1A2 isn't the main pathway for any of these three ingredients (codeine mostly uses CYP2D6 and CYP3A4, acetaminophen is handled differently, and butalbital is the more sedating piece). So a meaningful interaction is unlikely. Still, if you notice extra drowsiness, dizziness, or grogginess, ease up and check with your pharmacist or doctor.

References
  1. 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;111 PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Boswellia Serrata Also Interacts With Other Medications

Boswellia Serrata has 951 moderate known drug interactions in our database — the Acetaminophen, Butalbital, Codeine one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Boswellia Serrata

Covers the 2,830 medications we’ve checked against Boswellia Serrata. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Acetaminophen, Butalbital, Codeine

This page covers Boswellia Serrata only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Acetaminophen, Butalbital, Codeine page lists 240 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: 1,4-butanediol (major), Activated Charcoal (major), Asarabacca (major), Beer (major) and Gamma-hydroxybutyrate (ghb) (major).

By severity: 9 major · 191 moderate · 40 minor.

Open the Acetaminophen, Butalbital, Codeine interaction page

One more smart check

Taking Boswellia Serrata as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,914 real supplement products containing Boswellia Serrata, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Boswellia Serrata. Your product may carry other ingredients that interact with Acetaminophen, Butalbital, Codeine too, on top of Boswellia Serrata — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Boswellia Serrata and Acetaminophen, Butalbital, Codeine Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Boswellia Serrata
Top 10%

#90 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Acetaminophen, Butalbital, Codeine
Top 25%

#539 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Boswellia Serrata

What is Boswellia Serrata?

Boswellia Serrata
  • Osteoarthritis joint pain
  • Rheumatoid arthritis
  • Inflammation
  • Asthma
  • Inflammatory bowel conditions

Boswellia serrata is a tree resin used in traditional medicine, mainly for joint pain and inflammation. Some studies suggest it may help with osteoarthritis symptoms, but the overall evidence is limited and more research is needed. It is generally well tolerated, but you should check with your pharmacist or doctor before using it, especially during pregnancy or breastfeeding.

Read the full Boswellia Serrata monograph & all interactions
Keep checking

Other Drugs & Boswellia Serrata

Browse every other medication we’ve checked against Boswellia Serrata — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
951Moderate
0Minor
1,878No known interaction
Moderate

951 interactions

Showing 60 of 951 moderate interactions — see all 951 on the Boswellia Serrata page.

No interaction 1,878 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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Pharmacist Counseling Corner

Taking Boswellia Serrata and Acetaminophen, Butalbital, Codeine Together: Common Questions

Can you take Boswellia Serrata with Acetaminophen, Butalbital, Codeine?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Boswellia Serrata and Acetaminophen, Butalbital, Codeine?
Acetaminophen, Butalbital, Codeine belongs to more than one drug category, and Boswellia Serrata interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Boswellia Serrata and Acetaminophen, Butalbital, Codeine interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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