SImon asked
I take either Advil or Aleve when my joints really start to hurt. My friend recommended boswellia. Could I take that at the same time as those other two drugs?
At a glance
- There are no known interactions with boswellia and Advil or Aleve. Studies suggest that boswellia may have mild anticoagulant effects, but more studies are needed to determine if there is any risk.
- NSAIDs work by decreasing prostaglandin synthesis. Long term use is associated with several side effects. Combining NSAIDs is generally not recommended.
- Boswellia works via several mechanisms, including inhibition of 5-lipoxygenase. It has a different mechanism of action than NSAIDs like Advil and Aleve.
- Studies suggest potentially minor interactions between boswellia and NSAIDs but none have specifically looked at combined use. Currently, there is no known interaction.
Answer
There are no known drug interactions between boswellia and Advil (ibuprofen) or Aleve (naproxen).
Although boswellia is used to relieve joint pain, from what we understand, it has a different mechanism of action from Advil or Aleve and they don't share many side effects. They are not thought to conflict with one another.
Having said that, there have been some studies to suggest that boswellia has very minor anticoagulant (or blood thinning) effects.
There theoretically could be an increased anticoagulant effect combining boswellia with other drugs that do the same, such as NSAIDs. Nevertheless, further studies are needed to specifically evaluate the risk, if any.
NSAIDs
Advil and Aleve are both NSAIDs, or 'non-steroidal anti-inflammatory drugs'. In most cases, NSAIDs should not be combined due to the additive toxicity and increased risk of side effects unless specifically directed by your doctor.
Long term use of high dose NSAIDs has been associated with:
- Stomach bleeding
- Stomach ulcers
- Increased cardiovascular
- Increased bleeding
NSAIDs work by decreasing prostaglandin synthesis via inhibition of COX-1 and COX-2. These enzymes are necessary for prostaglandin formation, as they catalyze the conversion of a precursor molecule (arachidonic acid) to prostaglandins. Inhibition of COX enzymes stops this conversation.
Unfortunately, long term side effects of NSAIDs, such as increased bleeding risk and cardiovascular effects, come about due the wide ranging activity of COX enzymes in our body. It is important to not take additional medication with the same mechanism of action as they can have synergistic effects.
Boswellia
Boswellia, also known as Olibanum and frankincense, is used medically for a variety of indications, but most commonly for joint pain from arthritis.
While we don't know the exact mechanism of action, it doesn't appear to inhibit COX enzymes.
The primary anti-inflammatory actions of boswellia are thought to be due to inhibition of the 5-lipoxygenase enzyme as well as a reduction in leukotriene synthesis. Both are thought to be involved in bodily processes that bring on inflammation and pain.
Boswellia may also work to reduce inflammation via a number of other mechanisms as well, but doesn't appear to inhibit COX enzymes like NSAIDs
Boswellia With NSAIDs
Most studies suggest that boswellia has a good safety profile. One stated the following:
A number of clinical studies support the anti-inflammatory and anti-arthritic properties of Boswellia serrata extract (BSE) and have showed a very good safety profile except mild adverse effects such as nausea, acid reflux and gastrointestinal upset. There are no serious, long term or irreversible adverse effects and no evidence of serious interactions.
As stated above, there doesn't appear to be a significant interaction between boswellia and NSAIDs like Advil and Aleve. There may be some additive anticoagulant effects, but more studies are needed.
Lastly, it is important to note that boswellia may be an inhibitor of a major drug metabolizing enzyme known as CYP 2C9. Advil (ibuprofen) is metabolized via CYP 2C9 and inhibition of this enzyme could increase concentrations of the drug in the body, potentially increasing the risk of side effects.
Nevertheless, boswellia inhibition of CYP 2C9 has only been studied in a lab setting, has been noted as minor, and there have been no studies done in humans.
