Boswellia Serrata - Xarelto (Rivaroxaban) Interaction

Interaction Details

Rivaroxaban is classified as belonging to the following category: 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.

Interaction Rating

Likelihood of Occurrence

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

Pharmacist Analysis

The evidence on whether boswellia supplements could cause drug interactions by inhibiting the metabolizing enzyme CYP3A4 is mixed.

Although lab studies have shown that the resin extracted from the boswellia tree, known as frankincense, can mildly inhibit the enzyme, this effect has not been observed in humans (only in a lab setting).

It is worth noting that boswellic acids are specific chemical compounds found in frankincense resin, while frankincense itself is the resin obtained from the Boswellia tree.

Boswellic acids are considered to be the primary anti-inflammatory compounds in boswellia supplements, which are usually standardized based on their boswellic acid content.

Recent research suggests that the inhibitory effect of frankincense on CYP enzymes is not due to boswellic acids, so supplements with high amounts of these acids would be expected to have a lower risk of causing drug interactions than frankincense extracts with lower boswellic acid content. In other words, it appears that other compounds in frankincense are thought to cause CYP3A4 inhibition, not boswellic acids.

Overall, it's important to know about the potential interaction between boswellia supplements (especially those that have a high boswellic acid content) and drugs metabolized by CYP3A4, even though it's generally not considered a serious risk.

References

• 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
• 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.

Rivaroxaban Overview

• Rivaroxaban is used to treat deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in adults. Rivaroxaban is also used to prevent DVT and PE from happening again after initial treatment is completed in adults. It is also used to help prevent strokes or serious blood clots in adults who have atrial fibrillation (a condition in which the heart beats irregularly, increasing the chance of clots forming in the body, and possibly causing strokes) that is not caused by heart valve disease. Rivaroxaban is also used to prevent DVT and PE in adults who are having hip replacement or knee replacement surgery or in people who are hospitalized for serious illnesses and are at risk of developing a clot due to decreased ability to move around or other risk factors. It is also used along with aspirin to lower the risk of a heart attack, stroke, or death in adults with coronary artery disease (narrowing of the blood vessels that supply blood to the heart) or peripheral arterial disease (poor circulation in the blood vessels that supply blood to the arms and legs). Rivaroxaban is also used to treat and prevent DVT and PE from happening again in children and certain infants who have received at least 5 days of initial anticoagulation (blood thinner) treatment. It is also used to prevent DVT and PE after heart surgery in children 2 years of age or older who have congenital heart disease (abnormality in the heart that develops before birth). Rivaroxaban is in a class of medications called factor Xa inhibitors. It works by blocking the action of a certain natural substance that helps blood clots to form.

Boswellia Serrata - More Interactions

Boswellia Serrata interacts with 922 drugs

Interaction Rating Key

These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.