Boswellia With Xarelto Interaction Discussion
In our latest question and answer, the pharmacist discusses the interaction between Xarelto and Boswellia.
Is it safe to take Osteo Bi-Flex with UC-II Collagen while using Xarelto? This product does not contain turmeric but does contain Boswellia.
Apr 07, 2024- Boswellia may theoretically increase Xarelto levels in your body by affecting how your body breaks down the medication, which could raise bleeding risk. The specific Boswellia extract in Osteo-Bi-Flex (5-LOXIN) is less likely to cause this interaction than other frankincense products because it's standardized for boswellic acids. You should talk with your doctor before taking Boswellia with Xarelto and watch for signs of unusual bruising or bleeding.
Answer
Hello and thanks for reaching out!
I looked up this product on the Osteo-Bi-Flex website and found this: UC II Collagen For Joints - Mini Pill - Osteo Bi-Flex® Ease. It contains the ingredients you listed in your question, so I assume this is the correct product. Let me know if you are referring to something else.
Based on the website, it contains:
- UC-II Collagen
- Boswellia serrata Extract (5-LOXIN)
There is no known interaction between UC-II collagen and Xarelto. However, our 'drug-herbal interaction checker' does list one between Boswellia and Xarelto.
Boswellia - Xarelto Interaction Details
The interaction here is not because Boswellia has any known significant blood-thinning effects, but rather, is due to its potential to inhibit the CYP3A4 metabolizing enzyme.
Xarelto is metabolized via the CYP3A4 enzyme, and inhibitors of it can cause an increase in drug levels in the body, increasing the risk of side effects like bleeding.
So, on the surface, there is certainly concern about combining Boswellia with Xarelto (increased bleeding risk).
However, as I wrote about on the individual interaction page for Boswellia and Xarelto, it's unlikely that there is a major interaction here (caution is still advised though).
Boswellia trees produce a resin known as frankincense, which contains various compounds, including boswellic acids. Most Boswellia supplements are standardized for boswellic acid content and have less of the other compounds typically found in frankincense.
Recent studies suggest that while frankincense resin may inhibit the enzyme CYP3A4, this effect is not primarily due to boswellic acids. Supplements with high boswellic acid levels may pose a lower risk of drug interactions compared to full frankincense extracts since most studies conclude that it is mainly the other components in frankincense that are responsible for CYP3A4 inhibition.
The Boswellia extract in the Osteo-Bi-Flex product, 5-LOXIN, is standardized for a high content of boswellic acids. It would be less likely to significantly impact the CYP3A4 enzyme and, consequently, Xarelto, than a straight frankincense extract.
Regardless, I do think it's important to point out that this is all theoretical based mostly on lab studies. I couldn't find any studies that specifically evaluated the combined use of Boswellia and Xarelto in humans. Although in my opinion a clinically significant interaction is unlikely, there is still a risk that exists, especially in certain high-risk individuals.
Therefore, you should speak with your doctor before combining Boswellia and Xarelto so you can be appropriately monitored. If you do take them together under your doctor's supervision, be sure to look out for signs of easy bruising and bleeding.
Final Words
I hope you found this helpful. Be sure to reach out anytime.
References & sources
- Osteo Bi-Flex Website Ease Product Information — Osteo Bi-Flex
- 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 — PubMed
- An Evaluation of Potential Inhibition of CYP3A4/5 and CYP2C9 Enzymatic Activity by Boswellia serrata Extract — Semantic Scholar
- Boswellia serrata Extract, 5-Loxin®, Prevents Joint Pain and Cartilage Degeneration in a Rat Model of Osteoarthritis through Inhibition of Inflammatory Responses and Restoration of Matrix Homeostasis — PubMed
Glossary — Terms in This Answer
- UC-II Collagen
- A specific form of collagen derived from chicken cartilage that is used in joint health supplements.
- Boswellia serrata Extract
- A plant extract made from the Boswellia tree that is used in supplements, often for its anti-inflammatory properties.
- Xarelto
- A prescription blood thinner medication used to prevent blood clots.
- CYP3A4 enzyme
- A protein in the body responsible for breaking down and removing many medications from the bloodstream.
- Boswellic acids
- The active chemical compounds found in Boswellia extract that are thought to provide health benefits.
- Frankincense
- A resin produced by Boswellia trees that contains various compounds and has been used traditionally in medicine.
- Drug-herbal interaction
- A reaction that occurs when a prescription medication and a natural plant supplement affect each other's strength or safety in the body.
- Standardized
- A supplement formulation adjusted to contain a guaranteed amount of its active ingredient.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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