Drug & supplement interaction

Boswellia Serrata + Siltuximab

Siltuximab brand name: Sylvant.

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

Boswellia Serrata has a moderate interaction with Siltuximab. Theoretically, Boswellia serrata might increase or decrease the levels and clinical effects of CYP3A4 substrates.

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

Boswellia Serrata and Siltuximab

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Siltuximab

Siltuximab falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Boswellia Serrata interacts with.

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 good news on this pairing. Siltuximab (Sylvant) is a large monoclonal antibody, a lab-made protein given by infusion. Unlike many pills, it isn't broken down by the liver's CYP3A4 enzyme system, so the usual concern about Boswellia nudging that enzyme up or down really doesn't apply to it directly.

Interestingly, the relationship can run the other way. When your Castleman's disease is active, high inflammation can actually slow CYP3A4 and change how other medications behave. Since this whole interaction is only theoretical, based on lab studies, I wouldn't lose sleep over it. Still, before adding Boswellia, run your full medication list by your oncology pharmacist or doctor just to be safe.

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 Siltuximab one above is one of them. If you take anything else, check it against the full list below.

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

This page covers Boswellia Serrata only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Siltuximab page lists 121 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate), Adrafinil (moderate) and African Wild Potato (moderate).

By severity: 2 major · 87 moderate · 32 minor.

From our pharmacist’s overview on the Siltuximab page

“Genuine care is warranted with siltuximab (Sylvant), the infusion for multicentric Castleman disease, and the place to start is its two major-rated interactions: grapefruit and St. John's wort.”

Reviewed by 2 · Jul 18, 2026

Open the Siltuximab 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 Siltuximab 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 Siltuximab 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%

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

29 days ago today
Medication Siltuximab
Steady interest

#2,748 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 Siltuximab Injection

What Is Siltuximab Injection Used For?

Brand name: Sylvant

Sylvant (siltuximab) injection is approved to treat multicentric Castleman's disease (MCD) — a rare disorder involving abnormal lymph node growth driven by an overactive immune signal called IL-6. It is specifically approved for patients who test negative for both HIV and HHV-8 (human herpesvirus-8).

Sylvant has not been studied in patients with MCD who are HIV-positive or HHV-8-positive, because it does not block the form of IL-6 produced by those viruses.

See full Siltuximab Injection 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 Siltuximab, 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 Siltuximab supplement interactions › Every supplement checked against Siltuximab, ranked by severity Siltuximab Injection 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 Siltuximab Together: Common Questions

Can you take Boswellia Serrata with Siltuximab?
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.
How serious is the Boswellia Serrata and Siltuximab 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 Siltuximab 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.