Boswelia (Taylor Gannon , University of Mississippi School of Pharmacy

Boswellia serrata Roxb.

Indian Frankincense, Dhup, Salai Guggal

Taylor Gannon, Student Pharmacist, Spring 2022

History

Boswellia is thought to be related to the tree from the Bible that provided the frankincense gift given to baby Jesus by the wise men. It can be used within hair, clothes, or rooms as a perfume. Historically, the plant was burned to produce psychoactive effects in religious and spiritual ceremonies. In India, the plant can be used in Ayurvedic medicine for the treatment of multiple ailments. In Egypt, it can be used within the mummification process as an embalming fluid ingredient.1

http://blogs.reading.ac.uk/crg/files/2014/12/5Boswellia_sacraCC2.jpg

Common Uses1 FAST FACTS

Oleoresin Gum – anti-inflammatory effects • Asthma • Osteoarthritis • Rheumatoid Arthritis • Colitis • Irritable Bowel Syndrome (IBS) Boswellic Acids – immunomodulatory and antimicrobial effects

Dosage Forms1, 3

The most commonly available formulation is a tablet. The herb can also be formulated into a capsule or tincture. Many combination products exist with other herbal products.

Typical Dosing1

Inflammatory Conditions: 300 to 400 mg three times daily of extract or gum resin tablets/capsules

Mechanism of Action2

Most Likely – Inhibition of 5-lipoxygenase (5-LOX), which provides an antiinflammatory effect • 5-LOX is part of the arachidonic acid pathway and results in the production of leukotrienes that cause inflammation • Too many leukotrienes can result in excessive inflammation, which can be seen with many inflammatory disorders, such as rheumatoid arthritis or irritable bowel syndrome Other potential targets include cytokines, such as interleukins and TNF-alpha

Effectiveness1

While B. serrata has been used in many conditions for its touted antiinflammatory properties, clinical trials have not been promising. There is currently no scientific evidence that confirms the efficacy of this natural product.

Safety1

B. serratais considered to be relatively safe and mostly well tolerated. While a study in mice did report hepatotoxic effects, no such effects have been reported in humans. Patients that should avoid this herb include those with a hypersensitivity to B. serrataand females that are pregnant or lactating, as adequate safety data is lacking.

Adverse Effects, Toxicities, and Interactions1,3

Common adverse effects include nausea, anorexia, stomach pain, diarrhea, and dermatitis. No data has been reported for toxicology in humans. In rats, doses over 2 g/kg were determined to be the median lethal dose (LD50). B. serratais an inhibitor of many CYP450 enzymes and P-gp. A couple of case reports have also reported increased INR levels when taken with warfarin.

Professional Opinion

A literature review regarding the safety and efficacy of B. serrata reveals few studies. Published studies are typically low quality and are conducted in small patient populations. The studies are also predominantly conducted in countries outside of the United States, such as India, Armenia, and Iran. While trials do show some evidence that B.serrata is significant for improving pain over placebo treatment, no head-to-head studies against NSAIDs or other drug classes have been conducted. The low quality of the studies also elicits questions regarding both internal and external validity. No issues with safety were identified, however.4 Based on these factors, I would not recommend utilizing Boswelliaserrata for antiinflammatory, immunomodulatory, or antimicrobial effects, as I feel that scientific evidence for safe and effective usage is lacking. ~ T. Gannon

https://healthjade.com/boswellia/ https://www.organicveda.com/boswellia-serrata-capsules/

References

1. Frankincense, Indian. Lexicomp. https://online.lexi.com/lco/action/doc/retrieve/docid/fc_rnp2/3750151 ?cesid=5bnMlPVEuhx&searchUrl=%2Flco%2Faction%2Fsearch%3Fq% 3DBoswellia%26t%3Dname%26va%3DBoswellia#. Published October 20, 2020. Accessed February 4, 2022. 2. Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta

Med. 2006;72(12):1100-1116. Doi:10.1055/s-2006-947227 3. Boswellia . Micromedex . https://www.micromedexsolutions.com/micromedex2/librarian/CS/B3 5BF8/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIEL

DSYNC/4C2E23/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppPr oduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.D oIntegratedSearch?SearchTerm=Boswellia&UserSearchTerm=Boswellia &SearchFilter=filterNone&navitem=searchALL#. Published 2022.

Accessed February 4, 2022. 4. Bannuru RR, Osani MC, Al-Eid F, Wang C. Efficacy of curcumin and

Boswellia for knee osteoarthritis: Systematic review and metaanalysis. Semin Arthritis Rheum. 2018;48(3):416-429. doi:10.1016/j.semarthrit.2018.03.001