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Boron

Common Name(s): Borate, Borax sodium, Boric acid, Boric anhydride, Boric tartrate, Boron

Medically reviewed by Drugs.com. Last updated on Dec 1, 2022.

Clinical Overview

Use

Boron, a bioactive trace element, has been included in nutritional supplements or natural remedies designed to improve bone and joint health. Boron deficiency has been shown to impair brain function, inflammatory regulation, and immune response, and to increase the risk of some cancers. However, evidence is lacking suggesting that boron supplementation above the levels derived in a normal diet is beneficial. Therefore, supplementation is likely to be useful only when dietary intake is inadequate. Boron has been studied for a potential role in bone and joint health, dysmenorrhea, and radiation dermatitis. Boron compounds are also used to enhance the cell selectivity of radiation therapy and could lead to a new generation of drugs. Boric acid, a common boron compound not to be confused with boron, has been used traditionally for various purposes (eg, antimicrobial, rodent repellent, and insecticidal effects). Boric acid has also been administered intravaginally for recurrent and resistant vulvovaginal candidiasis.

Dosing

Boron has been studied using a wide range of doses and preparations. Evidence centers on deprivation studies. Evidence is lacking suggesting that boron supplementation above the levels derived in a normal diet is beneficial. Therefore, supplementation is likely to be useful only when dietary intake is inadequate.

Contraindications

Intravaginal boric acid use during the first 4 months of pregnancy has been associated with birth defects.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking; however, when used orally at doses below the upper intake level, boron is likely safe. However, boric acid should not be used in pregnancy. Intravaginal boric acid use during the first 4 months of pregnancy has been associated with birth defects.

Interactions

Vaginal antifungal agents may diminish the therapeutic effect of progesterone. Avoid combination.

Adverse Reactions

Data are limited regarding adverse effects of boron when used at doses less than the upper intake level. Intravaginal boric acid, when used during the first 4 months of pregnancy, has been associated with birth defects.

Toxicology

Although boric acid, borates, and other compounds containing boron are used medicinally, they can be toxic if ingested at high doses or absorbed through nonintact skin.

Source

The element boron (B, atomic number 5) is found in deposits in the earth's crust at a concentration of about 0.001% (10 ppm). Seawater contains an average of 4.6 ppm of boron (range, 0.5 to 9.6 ppm). Boron content in fresh water ranges from less than 0.01 to 1.5 ppm, with higher concentrations in regions of high soil boron levels.(Woods 1994) Boron is obtained in the form of various compounds and never in its elemental state.(O'Neil 2006)

Since 1857, it has been known that environmental boron is taken up by plants in trace amounts, and in 1923, boron was recognized as an essential nutrient for plants.(Devirian 2003) Accordingly, plants contribute to dietary boron intake, with primary sources being fruits, nuts, and vegetables.(Devirian 2003) Good sources of boron include peanuts, peanut butter, almonds, hazelnuts, seaweed, soybeans, parsley, cocoa, wine, raisins, prunes, apples, and peaches.(Choi 2008, Devirian 2003, Jamison 2003, Rainey 1999)

Boron was originally obtained in 1895 from the reduction of boric anhydride, which remains a commercially important way to produce impure boron today. Pure boron takes the form of clear red or black crystals, depending on its crystalline shape.(O'Neil 2006) The crystals can be as hard as diamonds. The chemistry of boron is extremely complex, with entire texts devoted solely to this topic.

History

Reports suggest the Babylonians used borax as flux for working gold 4,000 years ago; evidence exists of this use in the Saudi Arabian area of Mecca and Medina in the 8th century and by European goldsmiths in the 12th century.(Woods 1994) Boron was used as a food preservative between 1870 and 1920 and during World Wars I and II.(Nielsen 2008)

Borate-mineral concentrates, borax, boric acid, and other refined products have been used in glass, fiberglass, washing products, alloys and metals, fertilizers, wood treatments, insecticides, and microbicides.(Woods 1994) As an insect and rodent repellent, boric acid dust has been used in urban pest management, but concerns exist regarding health risks associated with dust inhalation.(Gore 2004)

Boron is used in nuclear medicine and chemistry as a neutron absorber.(Hunter 2009, Wittig 2008)

The structural and electronic aspects of boron and its compounds have created interest in a new generation of drugs that could possibly interfere with target molecules not readily accessible to carbon-based compounds. Bortezomib (Velcade), a proteasome inhibitor, is indicated for the treatment of hematologic malignancies, and other boron-based drugs are in the pipeline, including tavaborole (AN2690) for the treatment of onychomycosis and antibiotics that might be less likely to trigger resistance.(Hunter 2009)

Chemistry

Bioactive boron molecules (ie, single atom, cluster) have the ability to instantly convert from a trigonal planar (sp2 hybridized) neutral form to a tetrahedral (sp3 hybridized) anionic form. Boron sits adjacent to carbon on the periodic table and has the ability to adopt carbon-based transition states that facilitates its use in the design of inhibitors for enzyme-catalyzed hydrolytic processes. The polyhedral cage structure of electron-deficient boron cluster compounds, such as carborane clusters and polyhedral boranes, provides a unique ability to interact with targeted proteins and to serve as a neutron source for clinical treatment of cancers via boron neutron capture therapy (BNCT). The abiotic nature of boron clusters makes them resilient to catabolism, which facilitates its application in medical treatment but also introduces the risk of boron accumulation.(Ali 2020)

Uses and Pharmacology

Although no clear biological function for boron has been established in humans, evidence from numerous laboratories using a variety of experimental models shows that boron is a beneficial bioactive element(Nielsen 2008) referred to by some as an ultratrace mineral.(Jamison 2003, Nielsen 2008) It is postulated that boron may even be essential to humans.(Mastromatteo 1994, Nielsen 2009)

The evidence includes deprivation studies showing that boron is necessary for some higher animals to complete their life cycle (eg, frogs, zebrafish).(Fort 2002, Fort 1999, Rowe 1999) However, critical experiments demonstrating that boron is essential for a complete mammal life cycle or has an essential biochemical role for life are lacking.(Nielsen 2008)

In higher animals, low boron intake (0.1 to 0.5 mg/kg) when compared with diets of higher boron intake (1 to 15 mg/kg) has been found to induce biochemical and functional changes often considered detrimental, particularly to bone health (growth and maintenance), brain function, and inflammatory response.(Nielsen 2009, Nielsen 2009)

In humans, boron intake of 1 to 3 mg/day compared with intakes between 0.25 and 0.5 mg/day appears to have beneficial effects on bone and brain health,(Nielsen 2008) while boron deprivation studies have shown an effect on markers for inflammatory response.(Nielsen 2009, Nielsen 2009)

Boron deficiency

While no specific boron deficiency state has been described,(Jamison 2003, Nielson 2008) signs of boron deficiency in humans include the following: altered macromineral, electrolyte, energy substrate, nitrogen, and oxidative metabolism; changes to erythropoiesis and hematopoiesis; electroencephalogram (EEG) changes suggesting depressed behavioral activation and mental alertness; depressed psychomotor skills; and depressed cognitive processes of attention and memory.(Nielsen 2013)

Bone and joint health

Boron is known to influence a variety of metabolic actions. It interacts with calcium, vitamin D, and magnesium, which are all important in bone metabolism(Beattie 1993, Devirian 2003, Meacham 1994) and increases osteointegration and/or bone formation when incorporated into hydroxyapatite.(Cayir Bozoglu 2022, Ciftci Dede 2022) Boron accumulates in bone in concentrations dependent on the amount consumed(Chapin 1998); bone mineral density has been shown to be related to boron intake(Beattie 1993); calcium appears to be more readily stripped from bones in individuals with low boron intake; and boron may be particularly effective in protecting bone mass in individuals with vitamin D, magnesium, and potassium deficiencies.(Reid 1993, Schaafsma 2001) Boron may also influence the metabolism of other minerals, such as copper, potassium, and phosphorus.(Beattie 1993, Devirian 2003, Jamison 2003, Meacham 1995) Boron has also been found to increase estrogen concentrations in postmenopausal females(Nielsen 1987) and in healthy males.(Naghii 1997) Therefore, it is likely that boron plays a role in bone health through formation or enhancement of steroid hormones preventing calcium loss and consequent bone demineralization, which may explain the epidemiological evidence that boron is essential for healthy bones and joints.(Newnham 1994, Palacios 2006)

Animal data

Incorporating boron into a hydroxyapatite coating on a dental implant polymer improves the expression of osteogenic and extracellular matrix-related genes in periodontal ligament cells. Alkaline phosphatase gene expression was significantly higher (P<0.0001) and collagen genes were numerically higher, suggesting increased osteointegration potential.(Cayir Bozoglu 2022)

In one study in rats, boron deprivation (0.1 mg/kg diet) resulted in decreased bone volume fraction and trabecular thickness and increased trabecular separation and structural model index (a lower level is preferable) compared with boron supplementation (3 mg/kg diet).(Nielsen 2009, Nielsen 2006) In another study comparing rats fed boron 0.07 mg/kg (boron deficient) compared with 3 mg/kg (boron adequate), boron deprivation decreased bone volume fraction in the alveolus 14 days after tooth extraction.(Gorustovich 2008) Boron deprivation studies showed decreased bone strength in femurs of female rats(Nielsen 2004) and pigs.(Armstrong 2002, Armstrong 2000)

Boron deprivation may not markedly affect calcium and phosphorus concentrations in bone, but rather the concentrations of other minerals (eg, magnesium, potassium, copper, zinc)(Nielsen 1994, Nielsen 2004, Nielsen 2007) associated with the formation, differentiation, and activity of osteoblasts and osteoclasts. Mice fed a boron-deficient diet (0.07 mg/kg) for 9 weeks compared with mice supplemented with boron 3 mg/kg exhibited decreased osteoblast surface and increased quiescent bone-forming surface of periodontal alveolar bone.(Gorustovich 2008)

Various environmental and dietary factors may enhance the effects of boron. In several studies in which animal models were fed marginal amounts of vitamin D, classic signs of vitamin D deficiency related to bone and calcium metabolism were exhibited in boron-deprived animals but not in animals fed nutritional amounts of boron.(Bai 1996, Hegsted 1991, Hunt 1989) Similarly, boron increased the efficacy of estrogen supplementation in rats, resulting in a beneficial effect on trabecular bone volume fraction, bone growth plate density, and trabecular separation. The combination of boron and estrogen versus either alone also markedly improved the apparent absorption of calcium, phosphorus, and magnesium, as well as the retention of calcium and magnesium.(Sheng 2001a) In this and other studies in ovarectomized rats, boron supplementation alone did not improve any of these variables.(Sheng 2001a, Sheng 2001b) A study comparing rats and their offspring supplemented with boron 0 to 3 mg/kg and fed either safflower oil or fish oil showed boron supplementation had a beneficial effect on trabecular microarchitecture and cortical bone strength, and that fish oil rather than safflower oil is beneficial to vertebral and cortical bone strength. Boron and fish oil apparently have beneficial effects through different mechanisms that sometimes appear complementary.(Nielsen 2009b)

Clinical data

Studies have shown that the concentration of boron in bones(Newnham 1981) and synovial fluid(Havercroft 1991, Newnham 1981) of individuals with rheumatoid arthritis is lower than in those without this disorder.

Surgeons have observed that bones of patients who use boron supplements are much more difficult to cut than bones of patients who do not.(Newnham 1994) Boron supplementation also apparently accelerates the healing of broken bones.(Nielsen 2008)

An epidemiologic relationship has been established between various forms of arthritis (eg, osteoarthritis) and low boron intake. In areas of the world where boron intake is 1 mg/day or less, the estimated incidence of arthritis ranges from 20% to 70%, whereas in areas where boron intake is typically 3 to 10 mg/day, the estimated incidence ranges from 0% to 10%.(Newnham 1994) Low boron intake may also worsen rheumatoid arthritis and osteoarthritis and decrease the ability to engage in physical exercise that requires a high-energy output.(Jamison 2003)

In a double-blind trial comparing placebo and boron supplementation in 20 patients with osteoarthritis, 50% of patients receiving boron 6 mg/day improved on self-reported measures of joint swelling, restricted movement, and analgesia compared with only 10% of those receiving placebo.(Travers 1990)

In postmenopausal women, the increases in serum 17beta-estradiol induced by estrogen therapy were higher when consumed with 3.25 mg/day of boron compared with boron consumption of 0.25 mg/day.(Nielsen 1992) In nutritional studies involving postmenopausal females and men receiving boron with or without estrogen therapy, estrogen therapy increased plasma copper and serum 17beta-estradiol concentrations (with the increases depressed by boron deprivation) and increased serum immunoreactive ceruloplasmin and erythrocyte superoxide dismutase; these variables were also higher during boron repletion compared to depletion (all subjects regardless of estrogen ingestion). Dietary boron had no effect on these variables in men or women not ingesting estrogen. These findings suggest that boron can enhance and mimic some effects of estrogen ingestion.(Nielsen 1994)

Cancer/Boron neutron capture therapy

Boron-based compounds are used in conjunction with radiation therapy to enhance the selective killing of neoplastic cells. Boron neutron capture therapy is based on the ability of the stable isotope 10B to capture neutrons, which leads to a nuclear reaction producing an alpha- and a 7Li-particle, both having high biological effectiveness and a very short range in tissue, thus opening the possibility for a highly selective cancer therapy.(Hunter 2009, Wittig 2008)

In vitro data

In addition to the effects of boron neutron capture therapy, several boron derivatives have also exhibited antitumor effects. Boric acid, sodium perborate tetrahydrate, and sodium pentaborate pentahydrate tested in a small cell lung cancer cell line demonstrated anticancer activities via mechanisms such as upregulation of proapoptotic and tumor suppressor genes and cell cycle arrest at different phases.(Cebeci 2022) New synthetic derivatives of boron have shown in vitro cytotoxicity in hepatocellular carcinoma, as well as antioxidant and antimicrobial activities.(Gündüz 2022)

Clinical data

Boron neutron capture therapy has been examined in clinical trials in resistant and difficult-to-treat cancers.(Haselsberger 1994, Kankaanranta 2007, Miyatake 2007, Pisarev 2007, Suzuki 2007a, Suzuki 2007b)

CNS effects

Boron may be important in brain function,(Penland 1994, Penland 1998) with deprivation impairing cognitive and psychomotor function, resulting in decreased mental alertness and poorer performance at tasks requiring speed and dexterity, attention, and/or short-term memory.(IMPM 2001, Penland 1994) While boron deprivation may have an adverse effect on brain function, there is no evidence that supplementation above normal dietary levels can enhance mental acuity or improve alertness.

Animal data

Measures of brain electrophysiology and behavior have been shown to be sensitive to boron nutritional inadequacy in animals.(Penland 1989, Penland 1993) In a study comparing rats fed 0 mcg/g versus 3 mcg/g of boron for 75 days, more activity was observed in the lower frequencies than in the higher frequencies on electrocorticograms.(Penland 1993)

In one study, boron deprivation altered rat behavior and brain mineral composition differently when dietary fat (75 g/kg) was supplied as fish oil (65 g/kg plus 10 g/kg of linoleic acid) versus safflower oil. Boron-deficient (0.1 mg/kg diet) rats were less active than boron-adequate (3.1 mg/kg diet) rats when fed safflower oil, but when fed fish oil, the activity response to boron deprivation was attenuated.(Nielsen 2006)

Clinical data

Various studies in healthy older males and females assessed brain EEG activity and response to cognitive and psychomotor performance with dietary manipulation of boron (0.25 mg vs 3.25 mg per 2,000 kcal/day).) All studies provided evidence that relatively short periods of restricted boron intake can affect brain function and cognitive performance in otherwise healthy individuals.(Penland 1994)

In these studies, the most consistent EEG finding with low boron intake was a shift toward more activity in the lower frequencies and less activity in the higher, dominant frequencies of the EEG spectrum.(Penland 1994) Effects on psychomotor skills and cognitive processes of attention, perception, and memory were variable.(Nielsen 2008, Penland 1994)

In the same studies, search-count (a measure of attention) and symbol-count (a measure of encoding skills and short-term memory) consistently showed that boron deprivation impaired response times. However, not all tasks were adversely affected by dietary boron deprivation.(Penland 1994)

Dysmenorrhea

Clinical data

A triple-blind, randomized, placebo-controlled clinical trial conducted in 113 single female university students with primary dysmenorrhea explored the effects of boron supplementation on pain severity and duration. Boron supplementation (one 300 mg capsule [containing 88.5 mg of sodium tetraborate; equivalent to 10 mg of boron] daily) was taken for 5 days (through the first 3 days of menstrual flow) for 2 consecutive cycles. Over time across the 2 cycles, mean severity (P=0.001) and duration (P=0.032) of pain were significantly lower with boron than in the control group. No major side effects were observed.(Nikkhah 2015)

Hematoprotective effects

Animal data

In a study of rats, administering boron adjunctively with cyclophosphamide significantly reduced bone marrow suppression, as evidenced by significant improvements in leukocytes and platelets (P<0.001 for each). Although erythrocytes were improved with the addition of boron compared with cyclophosphamide alone (6.27×106/mm3 vs 5.94×106/mm3, respectively), hemoglobin and hematocrit levels were lower in the boron plus cyclophosphamide group (10.36 g/dL and 31.4%, respectively) than in the cyclophosphamide-only group (11.6 g/dL and 32.5%, respectively).(Cengiz 2018)

Inflammatory/Immune response

Other diverse responses reported for low boron intake include effects on membrane integrity and function, impairment of hormone receptors (including decreased insulin sensitivity) and signal transduction functions, and regulation of enzymatic activity.(Devirian 2003, Hunt 1998, Jamison 2003, Nielsen 2009) Some of these responses may play a role in inflammatory or immunological regulation and may be secondary to a primary action.

Animal data

There are numerous animal studies suggesting boron may have a regulatory role in inflammatory or immune responses. These include the following effects in boron-supplemented animals compared with boron-low or -deficient diets: reduced swelling and lower circulating concentrations of natural killer and immune cells after injection with an antigen to induce arthritis in rats(Hunt 1999); delayed onset of adjuvant-induced arthritis in rats(Hunt 1999); lower skin-fold thickness response to an intradermal injection of phytohemagglutination in pigs(Armstrong 2001); and lower antibody response to injected typhoid antigen in rats.(Bai 1997)

In a study in mice,(Bourgeois 2007) boron deprivation downregulated 30 of 31 cytokines or chemokines associated with the inflammatory response 6 days after infection with the nematode Heligmosomoides bakeri. Another study(Armstrong 2003) showed lower serum tumor necrosis factor alpha (TNF-alpha) and interferon-gamma after lipopolysaccharide injection in pigs fed a marginal boron-deficient diet than in those supplemented with a boron 5 mg/kg diet.

Clinical data

Boron status in humans has been shown to affect various immunological markers. These include increased white blood cells, increased percentage of polymorphonuclear neutrophils, and decreased percentage of lymphocytes in a study of perimenopausal women (N=43) during boron supplementation.(Nielsen 1999) Self-reported improvement in symptoms in patients with osteoarthritis consuming 6 mg/day of boron when compared with placebo(Travers 1990) may be a result of an effect on the inflammatory response.

Low boron intake has been associated with increased risk of prostate cancer,(Barranco 2007, Cui 2004) higher cytopathological indicators of cervical cancer,(Korkmaz 2007) some types of breast cancer,(Touillaud 2005) and lung cancer,(Mahabir 2008) possibly due to an immune system effect.

Nephroprotective effects

Animal data

Gentamicin-induced nephrotoxicity was alleviated in rats given a boron-supplemented diet 4 days prior to gentamicin and continued through day 14. Renal function parameters (ie, blood urea nitrogen, serum creatinine) in the boron group improved in a dose-dependent manner compared to untreated controls (P<0.05). Effects appeared to be related to significant increases in antioxidant pathways and reductions in several proinflammatory cytokines in the serum as well as renal tissue, including TNF-alpha, nuclear factor-kappaB, interleukin-1 beta, and interferon-gamma (P<0.05).(Ince 2020) In another study, boric acid treatment reduced damage associated with acetaminophen nephrotoxicity in rats.(Coban 2022)

Radiation dermatitis

Clinical data

In a study in patients being treated for breast cancer (N=257), participants in the intervention group were given a gel containing 3% sodium pentaborate pentahydrate 15 minutes before each radiotherapy, while those in the placebo group received a gel with no chemical substance. After 14 days of treatment, the boron-containing gel was found to be more protective against damage from radiation dermatitis than the placebo gel.(Sahin 2022)

Renal transplant

Clinical data

Data collected at least 1 year after transplant (median, 5.4 years) from a cohort of 707 renal transplant patients with functioning kidney allografts revealed that those in the highest tertile of boron excretion (more than 1,540 mcg per 24 hours) had a lower risk of all-cause mortality (13%), independent of confounders (hazard ratio, 0.43; 95% CI, 0.27 to 0.67). In contrast, no significant association was found between boron excretion and graft failure. Boron excretion was found to be positively correlated with male sex as well as wine, fruit, nut, soy, and fish consumption, and negatively correlated with consumption of potatoes and meat products. The proposed mechanism was thought to be related to antioxidant activity, DNA repair, telomere stability, and the aging process.(Kremer 2022)

Urolithiasis

Clinical data

One investigator has reported the use of boron supplementation in approximately 30 cases to facilitate dissolution and/or passing of urinary stones with minimal pain. Boron was supplemented at 10 mg/day with and without additional antioxidants for 2 to 60 days. Boron was well tolerated without observed side effects.(Naghii 2014, Naghii 2013, Naghii 2012) In the absence of a control group, it is difficult to attribute these results to boron.

Vulvovaginitis

Clinical data

Studies show that intravaginal boric acid is beneficial in treating candidiasis and other vaginal fungal infections, including resistant and chronic infections.(Guaschino 2001, Jovanovic 1991, Swate 1974, Thai 1993, Van Slyke 1981) In one study of vulvovaginal Candida albicans, cure rates were 92% with 14 daily intravaginal capsules containing 600 mg of boric acid powder versus 64% with identical capsules containing nystatin 100,000 units.(Van Slyke 1981) For Candida glabrata, intravaginal boric acid 600 mg daily for 2 to 3 weeks successfully treated 65% to 70% of azole-resistant infections.(Sobel 1997, Sobel 2003) For Candida krusei, which is rare but resistant to azole antifungal treatment, boric acid appeared to be effective in some cases.(Singh 2002)

Weight loss

Animal data

Due to a lack of clinical trials and limited human studies, only animal data were included in a meta-analysis that assessed the effect of boron and boron compounds on weight loss. Based on a total of 6 studies that contained 17 datasets, administration of boron was associated with a significant decrease in body weight (P<0.001) compared with baseline; however, heterogeneity among studies was extremely high. Subgroup analyses noted significantly better efficacy when the duration of intervention was no more than 4 weeks (P=0.005), when the borax form was used (vs sodium pentaborate pentahydrate or boric acid), when given via gavage diet (vs drinking water), when assessed in Sprague Dawley male rats (vs mice or Wistar albino rats), and when administered in males (P<0.001 for each). The overall quality of studies was low.(Farrin 2022)

Dosing

Boron has been studied using a wide range of doses and preparations. Evidence centers on deprivation studies. Evidence is lacking suggesting that boron supplementation above the levels derived in a normal diet is beneficial. Therefore, supplementation is likely to be useful only when dietary intake is inadequate.

Oral dosing

Dietary intake

The 1994-96 Continuing Survey of Food Intakes by Individuals indicated that median dietary boron intakes ranged from a low of about 0.87 mg/day to a high of about 1.35 mg/day in adults.(NIH 2022) No recommended daily allowance has been established for boron because an essential biological role has not been identified, although the World Health Organization has suggested 1 to 13 mg/day(WHO 1996) as an acceptable safe range for adults. Dietary intake varies. Diets considered high in boron provide about 3.25 mg of boron per 2,000 kcal/day. Diets considered low in boron provide 0.25 mg of boron per 2,000 kcal/day.(Penland 1994)

A 2009 review recommended that patients on parenteral nutrition receive boron 1 mg/day, because it is unlikely that this amount is being delivered in most parenteral solutions, which supply boron only through contamination of ingredients.(Nielsen 2009)

Tolerable upper limits for boron (ie, maximum dose at which no harmful effects would be expected) are as follows(Nielsen 2009, NIH 2022):

Adults 19 years and older, including those who are pregnant or breastfeeding

20 mg/day.

Adolescents 14 to 18 years of age, including those who are pregnant or breastfeeding

17 mg/day.

Children 9 to 13 years of age

11 mg/day.

Children 4 to 8 years of age

6 mg/day.

Children 1 to 3 years of age

3 mg/day.

Infants younger than 1 year

Upper limit has not been established.

Dysmenorrhea

Boron supplementation (one 300 mg capsule [containing 88.5 mg of sodium tetraborate; equivalent to 10 mg of boron] daily) was taken for 5 days (through the first 3 days of menstrual flow) for 2 consecutive cycles in a study of females with primary dysmenorrhea.(Nikkhah 2015)

Vaginal dosing

Vulvovaginitis

For treatment of vulvovaginal candidiasis, boric acid 600 mg daily for 2 to 3 weeks has been studied.(Sobel 1997, Sobel 2003, Van Slyke 1981)

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking; however, when boron is used orally in doses below the upper intake level, it is likely to be safe.(IMPM 2001) Boric acid should not be used in pregnancy. Intravaginal boric acid use during the first 4 months of pregnancy has been associated with birth defects.(Acs 2006, Medline Plus 2022, Thai 1993)

Interactions

Boron supplementation should be avoided in patients with estrogen-sensitive conditions (eg, breast cancer, uterine cancer, ovarian cancer, endometriosis, uterine fibroids), and it should be used cautiously with concomitant estrogens because it may increase the levels or enhance the activity of estrogen.(Medline Plus 2022)

There are no known interactions with other drugs or foods(Medline Plus 2022); however, supplementation may result in changes in plasma levels of phosphorous and magnesium.(Meacham 1994)

Progesterone: Vaginal antifungal agents may diminish the therapeutic effect of progesterone. Avoid combination.(Endometrin February 2008, Endometrin May 2015, Milprosa April 2020)

Adverse Reactions

Clinical information is limited concerning the adverse effects of boron. Recommendations regarding the oral dosage below which adverse reactions are unlikely range from 10 mg/day(Naghii 1997) to 20 mg/day.(IMPM 2001)

Although compounds containing boron are used medicinally, they are potentially toxic if ingested or absorbed through nonintact skin. Long-term use of boric acid orally at 1 g/day or boric tartrate 15 g/day can cause dermatitis, alopecia, anorexia, lethargy, and indigestion.(IMPM 2001) Boric acid has been well tolerated intravaginally(Rein 1981) and does not appear to result in systemic absorption.(Thai 1993) Vulvovaginal burning has been reported. Dyspareunia may occur in males if intercourse occurs shortly after vaginal treatment.(Van Kessel 2003)

Intravaginal boric acid used during the first 4 months of pregnancy has been associated with birth defects.(Acs 2006, Medline Plus 2022, Thai 1993)

Toxicology

Boric acid and borates can be toxic when ingested. The minimum lethal dose of boric acid is 640 mg/kg/day, with the potential lethal dose reported to be 15 to 20 g/day for adults and 3 to 6 g/day for infants.(IMPM 2001) Animal studies have shown that high doses of borax and boric acid may adversely affect male fertility; however, this has not been observed in humans.(IMPM 2001, Scialli 2010)

Boric acid solutions should not be used on broken skin or on severely irritated or inflamed mucous membranes in order to prevent possible toxicity via absorption.(IMPM 2001)

Boron should be used with caution in patients with impaired kidney function because it is primarily excreted renally.(IMPM 2001, Usuda 1996)

Fatalities have been reported because of confusion between boric acid and similar-looking powders (ie, baking soda, dextrose). Stringent controls should be maintained in hospitals, nursing homes, and other public facilities to prevent possible intoxications due to errant use of boron-containing products.

There is no effective antidote to boron poisoning, and treatment is symptomatic and supportive. Symptoms associated with accidental consumption of boric acid or borax (sodium borate), contained in some household cleaning products and pesticides, include nausea, GI discomfort, vomiting, diarrhea, skin flushing, rash, excitation, convulsions, depression, and vascular collapse. Boron toxicity can cause headache, hypothermia, restlessness, weariness, renal injury, dermatitis, alopecia, anorexia, and indigestion. Extremely high doses of boron (15,000 to 20,000 mg in adults) can cause death.(NIH 2022)

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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Acs N, Bánhidy F, Puhó E, Czeizel AE. Teratogenic effects of vaginal boric acid treatment during pregnancy. Int J Gynaecol Obstet. 2006;93(1):55-56. doi:10.1016/j.ijgo.2005.12.03116530197
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