NutriStack
Boswellia and Warfarin, a caution.
Boswellia serrata extracts inhibit CYP2C9, CYP3A4, and CYP2C19, the isoenzymes responsible for warfarin metabolism. Spontaneous postoperative bleeding, hematomas, hematemesis, melena, and subarachnoid hemorrhage have been reported in warfarin patients who added boswellia. Boswellic acids also inhibit COX-1 and 5-lipoxygenase, adding a pharmacodynamic antiplatelet component.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Emerging evidence
Caution
What is happening. Boswellia serrata extracts inhibit CYP2C9, CYP3A4, and CYP2C19, the isoenzymes responsible for warfarin metabolism. Spontaneous postoperative bleeding, hematomas, hematemesis, melena, and subarachnoid hemorrhage have been reported in warfarin patients who added boswellia. Boswellic acids also inhibit COX-1 and 5-lipoxygenase, adding a pharmacodynamic antiplatelet component.
Mechanism. Boswellia serrata extract inhibits CYP2C9 (the main metaboliser of S-warfarin) along with CYP3A4 and CYP2C19, reducing warfarin clearance. Boswellic acids independently inhibit COX-1 and 5-lipoxygenase, dampening platelet aggregation.
Recommendation. Avoid boswellia supplements while taking warfarin. If you are already taking both, do not stop abruptly without telling your anticoagulation clinic, and arrange an INR check within 1-2 weeks.
Sources (2)
- Ge B, Zhang Z, Zuo Z. Updates on the clinical evidenced herb-warfarin interactions [Warfarin Interactions with Medicinal Herbs review]. Evid Based Complement Alternat Med. 2014;2014:957362. (PubMed indexed review) PMID 25233607
- Tan CSS, Lee SWH. Warfarin and food, herbal or dietary supplement interactions: A systematic review. Br J Clin Pharmacol. 2021;87(2):352-374. PMID 32478963
Stack Score
How this pair moves the number.
Effect on the composite score
If both Boswellia and Warfarin are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
Check your full routine
One pair was the worked example. NutriStack runs every pair in your stack at once.
Drop in your supplements and prescriptions and the public database surfaces every interaction, synergy, timing rule, and contraindication, every one linked to its primary source.