Boswellia Serrata - Rinvoq (Upadacitinib Hemihydrate) Interaction

Interaction Details

Upadacitinib Hemihydrate 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.

Upadacitinib Hemihydrate Overview

• Upadacitinib is used alone or with other medications to treat rheumatoid arthritis (condition in which the body attacks its own joints causing pain, swelling, and loss of function) in people who are unable to take or have not responded well to one or more tumor necrosis factor (TNF) inhibitor medication(s). It is also used to treat psoriatic arthritis (a condition that causes joint pain and swelling and scales on the skin) in adults who are unable to take or did not respond to or tolerate one or more TNF inhibitor medication(s). Upadacitinib is also used to treat symptoms of eczema (atopic dermatitis; a skin disease that causes the skin to be dry and itchy and to sometimes develop red, scaly rashes) in adults and children 12 years and older who cannot use other medications for their condition or whose eczema has not responded to other medications. It is also used to treat ulcerative colitis (a condition that causes swelling and sores in the lining of the colon [large intestine] and rectum) in adults who are unable to take or who did not respond to one or more TNF inhibitor medication(s). Upadacitinib is used to treat ankylosing spondylitis (a condition in which the body attacks the joints of the spine and other areas, causing pain, swelling, and joint damage) in adults who are unable to take or who did not respond to one or more TNF inhibitor medication(s). Upadacitinib is in a class of medications called Janus kinase (JAK) inhibitors. It works by decreasing the activity of the immune system.

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.