Herb-Drug Interaction with Acalabrutinib and Boswellia Serrata

[Katie-LMHC-Artist]

Looking for information to see if there is a herb-drug interaction between Acalabrutinib and Boswellia. Boswellia is an herb that is good for joint pain and has anti-inflammatory effects. I have previously read that people on blood thinners should not take the herb. Would this herb affect the efficacy of Acalabrutinib?

[albie58]

Hi Katie!

This is a great site that was recommended to me by my speciality pharmacy. It gives alot of information about drugs and their interactions with different herbs, etc.

mskcc.org/cancer-care/diagn...

[Katie-LMHC-Artist in reply to albie58]

Thank you. I went onto the site and could not find the exact answer. I did read that Boswellia can increase your bleeding if you are on blood thinners. I’m not on a blood thinner. Blood thinners may interact with Acalabrutinib. My oncologist has advised not to take NSAIDS because of this. Still searching!!! Thank you!

[SofiaDeo in reply to Katie-LMHC-Artist]

If you're not supposed to take NSAIDS and Boswellia can increase your bleeding if you are on blood thinners, you should not be taking it. The key part for Boswellia/other "avoid blood thinner" herbs is where it's noted it interacts with platelets:

"Anticoagulant and/or antiplatelet drugs: Boswellia extracts can inhibit platelet aggregation and may increase risk of bleeding when used with these drugs (34). Clinical significance has yet to be determined."

This means don't use with any med affecting platelets (like all the BTKi's) unless under medical supervision. The "clinical significance has yet to be determined" part means there haven't been any, or enough, studies done to determine if/the extent of the interaction.

[Katie-LMHC-Artist in reply to SofiaDeo]

I’m not on blood thinners. If there is a supplement that contains Bosweilla Serrata as part of the proprietary blend is it acceptable to take it. I’ll send a message to my oncologist to see what his suggestion is. Thanks for the feedback!

[SofiaDeo in reply to Katie-LMHC-Artist]

You are on a "blood thinner" if you are taking a BTKi. By definition, anything affecting platelets can "thin the blood" and is what the literature is referring to when talking about "blood thinners." Apologies for not being clear. The use of the term "blood thinner" is not because of "the effect one is trying to get", but more along the lines of "what the drug can do". Whether that effect is the main point of taking the drug, or not.

Your doc may be fine with you taking it, it would be a data point to know, to watch for any unwanted effect on platelets. But if he's specifically said avoid NSAIDS, which are blood thinners because they can affect platelets, then he may say "don't". Because BTKi's as well as NSAIDs plus Boswellia all can affect platelets. They all are considered "blood thinners."

[CaptRon1976 in reply to Katie-LMHC-Artist]

CLL itself acts like a blood thinner by decreasing your platlet number and quality of function. Acala affects platlets function.

Why risk it?

You could try a Bosweilla holiday.

[craterlake in reply to Katie-LMHC-Artist]

Hi Katie , if you are on calquence i would definitely not take anything that thins the blood ...... ..when i was on calquence i had purpura on my arms and petechiae from my knees to my toes ... and the longer i took it occasional nose bleeds ... i took papaya leaf extract that helped with the bleeding issue ... most people take curcummin for joint pain ... etc. but to much of it can thin the blood also ... drinking more water and eating more uncooked , healthy food helped with the joint pain that i experienced when i was on calquence ...i have been taking different herbs for years but i use the most common ones ..... notice this quote from the website that explains what to use boswellia for but it also says ;----"Do not take boswellia if you are pregnant or breastfeeding.

Boswellia may inhibit the liver enzymes that break down drugs, which can increase the drug effects. Avoid taking boswellia concurrently with other medications unless specifically prescribed by your physician." ... this statement regarding the physician is a common disclaimer for almost everything though ... ---- it is very doubtful that any physician would prescribe any herb for you take anyway , unless you live in Germany or places like that where doctors do prescribe herbs for their patients ... in the states they are woefully ignorant about natural remedies or even the benefits of a healthy diet .. notice the reason given for not taking boswellia with other drugs is the liver issue so it will probably increase the effect of the calquence like grapefruit and seville oranges do ... my liver enzymes are elevated so i take milk thistle herb to help support my liver .. i am on venetoclax and doing well ... hope you find relief --- keep looking up .. blessings , james

[Katie-LMHC-Artist in reply to craterlake]

Thanks. I actually have had some awareness of Bosweilla. When I first started taking Acalabrutinib I gave some of my previous bought supplements away to my sisters. I didn’t think I could get by without taking an occasional NSAID (took previously because of a tight ITBand due to an injury). I learned to manage without NSAIDS! I think I’m like a little kid that wants to push the limits sometimes! Lol! I appreciate all the information and support!!!

[CycleWonder in reply to Katie-LMHC-Artist]

Katie-LMHC

Have you see a PT about your tight ITBand? I experienced that after a hip replacement. I found the exercises to be very helpful that were provided by the PT.

[Katie-LMHC-Artist in reply to CycleWonder]

I have gone through 3 years of pain. I went to P/T with 3 different providers, had cortisone injections, and all the providers had different opinions about the cause of the pain. I continue to do exercises at home. Before I started treatment my local oncologist in a casual way mentioned the possibly of enlarged lymph nodes hitting a nerve in my back causing the pain. I probably discounted his opinion while I tried managing the pain. It’s now been a little over 9 months on Acalabrutinib and my pain is almost gone!!! I told my oncologist he could write a paper on my case. Lol!!! While reading “For Blood and Money”, a book telling the story of how Ibrutinib and Acalabrutinib came to market there was a mention of a patient whose lymph nodes had become so enlarged he was in chronic pain and could not walk anymore. He enrolled in an early clinical trial for Ibrutinib and a month later his lymph nodes had decreased and he was walking again. Incredible! So I believe my lymph nodes in my back were causing all the pain and now I am almost pain free with that! Thanks for your feedback!

[CycleWonder in reply to Katie-LMHC-Artist]

I’m glad you found relief!

[Katie-LMHC-Artist in reply to craterlake]

James…I’m glad your doing well. As the Grateful Dead sang….”What a long strange trip it’s been”! Continue to do well!!!

[craterlake in reply to Katie-LMHC-Artist]

thanks ...😊

[albie58]

I agree with what SofiaDeo is saying. I'd check with you doc about this. Think about it this way...let's day you aren't on acalabrutinib and you take the herb, it can cause bleeding by itself. Okay...now let's add acalabrutinib to the mix. We already know the med causes the platelet function to be less effective which causes bleeding. So now you have put two items together that double your chance of severe bleeding if you get cut or you may get severe bruising. If it were me I'd hold off on the herb and call the speciality pharmacy where you get your meds. This warning also goes for vitamin E and fish oil supplements. Please be very careful.

[Katie-LMHC-Artist in reply to albie58]

Thanks for all the information and ……education!!! I’m trying to find a good supplement for muscle and joint pain. The products that are recommended have Bosweilla in them. I’ll keep searching. Thank you!!!

[albie58]

Hey Katie one more thing to consider as you are looking around....calquence is broken down by the liver. Some herbs such as Boswellia can inhibit those liver enzymes that break down the calquence and can increase calquence's drug effects.

[Katie-LMHC-Artist in reply to albie58]

I feel like I have just taken a class with all the info! Thank you!

[CaptRon1976]

the bleeding you see is one thing.

The bleeding you don’t see internally is by far another.

[Katie-LMHC-Artist in reply to CaptRon1976]

Thanks for the info.!

[Eucalyptus22]

Boswellia Serrata is from the frankincense plant. You could use frankincense oil on your joints rather than taking it internally. Blend it will ginger, peppermint and Cajeput oils for greater effect. Olive oil from Eastern Crete is a powerful anti inflammatory and consumed every day would in my opinion be safer than taking Boswellia Serrata with Acalabrutinib. And of course Vit D3 and ginger powder good too !

Kate

[Katie-LMHC-Artist in reply to Eucalyptus22]

Thank you. I live near a herbalist. I will consult with her.

[Eucalyptus22 in reply to Katie-LMHC-Artist]

I would also add that I am on Acalabrutinib and wouldn't touch anything herbal internally. I used lots of stuff from a herbalist on WW to no good effect. In some cases herbs/vits/supplements can accelerate our CLL because of their mechanism of action in the body as opposed to the food we eat in its natural state.

[Katie-LMHC-Artist in reply to Eucalyptus22]

I agree with diet and food. I earned a certificate from the Institute for Integrative Nutrition in 2013 and often combine it in the work I do. When I mentioned the herbalist I was referring to talking to her about putting some of the things you suggested together to use externally. Thanks again!