Drug & supplement interaction

Boswellia Serrata + Brexpiprazole

Brexpiprazole brand name: Rexulti.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Brexpiprazole 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 Brexpiprazole

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. Brexpiprazole 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 Brexpiprazole

Brexpiprazole 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

Here's the gist for Brexpiprazole (Rexulti): your liver uses an enzyme called CYP2D6 to help break this medication down. In lab-dish studies, boswellic acids from Boswellia appear to slow that same enzyme. If that happened in your body, Brexpiprazole could clear a bit more slowly and build up, which might mean stronger effects or more side effects like drowsiness, restlessness (feeling unable to sit still), dizziness, or weight gain.

I want to be honest, though: this is a theoretical concern based only on test-tube data, not on real patients. It may never cause a problem. Still, since this is a brain medication that's carefully dosed, it's worth a quick chat with your pharmacist or prescriber before adding Boswellia. Don't change your dose on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
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 3A4 (CYP3A4) SUBSTRATES

2 of 2

Brexpiprazole also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, Boswellia serrata might increase or decrease the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that Boswellia serrata gum resin inhibits CYP3A4 enzymes. Other in vitro research shows that Boswellia serrata extract inhibits CYP3A4 enzymes at most concentrations, although it may modestly induce enzyme activity at low concentrations.
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 connection: your body relies on a liver enzyme called CYP3A4 to help clear brexpiprazole (Rexulti). In lab studies, boswellic acids from boswellia mostly slow that enzyme down (though at very low amounts they might speed it up a touch). If the enzyme is blocked, brexpiprazole could build up a bit more than usual. That might mean stronger side effects like drowsiness, restlessness, dizziness, or weight changes.

I want to be honest, though: this is theoretical, based only on test-tube research, not real people taking the two together. So I'm not raising big alarms. Brexpiprazole isn't a prodrug, so it works as the active drug itself. Still, since brexpiprazole already needs careful dosing, just check with your pharmacist or doctor before adding boswellia.

Contact Dr. Brian directly if you have additional questions on this interaction
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
  2. Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. 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 Brexpiprazole one above is among them. If you take anything else, check it against the full list below.

Moderate 951 No known interaction 1,879 (incl. Brexpiprazole)
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 Brexpiprazole

This page covers Boswellia Serrata only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Brexpiprazole page lists 177 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), Indian Snakeroot (major), Lithium (major) and Rauvolfia Vomitoria (major).

By severity: 6 major · 130 moderate · 41 minor.

From our pharmacist’s overview on the Brexpiprazole page

“Brexpiprazole (Rexulti) treats schizophrenia and is added to antidepressants for depression, and its supplement list warrants real care before you add anything to it. The bulk of the 177 entries change how your liver clears the drug, so grapefruit can push levels up while St.”

Reviewed by 2 · Jul 18, 2026

Open the Brexpiprazole 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 Brexpiprazole 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 Brexpiprazole 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%

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

29 days ago today
Medication Brexpiprazole
Steady interest

#1,780 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
Medication

About Brexpiprazole

What Is Brexpiprazole Used For?

Brand name: Rexulti

Brexpiprazole tablets are approved for two uses in adults: as an add-on (adjunctive) treatment alongside antidepressants for major depressive disorder (MDD), and as a treatment for schizophrenia. These uses apply to both the generic brexpiprazole tablets and Rexulti.

Rexulti has one additional approved use: treating agitation associated with dementia due to Alzheimer's disease in adults. Rexulti is also approved for schizophrenia in adolescents ages 13 and older. Note that Rexulti is not approved for dementia-related psychosis without agitation from Alzheimer's disease, and it is not meant to be used on an as-needed basis for Alzheimer's-related agitation.

See full Brexpiprazole drug information
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
951 Moderate 1,878 No 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

We also checked Boswellia Serrata against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,878 medications checked with no known interaction — see the full Boswellia Serrata list.

See the full Boswellia Serrata interactions page
See every supplement checked against Brexpiprazole, ranked by severity
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

Keep exploring
Boswellia Serrata monograph › Uses, safety, and every drug interaction in one place Brexpiprazole supplement interactions › Every supplement checked against Brexpiprazole, ranked by severity Brexpiprazole drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Boswellia Serrata and Brexpiprazole Together: Common Questions

Can you take Boswellia Serrata with Brexpiprazole?
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 Brexpiprazole?
Brexpiprazole 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 Brexpiprazole 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

Still Have a Question About Brexpiprazole and Boswellia Serrata?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.