Herb & supplement monograph

Berberine Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by ·Updated July 2026
What is this page for?

First and foremost: how Berberine interacts with medications. The heart of this page is the interaction list — every drug Berberine is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Berberine is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Berberine Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Berberine drug interaction appears low for most people, though a few closely monitored medicines call for genuine caution. Only one listed interaction is rated major, and the great majority are moderate concerns supported mainly by theoretical or early evidence.

Interactions deserving the most attention

The strongest concern is cyclosporine, a transplant medicine with a narrow safety margin; human evidence shows berberine can slow its breakdown and raise its blood levels. A case report also links berberine to a sharp rise in tacrolimus levels, another transplant drug where small changes matter. Because clinical research shows berberine can lower blood glucose, people taking diabetes medications should watch for added blood sugar lowering. Possible added effects with blood thinners, blood pressure medicines, and sedatives are mostly theoretical.

What the rest of the list means

The very long list of interactions largely reflects one shared mechanism: berberine may slow enzymes the body uses to clear many medications, so a wide range of drugs gets flagged. For most of them, this is a possibility seen in lab or early research, not an effect shown to cause meaningful problems in people.

Check your medications against Berberine

Based on HelloPharmacist’s Berberine interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Berberine

1160 medications have a known interaction with Berberine, graded by severity. Select any drug for the full evidence-based detail.

1 major interaction. These combinations can be clinically significant — best avoided, or used only with close professional supervision. Always check with your pharmacist before combining them with Berberine.

2,830 drugs
CyclosporineCequa, Ciclosporine, Gengraf, Neoral, Sandimmune, Verkazia +1 more
Major Cyclosporine (neoral, Sandimmune)

Berberine can increase serum levels of cyclosporine.

Read the full Berberine + Cyclosporine interaction Cyclosporine drug page: uses, dosage & side effects
Ado-trastuzumab EmtansineKadcyla
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Ado-trastuzumab Emtansine interaction Ado-trastuzumab Emtansine drug page: uses, dosage & side effects
AbciximabReoPro
Moderate Anticoagulant/antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.

Read the full Berberine + Abciximab interaction
AbemaciclibVerzenio
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Abemaciclib interaction Abemaciclib drug page: uses, dosage & side effects
Abiraterone
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Abiraterone interaction Abiraterone drug page: uses, dosage & side effects
Abiraterone AcetateYonsa, Zytiga
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Abiraterone Acetate interaction Abiraterone Acetate drug page: uses, dosage & side effects
AbrocitinibCibinqo
Moderate Anticoagulant/antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.

Read the full Berberine + Abrocitinib interaction Abrocitinib drug page: uses, dosage & side effects
AcalabrutinibCalquence
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acalabrutinib interaction Acalabrutinib drug page: uses, dosage & side effects
AcarboseGlucobay, Prandase, Precose
Moderate Antidiabetes Drugs

Theoretically, berberine may increase the risk of hypoglycemia when taken with antidiabetes drugs.

Read the full Berberine + Acarbose interaction Acarbose drug page: uses, dosage & side effects
AcebutololRhotral, Sectral
Moderate Antihypertensive Drugs

Theoretically, berberine might have additive effects with antihypertensive drugs.

Read the full Berberine + Acebutolol interaction Acebutolol drug page: uses, dosage & side effects
AcenocoumarolSintrom
Moderate Anticoagulant/antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.

Read the full Berberine + Acenocoumarol interaction
AcepromazineAtravet
Moderate Cns Depressants

Theoretically, berberine might increase the sedative effects of CNS depressants.

Read the full Berberine + Acepromazine interaction
Acetaminophen, AspirinGemnisyn
Moderate Anticoagulant/antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.

Read the full Berberine + Acetaminophen, Aspirin interaction
Acetaminophen, Aspirin, CaffeineExcedrin, Excedrin Extra Strength, Excedrin Migraine
Moderate Anticoagulant/antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.

Read the full Berberine + Acetaminophen, Aspirin, Caffeine interaction
Acetaminophen, Butalbital, CaffeineEsgic, Esgic Plus, Fiogesic, Fioricet, Repan, Tecnal +1 more
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acetaminophen, Butalbital, Caffeine interaction Acetaminophen, Butalbital, Caffeine drug page: uses, dosage & side effects
Acetaminophen, Butalbital, Caffeine, CodeineEsgic with Codeine, Fioricet w/ Codeine
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acetaminophen, Butalbital, Caffeine, Codeine interaction
Acetaminophen, Butalbital, CodeineBancap w/ Codeine
Moderate Cytochrome P450 2d6 (cyp2d6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.

Read the full Berberine + Acetaminophen, Butalbital, Codeine interaction
Acetaminophen, Butalbital, Codeine PhosphatePhrenilin #3
Moderate Cns Depressants

Theoretically, berberine might increase the sedative effects of CNS depressants.

Read the full Berberine + Acetaminophen, Butalbital, Codeine Phosphate interaction
Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, PhenylephrineHycomine Compound
Moderate Cytochrome P450 2d6 (cyp2d6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.

Read the full Berberine + Acetaminophen, Caffeine, Chlorpheniramine, Hydrocodone, Phenylephrine interaction
Acetaminophen, Caffeine, CodeineGesic C15, Gesic C30, Gesic C8, Lenoltec 1, Lenoltec 2, Lenoltec 3 +1 more
Moderate Cns Depressants

Theoretically, berberine might increase the sedative effects of CNS depressants.

Read the full Berberine + Acetaminophen, Caffeine, Codeine interaction
Acetaminophen, Caffeine, Codeine, SalicylamideCodalan No.1, Codalan No.2, Codalan No.3
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acetaminophen, Caffeine, Codeine, Salicylamide interaction
Acetaminophen, Caffeine, DihydrocodeineDHC Plus, Panlor DC, Panlor SS
Moderate Cytochrome P450 2d6 (cyp2d6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.

Read the full Berberine + Acetaminophen, Caffeine, Dihydrocodeine interaction
Acetaminophen, Caffeine, IsomethepteneMigralam
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acetaminophen, Caffeine, Isometheptene interaction
Acetaminophen, Caffeine, PyrilamineMidol Max Strength Menstrual
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acetaminophen, Caffeine, Pyrilamine interaction
Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan HbrVicks Formula 44M Cough, Cold & Flu Relief
Moderate Cytochrome P450 2d6 (cyp2d6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.

Read the full Berberine + Acetaminophen, Chlorpheniramine Maleate, Dextromethorphan Hbr interaction
Acetaminophen, Chlorpheniramine, Codeine, PhenylephrineColrex
Moderate Cytochrome P450 2d6 (cyp2d6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.

Read the full Berberine + Acetaminophen, Chlorpheniramine, Codeine, Phenylephrine interaction
Acetaminophen, Chlorpheniramine, DextromethorphanCoricidin II Extra Strength Cold and Flu
Moderate Cytochrome P450 2d6 (cyp2d6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.

Read the full Berberine + Acetaminophen, Chlorpheniramine, Dextromethorphan interaction
Acetaminophen, Chlorpheniramine, Dextromethorphan HydrobromideCoricidin HBP Maximum Strength Flu
Moderate Dextromethorphan (robitussin Dm, Others)

Theoretically, berberine may increase serum levels of dextromethorphan.

Read the full Berberine + Acetaminophen, Chlorpheniramine, Dextromethorphan Hydrobromide interaction
Acetaminophen, Chlorpheniramine, Dextromethorphan, PhenylpropanolamineMulti Symptom Cold Relief
Moderate Dextromethorphan (robitussin Dm, Others)

Theoretically, berberine may increase serum levels of dextromethorphan.

Read the full Berberine + Acetaminophen, Chlorpheniramine, Dextromethorphan, Phenylpropanolamine interaction
Acetaminophen, Chlorpheniramine, Dextromethorphan, PseudoephedrineChildren's Tylenol Cold Plus Cough, Tylenol Cold Ex Strength
Moderate Cytochrome P450 3a4 (cyp3a4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.

Read the full Berberine + Acetaminophen, Chlorpheniramine, Dextromethorphan, Pseudoephedrine interaction
Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

  • Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
  • Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
  • Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
  • No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

  • Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
  • Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
  • Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

  • Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
  • Each drug listed above links to the full report for that exact Berberine combination — clinical detail, likelihood, evidence level, and citations.
  • Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
The big picture

The kinds of drugs Berberine affects

Every type of medication (drug category) Berberine is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 15 drug categories Berberine interacts with
Cyclosporine (neoral, Sandimmune)Anticoagulant/antiplatelet DrugsAntidiabetes DrugsAntihypertensive DrugsCns DepressantsCytochrome P450 2c9 (cyp2c9) SubstratesCytochrome P450 2d6 (cyp2d6) SubstratesCytochrome P450 3a4 (cyp3a4) SubstratesDextromethorphan (robitussin Dm, Others)Losartan (cozaar)Metformin (glucophage)Midazolam (versed)Pentobarbital (nembutal)Tacrolimus (prograf)Acetazolamide
Cyclosporine (Neoral, Sandimmune)

Berberine can increase serum levels of cyclosporine.
Berberine can reduce metabolism and increase serum levels of cyclosporine. Berberine might inhibit cytochrome P450 3A4 (CYP3A4), which metabolizes cyclosporine.

Likelihood Probable Evidence A
Anticoagulant/Antiplatelet Drugs

Theoretically, berberine might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
In vitro and in vivo research suggest that berberine can inhibit platelet aggregation. Theoretically, berberine might have additive effects when used with anticoagulant and antiplatelet drugs and increase the risk of bleeding.

Likelihood Possible Evidence D
Antidiabetes Drugs

Theoretically, berberine may increase the risk of hypoglycemia when taken with antidiabetes drugs.
Clinical research shows that berberine may lower blood glucose levels. Theoretically, berberine might have additive effects with antidiabetes drugs and increase the risk of hypoglycemia.

Likelihood Possible Evidence D
Antihypertensive Drugs

Theoretically, berberine might have additive effects with antihypertensive drugs.
Animal research suggests that berberine can have hypotensive effects. Also, a clinical study suggests that taking berberine in combination with amlodipine can lower systolic and diastolic blood pressure when compared with amlodipine alone.

Likelihood Possible Evidence D
Cns Depressants

Theoretically, berberine might increase the sedative effects of CNS depressants.
Animal research suggests that berberine may have sedative effects. Theoretically, use of berberine along with CNS depressants might produce additive therapeutic and adverse effects.

Likelihood Possible Evidence D
Cytochrome P450 2C9 (Cyp2C9) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2C9.
Preliminary clinical research shows that berberine can inhibit CYP2C9. Theoretically, taking berberine with drugs metabolized by CYP2C9 might increase drug levels and increase the risk of adverse effects.

Likelihood Possible Evidence B
Cytochrome P450 2D6 (Cyp2D6) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP2D6.
In vitro research and preliminary clinical evidence show that berberine can inhibit CYP2D6. Theoretically, use of berberine with drugs metabolized by CYP2D6 might increase drug levels and increase the risk of adverse effects.

Likelihood Possible Evidence B
Cytochrome P450 3A4 (Cyp3A4) Substrates

Theoretically, berberine might increase serum levels of drugs metabolized by CYP3A4.
In vitro research and preliminary clinical research show that berberine moderately inhibits CYP3A4. Theoretically, use of berberine with drugs metabolized by CYP3A4 might increase drug levels and increase the risk of adverse effects.

Likelihood Possible Evidence A
Dextromethorphan (Robitussin Dm, Others)

Theoretically, berberine may increase serum levels of dextromethorphan.
Preliminary clinical research shows that berberine can inhibit cytochrome P450 2D6 (CYP2D6) activity and reduce the metabolism of dextromethorphan. This may increase the effects and side effects of dextromethorphan.

Likelihood Possible Evidence B
Losartan (Cozaar)

Berberine might reduce the therapeutic effects of losartan by decreasing its conversion to its active form.
Preliminary clinical research suggests that berberine can inhibit cytochrome P450 2C9 (CYP2C9) activity and reduce metabolism of losartan.

Likelihood Possible Evidence B
Metformin (Glucophage)

Theoretically, berberine might increase the therapeutic and adverse effects of metformin.
In vitro and animal studies show that berberine can increase the systemic exposure and half-life of metformin, potentially increasing metformin's effects and side effects. This interaction seems to be most apparent when berberine is administered 2 hours prior to metformin. Taking berberine and metformin at the same time does not appear to increase systemic exposure to metformin.

Likelihood Possible Evidence D
Midazolam (Versed)

Berberine can reduce metabolism of midazolam, which might increase the risk of severe adverse effects.
Preliminary clinical research shows that berberine can inhibit cytochrome P450 3A4 (CYP3A4) activity and reduce metabolism of midazolam.

Likelihood Possible Evidence B
Pentobarbital (Nembutal)

Berberine might increase the sedative effect of pentobarbital.
Evidence from animal research shows that berberine can prolong pentobarbital-induced sleeping time. Theoretically, combining berberine and pentobarbital might increase the sedative effects of pentobarbital.

Likelihood Possible Evidence D
Tacrolimus (Prograf)

Berberine has been associated with increased blood levels of tacrolimus.
In a 16-year-old patient with idiopathic nephrotic syndrome who was being treated with tacrolimus 6.5 mg twice daily, intake of berberine 200 mg three times daily increased the blood concentration of tacrolimus from 8 to 22 ng/mL. Following a reduction of the tacrolimus dose to 3 mg daily, blood levels of tacrolimus decreased to 12 ng/mL.

Likelihood Possible Evidence D
Acetazolamide

Laboratory studies and initial clinical findings suggest that berberine has the potential to increase acetazolamide concentrations in the body. More research is needed to confirm this interaction.

Likelihood Possible Evidence C
Monograph

Berberine: Uses, Safety & Side Effects

Medically reviewed by · Reviewed July 2026 ·
The bottom line

Berberine is a yellow plant compound that has shown promise for lowering blood sugar and cholesterol in some studies, but the quality of research varies and it is not a replacement for prescribed medicine. It can cause stomach upset and should be avoided during pregnancy and breastfeeding. Always check with your pharmacist or doctor before starting it, especially if you take other medications.

Berberine
Part used
Roots, bark, and stems of berberine-containing plants (such as goldenseal, barberry, goldthread, and Oregon grape)
Common forms
Capsules, tablets, powders, and tinctures
People commonly use it for
  • Blood sugar control
  • High cholesterol
  • Heart and metabolic health
  • Digestive upset
  • Antimicrobial support
  • Weight management

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance
OverallUse caution

Generally tolerated short-term but can cause digestive side effects and interacts with many medicines.

PregnancyLikely Unsafe

When used orally. Berberine is thought to cross the placenta and may cause harm to the fetus. Kernicterus has developed in newborn infants exposed to...

Read the full pregnancy detail
BreastfeedingLikely Unsafe

When used orally. Berberine can be transferred to the infant through breast milk.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Jump to a section

Overview

Berberine is a naturally occurring compound (an alkaloid) found in several plants, including goldenseal, barberry, goldthread, phellodendron, and Oregon grape. It is easy to recognize because of its bright yellow color and very bitter taste.

It has been used for hundreds of years in traditional Chinese and Ayurvedic medicine, often for digestive problems and infections. Today, berberine is sold as a dietary supplement, most often in capsules or tablets, and is popular for supporting blood sugar, cholesterol, and overall metabolic health.

How it works

Berberine is thought to work in several ways. One main proposed mechanism is that it activates an enzyme called AMP-activated protein kinase (AMPK), sometimes described as a "metabolic master switch." This may help cells use sugar and fat more efficiently.

Researchers also believe berberine may affect how the body handles glucose in the liver and muscles, may influence cholesterol processing, and may change the balance of bacteria in the gut. Berberine has shown antibacterial and anti-inflammatory effects in test-tube studies as well.

It is important to know that many of these mechanisms come from laboratory and animal research. How well they translate to clear health benefits in people is still being studied.

Effectiveness

Does Berberine work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by .

Evidence overview · 31 uses evaluated
6 Possibly effective 25 Insufficient evidence
How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.
2Likely EffectiveGood evidence, though not yet conclusive.
3Possibly EffectiveSome evidence suggests a benefit.
4Possibly IneffectiveSome evidence it may not help.
5Likely IneffectiveFairly strong evidence it doesn’t help.
6IneffectiveStrong evidence it doesn’t work.
7Insufficient Reliable Evidence to RateToo little research to say either way.
Possibly Effective Canker sores
Rating & evidence shown verbatim from Natural Medicines

Some evidence shows that berberine gel applied to canker sores may reduce pain and the size of the sores, but it has not been compared to conventional treatments.

Possibly Effective Diabetes
Rating & evidence shown verbatim from Natural Medicines

Berberine seems to moderately reduce blood glucose in people with type 2 diabetes; it may provide additional benefit when given with conventional medications.

Possibly Effective Helicobacter pylori
Rating & evidence shown verbatim from Natural Medicines

Oral berberine, when taken with amoxicillin and a proton pump inhibitor (PPI) with or without clarithromycin, might be as effective as bismuth-containing quadruple therapy (BQT), vonoprazan quadruple therapy, and PPI-based triple therapy for eradication of Helicobacter pylori.

Possibly Effective Hyperlipidemia
Rating & evidence shown verbatim from Natural Medicines

Clinical research shows that taking berberine orally, alone or in combination with other ingredients, reduces total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides in people with hyperlipidemia.

Possibly Effective Hypertension
Rating & evidence shown verbatim from Natural Medicines

Berberine may have added benefits for reducing blood pressure when used in combination with amlodipine.

Possibly Effective Polycystic ovary syndrome (PCOS)
Rating & evidence shown verbatim from Natural Medicines

Berberine may improve some metabolic characteristics in women with PCOS and insulin resistance. It may also increase live births, although the data are conflicting.

Also studied for 25 conditions — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Antipsychotic-induced metabolic side effects
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial in patients with antipsychotic-induced metabolic side effects.

Insufficient Reliable Evidence To Rate Atrial fibrillation
Rating & evidence shown verbatim from Natural Medicines

Limited research suggests that oral berberine might prevent atrial fibrillation shortly after coronary artery bypass graft (CABG) surgery.

Insufficient Reliable Evidence To Rate Biliary disorders
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial in patients with biliary disorders.

Insufficient Reliable Evidence To Rate Burns
Rating & evidence shown verbatim from Natural Medicines

Topical berberine has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Insufficient Reliable Evidence To Rate Cholera
Rating & evidence shown verbatim from Natural Medicines

Although taking a single dose of berberine may be modestly beneficial for reducing stool volume, using berberine daily with tetracycline does not seem to provide added benefit.

Insufficient Reliable Evidence To Rate Colorectal adenoma
Rating & evidence shown verbatim from Natural Medicines

Berberine may help prevent adenoma recurrence after polypectomy.

Insufficient Reliable Evidence To Rate Congestive heart failure (CHF)
Rating & evidence shown verbatim from Natural Medicines

Berberine may provide additional benefit to patients with CHF who are taking conventional medications.

Insufficient Reliable Evidence To Rate Coronary heart disease (CHD)
Rating & evidence shown verbatim from Natural Medicines

Oral berberine has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Insufficient Reliable Evidence To Rate Diarrhea
Rating & evidence shown verbatim from Natural Medicines

Limited data suggest that berberine may be helpful for diarrhea caused by bacteria.

Insufficient Reliable Evidence To Rate Glaucoma
Rating & evidence shown verbatim from Natural Medicines

It is unclear if berberine is beneficial for glaucoma when used as an eye drop.

Insufficient Reliable Evidence To Rate Hepatitis B
Rating & evidence shown verbatim from Natural Medicines

It is unclear if berberine is beneficial for improving liver function in people with hepatitis B.

Insufficient Reliable Evidence To Rate Hepatitis C
Rating & evidence shown verbatim from Natural Medicines

It is unclear if berberine is beneficial for improving liver function in people with this form of hepatitis.

Insufficient Reliable Evidence To Rate Impaired glucose tolerance (prediabetes)
Rating & evidence shown verbatim from Natural Medicines

Small studies suggest that oral berberine may be beneficial in adults with prediabetes.

Insufficient Reliable Evidence To Rate Irritable bowel syndrome (IBS)
Rating & evidence shown verbatim from Natural Medicines

One small clinical study suggests that oral berberine may be beneficial in people with diarrhea-predominant IBS.

Insufficient Reliable Evidence To Rate Menopausal symptoms
Rating & evidence shown verbatim from Natural Medicines

Oral berberine has only been evaluated in combination with other ingredients; its effect when used alone is unclear.

Insufficient Reliable Evidence To Rate Metabolic dysfunction-associated steatotic liver disease (MASLD)
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial in patients with MASLD.

Insufficient Reliable Evidence To Rate Metabolic syndrome
Rating & evidence shown verbatim from Natural Medicines

Berberine may reduce some of the signs and symptoms of metabolic syndrome, but the evidence is weak.

Insufficient Reliable Evidence To Rate Obesity
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial in patients with obesity.

Insufficient Reliable Evidence To Rate Radiation fibrosis
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial for reducing radiation-induced lung damage.

Insufficient Reliable Evidence To Rate Radiation-induced diarrhea
Rating & evidence shown verbatim from Natural Medicines

One small study suggests that oral berberine may reduce diarrhea associated with radiation-induced intestinal damage.

Insufficient Reliable Evidence To Rate Stroke
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial in adults with acute ischemic stroke.

Insufficient Reliable Evidence To Rate Thrombocytopenia
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral berberine is beneficial for improving platelet counts in people with this condition.

Insufficient Reliable Evidence To Rate Trachoma
Rating & evidence shown verbatim from Natural Medicines

It is unclear if berberine is beneficial for trachoma when administered as eye drops.

Insufficient Reliable Evidence To Rate Ulcerative colitis
Rating & evidence shown verbatim from Natural Medicines

It is unclear if oral or rectal berberine is beneficial for ulcerative colitis.

Insufficient Reliable Evidence To Rate Ventricular arrhythmias
Rating & evidence shown verbatim from Natural Medicines

Limited research suggests that oral berberine might lower the frequency of premature ventricular contractions (PVCs).

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

For most healthy adults, berberine appears to be reasonably well tolerated when used short-term, but long-term safety is not well established. Because it can lower blood sugar, people with diabetes should monitor their levels closely to avoid blood sugar dropping too low.

Pregnancy: Avoid berberine if you are pregnant. It may cross the placenta, and there are concerns that it can cause harm to a developing baby, including a dangerous form of newborn jaundice (kernicterus).

Breastfeeding: Avoid berberine while breastfeeding, since it may pass into breast milk and could affect the infant.

Do not give berberine to newborns or infants. People with liver conditions, low blood pressure, or those taking multiple medications should talk to a pharmacist or doctor before using it. Because supplements are not tightly regulated, product quality and purity can vary between brands.

Side effects

The most common side effects of berberine involve the digestive system. These can include stomach upset, cramping, diarrhea, constipation, gas, and nausea. Taking it with food or splitting the dose throughout the day may help reduce stomach discomfort.

Less commonly, berberine may cause headache or low blood sugar, especially in people who also take blood sugar–lowering medicines. Serious side effects are uncommon at typical doses, but stop using it and seek medical advice if you have an unusual or severe reaction.

Berberine: Reported Adverse Effects

Documented safety reports on Berberine from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, berberine is generally well tolerated.

Most Common Adverse Effects:

Orally: Abdominal pain and distension, constipation, diarrhea, flatulence, nausea, vomiting.

Intravenously: Facial flushing, painful swelling at the injection site.

Serious Adverse Events (Rare):

Intravenously: Ventricular tachycardia consistent with torsades de pointes.

Reports by condition
Cluster headache Neurologic/CNS

Orally, berberine may cause dizziness, drowsiness, fatigue, and headache.

  1. Choudhry, V. P., Sabir, M., and Bhide, V. N. Berberine in giardiasis. Indian Pediatr. 1972;9(3):143-146.
  2. Ju J, Li J, Lin Q, Xu H. Efficacy and safety of berberine for dyslipidaemias: A systematic review and meta-analysis of randomized clinical trials. Phytomedicine. 2018;50:25-34.
  3. Nie Q, Li M, Huang C, et al. The clinical efficacy and safety of berberine in the treatment of non-alcoholic fatty liver disease: a meta-analysis and systematic review. J Transl Med 2024;22(1):225.
Congestive heart failure (CHF) Cardiovascular

In four of 12 patients with refractory congestive heart failure, intravenous infusion of berberine at a rate of 0.2 mg/kg per minute caused ventricular tachycardia consistent with torsades de pointes.

  1. Marin-Neto, J. A., Maciel, B. C., Secches, A. L., and Gallo, Junior L. Cardiovascular effects of berberine in patients with severe congestive heart failure. Clin.Cardiol. 1988;11(4):253-260.
Constipation Gastrointestinal

Orally, berberine may cause diarrhea, constipation, flatulence, nausea, vomiting, abdominal pain, abdominal distention, gastroesophageal reflux, and bitter taste.

  1. Choudhry, V. P., Sabir, M., and Bhide, V. N. Berberine in giardiasis. Indian Pediatr. 1972;9(3):143-146.
  2. Sharda DC. Berberine in the treatment of diarrhoea of infancy and childhood. J Indian M A 1970;54(1):22-24.
  3. Zhang, Y., Li, X., Zou, D., Liu, W., Yang, J., Zhu, N., Huo, L., Wang, M., Hong, J., Wu, P., Ren, G., and Ning, G. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol.Metab 2008;93(7):2559-2565.
  4. Yin, J., Xing, H., and Ye, J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism 2008;57(5):712-717.
  5. Meng, S., Wang, L. S., Huang, Z. Q., Zhou, Q., Sun, Y. G., Cao, J. T., Li, Y. G., and Wang, C. Q. Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention. Clin Exp.Pharmacol Physiol 2012;39
  6. Dong H, Zhao Y, Zhao L, Lu F. The effects of berberine on blood lipids: a systemic review and meta-analysis of randomized controlled trials. Planta Med 2013;79(6):437-46.
  7. Li G, Zhao M, Qiu F, Sun Y, Zhao L. Pharmacokinetic interactions and tolerability of berberine chloride with simvastatin and fenofibrate: an open-label, randomized, parallel study in healthy Chinese subjects. Drug Des Devel Ther. 2018;13:129-139.
  8. Ju J, Li J, Lin Q, Xu H. Efficacy and safety of berberine for dyslipidaemias: A systematic review and meta-analysis of randomized clinical trials. Phytomedicine. 2018;50:25-34.
  9. Xu L, Zhang Y, Xue X, et al. A phase I trial of berberine in Chinese with ulcerative colitis. Cancer Prev Res (Phila). 2020;13(1):117-26.
  10. Chen YX, Gao QY, Zou TH, et al. Berberine versus placebo for the prevention of recurrence of colorectal adenoma: a multicentre, double-blinded, randomised controlled study. Lancet Gastroenterol Hepatol. 2020;5(3):267-75.
  11. Zhang J, Wang Y, Jiang H, et al. Preventive effect of berberine on postoperative atrial fibrillation. Circ Arrhythm Electrophysiol 2022;15(10):e011160.
  12. Blais JE, Huang X, Zhao JV. Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Drugs 2023;83(5):403-427.
  13. Panigrahi A, Mohanty S. Efficacy and safety of HIMABERB® Berberine on glycemic control in patients with prediabetes: double-blind, placebo-controlled, and randomized pilot trial. BMC Endocr Disord 2023;23(1):190.
  14. Nie Q, Li M, Huang C, et al. The clinical efficacy and safety of berberine in the treatment of non-alcoholic fatty liver disease: a meta-analysis and systematic review. J Transl Med 2024;22(1):225.
  15. Koperska A, Moszak M, Seraszek-Jaros A, Bogdanski P, Szulinska M. Does berberine impact anthropometric, hepatic, and metabolic parameters in patients with metabolic dysfunction-associated fatty liver disease? Randomized, double-blind placebo-controlled tr
Hypoglycemia Endocrine

Orally, berberine may cause hypoglycemia.

  1. Blais JE, Huang X, Zhao JV. Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Drugs 2023;83(5):403-427.
Niacin-induced flushing Dermatologic

When administered intravenously, berberine can cause painful swelling at the injection site or facial flushing. In three of 12 people injected subcutaneously with berberine, permanent hyperpigmentation at the injection site occurred.

Orally, berberine may cause rash, but this event appears to be rare.

  1. Saksena HC, Tomar VN, and Soangra MR. Efficacy of a new salt of Berberine Uni-Berberine in oriental sore. Current Medical Practice 1970;14:247-252.
  2. Seery TM and Bieter RN. A contribution to the pharmacology of berberine. J Pharmacol Exp Ther 1940;69:64-67.
  3. Meng, S., Wang, L. S., Huang, Z. Q., Zhou, Q., Sun, Y. G., Cao, J. T., Li, Y. G., and Wang, C. Q. Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention. Clin Exp.Pharmacol Physiol 2012;39
  4. Zhang J, Wang Y, Jiang H, et al. Preventive effect of berberine on postoperative atrial fibrillation. Circ Arrhythm Electrophysiol 2022;15(10):e011160.
Pain Musculoskeletal

Reports of mild muscle pain and muscle weakness have been reported following the use of a combination product containing berberine, policosanol, red yeast rice, folic acid, coenzyme Q10, and astaxanthin. It is unclear if these effects are due to berberine or other constituents.

  1. Marazzi, G., Cacciotti, L., Pelliccia, F., Iaia, L., Volterrani, M., Caminiti, G., Sposato, B., Massaro, R., Grieco, F., and Rosano, G. Long-term effects of nutraceuticals (berberine, red yeast rice, policosanol) in elderly hypercholesterolemic patients.
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no official, standardized dose of berberine, and the right amount can depend on the product and the reason it is being used. Many supplement products are taken in divided doses across the day, often with meals, partly because the body does not absorb berberine very well and because dividing doses can ease stomach upset.

The best approach is to follow the directions on the product label and to talk with your pharmacist or doctor before starting. They can help you decide whether berberine is appropriate for you and review it against your other medicines and health conditions.

Pregnancy & Breastfeeding

Berberine & Pregnancy

Likely Unsafe

When used orally. Berberine is thought to cross the placenta and may cause harm to the fetus. Kernicterus has developed in newborn infants exposed to berberine. Also, berberine may stimulate uterine contractions.

  1. Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate 1993;63:201-8.
  2. Abascal K, Yarnell E. Recent clinical advances with berberine. Altern Complement Ther 2010;16(5):281-7.

Berberine & Breastfeeding

Likely Unsafe

When used orally. Berberine can be transferred to the infant through breast milk.

  1. Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate 1993;63:201-8.
DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

© 2026 Therapeutic Research Center

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 41 references that drive our Berberine monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

  1. Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate 1993;63:201-8. PubMed
  2. Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia 2000;71:25-33.. PubMed
  3. Wu X, Li Q, Xin H, Yu A, Zhong M. Effects of berberine on the blood concentration of cyclosporin A in renal transplanted recipients: clinical and pharmacokinetic study. Eur J Clin Pharmacol 2005;61:567-72. PubMed
  4. Zhang Y, Li X, Zou D, et al. Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberine. J Clin Endocrinol Metab 2008;93:2559-65. PubMed
  5. Huang XS, Yang GF, Pan YC. Effect of berberin hydrochloride on blood concentration of cyclosporine A in cardiac transplanted patients. Zhongguo Zhong Xi Yi Jie He Za Zhi 2008;28:702-4.
  6. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
  7. Chatterjee P, Franklin MR. Human cytochrome p450 inhibition and metabolic-intermediate complex formation by goldenseal extract and its methylenedioxyphenyl components. Drug Metab Dispos 2003;31:1391-7. PubMed
  8. Marin-Neto, J. A., Maciel, B. C., Secches, A. L., and Gallo, Junior L. Cardiovascular effects of berberine in patients with severe congestive heart failure. Clin.Cardiol. 1988;11(4):253-260. PubMed
  9. Choudhry, V. P., Sabir, M., and Bhide, V. N. Berberine in giardiasis. Indian Pediatr. 1972;9(3):143-146.
  10. Shanbhag, S. M., Kulkarni, H. J., and Gaitonde, B. B. Pharmacological actions of berberine on the central nervous system. Jpn.J Pharmacol 1970;20(4):482-487. PubMed
  11. Wu, J. F. and Liu, T. P. [Effects of berberine on platelet aggregation and plasma levels of TXB2 and 6-keto-PGF1 alpha in rats with reversible middle cerebral artery occlusion]. Yao Xue.Xue.Bao. 1995;30(2):98-102.
  12. Peng, W. H., Hsieh, M. T., and Wu, C. R. Effect of long-term administration of berberine on scopolamine-induced amnesia in rats. Jpn J Pharmacol 1997;74(3):261-266. DOI
  13. Sharda DC. Berberine in the treatment of diarrhoea of infancy and childhood. J Indian M A 1970;54(1):22-24.
  14. Sabir M and Bhide NK. Study of some pharmacological actions of berberine. Ind J Physiol & Pharmac 1971;15(3):111-132.
  15. Tripathi YB and Shukla SD. Berberis artistata inhibits PAF induced aggregation of rabbit platelets. Phytotherapy Research 1996;10:628-630.
Keep reading

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Brand directory

Brands that make products with Berberine

316 brands in our database make a supplement containing Berberine.

Product directory

Supplement products with Berberine

910 products in our database contain Berberine. Open any to see its full ingredient list and every drug interaction we check.

A.C. Formula II by Pure Encapsulations Capsule 120 Capsule(s) View ingredients & interactions ADA Load by Steel Supplements Capsule 120 Capsule(s) View ingredients & interactions Advanced Berberine 1200 by Bio Nutrition Capsule 50 Vegetarian Capsules View ingredients & interactions Advanced Digestive Support by AXIS Nutrition Capsule 60 Veggie Capsule(s) View ingredients & interactions Advanced Glucose Support by Clinical Synergy Professional Formulas Capsule 90 Vegetarian Capsule(s) View ingredients & interactions Advanced IN-F Plus by New Sun Capsule 90 Veg Capsule(s) View ingredients & interactions Advanced Pain Relief Formula by Ormus Minerals Capsule 120 Capsule(s) View ingredients & interactions Advanced Pain Relief Formula (Vegan) by Ormus Minerals Capsule 60 Capsule(s) View ingredients & interactions AI-5 by IF Intestinal Fortitude Capsule 90 Capsule(s) View ingredients & interactions ALAmax Protect by XYMOGEN Capsule 120 Vegetable Capsule(s) View ingredients & interactions ALAmax Protect by XYMOGEN Tablet Or Pill 120 Vegetarian Capsule(s) View ingredients & interactions Alkemi by Ambrosia Collective Capsule 120 Capsule(s) View ingredients & interactions Altai Balance by S.O Labs Capsule 60 Capsule(s) View ingredients & interactions AMPK Formula by Botanic Choice Capsule 90 Vege Capsule(s) View ingredients & interactions Anytime Burn V4 by Like A Pro Supplements Capsule 120 Capsule(s) View ingredients & interactions Babe Bikini by Babe by Bucked Up Capsule 90 Capsule(s) View ingredients & interactions Balance by Legion Capsule 150 Capsule(s) View ingredients & interactions Berbemycin by XYMOGEN Capsule 120 Vegetarian Capsule(s) View ingredients & interactions BerberActiv-QR by Tesseract Medical Research Capsule 90 Vegetarian Capsule(s) View ingredients & interactions Berberine by Solaray Capsule 60 VegCap(s) View ingredients & interactions Berberine by Simply Natures Pure Capsule 120 Capsule(s) View ingredients & interactions Berberine by Thorne Capsule 60 Capsule(s) View ingredients & interactions Berberine by Thorne Capsule 60 Capsule(s) View ingredients & interactions Berberine by Enzymedica Capsule 120 Targeted Delivery Capsule(s) View ingredients & interactions
Pharmacist Counseling Corner

Berberine: Common Questions

What is Berberine used for, and does it work?
People use Berberine for many reasons, but the evidence varies by use. According to the Natural Medicines database, there is at least some clinical evidence supporting Berberine for Canker sores, Diabetes, Helicobacter pylori and Hyperlipidemia. For most other uses it has been studied for, the evidence is currently insufficient to rate. See the graded list on this page, and always confirm with your pharmacist or doctor.
Does Berberine interact with prescription medications?
Yes. We list 1160 medications with a known interaction with Berberine, including 1 rated major. Use the checker above to see how Berberine interacts with a specific drug.
How are Berberine interactions rated?
Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.
Is it safe to take Berberine with my medications?
It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.
Where does this Berberine interaction information come from?
Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.
What is Berberine used for?
People most commonly take Berberine to help support healthy blood sugar and cholesterol levels, and sometimes for weight management or digestive issues. The strongest research is for blood sugar and cholesterol, but it is still considered preliminary.
Is Berberine safe to take?
It is generally tolerated short-term in healthy adults, but it can cause digestive side effects and is not well studied for long-term use. Because it can lower blood sugar and interacts with many medications, check with your pharmacist or doctor first.
Can I take Berberine while pregnant or breastfeeding?
No. Berberine should be avoided during pregnancy and breastfeeding because it may reach the baby and has been linked to potential harm, including a serious form of newborn jaundice.
Does Berberine work like a diabetes medication?
Some studies suggest Berberine can lower blood sugar, and it is sometimes compared to certain diabetes drugs, but it is a supplement and not an approved treatment. Never stop or replace your prescribed diabetes medicine without talking to your doctor.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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Products that contain Berberine

A rotating sample of real supplements in our database that list Berberine — open any to see its full ingredients and every drug interaction we check.

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