Drug & supplement interaction

European Barberry + Sorafenib

Sorafenib brand name: Nexavar.

Moderate Interaction
Medically reviewed by · Updated October 2026
The bottom line Moderate

Sorafenib falls into 2 drug categories that European Barberry can interact with; the most serious is rated moderate. Theoretically, European barberry might increase the levels and clinical effects of CYP3A4 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

European Barberry and Sorafenib

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

European Barberry interacts with whole categories of medication. Sorafenib falls into 2 of those categories, so it can interact with European Barberry in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

1 of 2

Why this applies to Sorafenib

Sorafenib falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group European Barberry interacts with.

Theoretically, European barberry might increase the levels and clinical effects of CYP3A4 substrates.
There is very preliminary evidence suggesting that berberine, a constituent of European barberry, might inhibit the CYP3A4 enzyme. Theoretically, European barberry might have a similar effect.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist with Nexavar (sorafenib). Your liver uses an enzyme called CYP3A4 to help clear this drug from your body. Berberine, the main active compound in European barberry, has shown some early hints in lab work that it may slow that same enzyme down. If that happens, sorafenib could clear more slowly and build up a bit, which in theory could mean stronger effects and more side effects like hand-foot skin reactions, rashes, high blood pressure, diarrhea, or fatigue.

I want to be honest though: this is theoretical, based on how things behave in the lab, not from real patient reports. Still, since you're treating a serious cancer, I'd loop in your oncology team or pharmacist before adding any barberry or berberine supplement so nothing throws off your treatment.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Sorafenib also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, European barberry may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.
In vitro and animal evidence suggest that berberine, a constituent of European barberry, might inhibit platelet aggregation. Theoretically, European barberry might have a similar effect.
Severity Moderate Likelihood Possible Evidence D

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.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing to know about pairing European barberry with sorafenib (Nexavar). The concern on file is about bleeding. Barberry contains berberine, and in lab dishes and animal studies that compound seems to make platelets (the cells that help your blood clot) a little less sticky. Sorafenib itself can already raise bleeding risk in some people, so stacking the two could, in theory, add up.

I want to be honest about the evidence: this is theoretical, based on test-tube and animal work, not human studies. So I don't want to alarm you. Still, with a cancer therapy like this, watch for easy bruising, nosebleeds, bleeding gums, or blood in your stool. Please check with your oncologist or pharmacist before adding barberry, and don't change your sorafenib on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Kostalova, D., Bukovsky, M., Koscova, H., and Kardosova, A. [Anticomplement activity of Mahonia aquifolium bisbenzylisoquinoline alkaloids and berberine extract]. Ceska.Slov.Farm 2001;50(6):286-289.
  2. 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.
  3. Xuan, B., Wang, W., and Li, D. X. Inhibitory effect of tetrahydroberberine on platelet aggregation and thrombosis. Zhongguo Yao Li Xue.Bao. 1994;15(2):133-135.
  4. Tripathi YB and Shukla SD. Berberis artistata inhibits PAF induced aggregation of rabbit platelets. Phytotherapy Research 1996;10:628-630.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction 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.
  • PossibleInteraction 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.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

European Barberry Also Interacts With Other Medications

European Barberry has 1,211 moderate known drug interactions in our database — the Sorafenib one above is among them. If you take anything else, check it against the full list below.

Moderate 1,211 No known interaction 1,619 (incl. Sorafenib)
Taking anything else?

Check Another of Your Medications Against European Barberry

Covers the 2,830 medications we’ve checked against European Barberry. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Sorafenib

This page covers European Barberry only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Sorafenib page lists 285 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Grapefruit (major), Piracetam (major) and St. John's Wort (major).

By severity: 5 major · 241 moderate · 39 minor.

From our pharmacist’s overview on the Sorafenib page

“If you're on sorafenib (Nexavar) for cancer, be genuinely careful here, and learn the five major-rated entries first. Most of the 285 ingredients listed either have blood-thinning effects that stack onto sorafenib's bleeding risk (more than 200 do) or affect CYP3A4, the liver enzyme that clears the drug, pushing its level too high or t…”

Reviewed by 2 · Jul 18, 2026

Open the Sorafenib interaction page

One more smart check

Taking European Barberry as Part of a Dietary Supplement Product? Check It for Interactions

We hold 2 real supplement products containing European Barberry, each one broken down to its full ingredient list — and combination products often carry several ingredients besides European Barberry. Your product may carry other ingredients that interact with Sorafenib too, on top of European Barberry — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where European Barberry and Sorafenib Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement European Barberry
Top 25%

#296 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Sorafenib
Steady interest

#2,627 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About European Barberry

What is European Barberry?

European Barberry
  • Digestive upset
  • Antimicrobial support
  • Blood sugar support
  • Cholesterol and metabolic support
  • Skin conditions

European barberry is a shrub whose root, bark, and berries contain berberine, a bitter plant alkaloid that has been studied mostly in isolated form. Some early research on berberine is promising for blood sugar and cholesterol, but high-quality evidence for the whole barberry herb is limited. Talk with your pharmacist or doctor before using it, and avoid it during pregnancy and breastfeeding.

Read the full European Barberry monograph & all interactions
Medication

About Sorafenib

What Is Sorafenib Used For?

Brand name: Nexavar

Sorafenib tablets are approved to treat three types of cancer. The first is unresectable hepatocellular carcinoma (HCC) — liver cancer that cannot be removed with surgery. The second is advanced renal cell carcinoma (RCC) — kidney cancer that has spread or progressed. Both the brand Nexavar and generic sorafenib tablets are approved for these two uses.

The third use is for locally recurrent or metastatic, progressive differentiated thyroid carcinoma (DTC) — thyroid cancer that has spread or worsened and no longer responds to radioactive iodine treatment. Nexavar and sorafenib tablets are both approved for this use as well.

See full Sorafenib drug information
Keep checking

Other Drugs & European Barberry

Browse every other medication we’ve checked against European Barberry — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
1,211Moderate
0Minor
1,618No known interaction
1,211 Moderate 1,618 No interaction
Moderate

1,211 interactions

Showing 60 of 1,211 moderate interactions — see all 1,211 on the European Barberry page.

No interaction 1,618 drugs checked — show the list

We also checked European Barberry against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,618 medications checked with no known interaction — see the full European Barberry list.

See the full European Barberry interactions page
See every supplement checked against Sorafenib, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

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

Keep exploring
European Barberry monograph › Uses, safety, and every drug interaction in one place Sorafenib supplement interactions › Every supplement checked against Sorafenib, ranked by severity Sorafenib drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking European Barberry and Sorafenib Together: Common Questions

Can you take European Barberry with Sorafenib?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for European Barberry and Sorafenib?
Sorafenib belongs to more than one drug category, and European Barberry interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the European Barberry and Sorafenib interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

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

Still Have a Question About Sorafenib and European Barberry?

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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.