Drug & supplement interaction

Goldenseal + Tocilizumab

Tocilizumab brand name: Actemra.

No Known Interaction

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Updated July 2026 · Pair last verified Sep 20, 2026

The bottom line No known interaction

We found no known interaction between Goldenseal and Tocilizumab in our sources. Absence of a documented interaction is not the same as proven safety, and does not guarantee one does not exist. Do not start, stop, or change a medication or supplement based on this page; confirm with your pharmacist or doctor first. Additionally, although there is no interaction, the two are separately associated with some of the same side effects, which would make a new symptom harder to attribute to one or the other.

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Interaction report

Goldenseal and Tocilizumab

We checked these two against our interaction database. Here is what we found.

No Known Interaction Found

We did not find a documented interaction between Tocilizumab and Goldenseal in our sources. This does not guarantee that the combination is completely free of risk — there is often limited research on supplements and herbal products, especially around drug interactions.

If you decide to take both, the practical routine is simple: add one new thing at a time and note the date you started it. If the combination is going to disagree with you, it usually shows in the first days to a couple of weeks — and a start date turns “I’ve been feeling off” into something a pharmacist can actually work with. Do not stop a prescribed medicine on your own.

Always talk with your pharmacist or doctor before making changes to your medications or supplements, particularly if you take several medications or have an ongoing health condition.

Goldenseal safety at a glance

Goldenseal overall Use caution Generally used short-term by healthy adults, but human safety data are limited.

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 goldenseal... Read the full pregnancy detail

Breastfeeding Avoid Avoid while breastfeeding because berberine may pass to the infant and cause harm.

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center) — the full detail is in the Special populations card below. Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Still wondering about combining Tocilizumab and Goldenseal? Ask Dr. Brian Staiger, PharmD, BCPS directly ›

How we checked

Why No Interaction Is Listed for Tocilizumab

Interactions in our licensed database are recorded against drug classes, not just single drug names. Tocilizumab is filed under 2 classifications — immunosuppressants, hepatotoxic drugs. Goldenseal has documented interactions with 16 drug classes — the most serious being anticoagulant/antiplatelet drugs (moderate), antidiabetes drugs (moderate) and antihypertensive drugs (moderate) — and none of Tocilizumab’s classifications are among them.

Classification data comes from our licensed Natural Medicines dataset. A medication can belong to classes beyond those recorded there, so this describes how the check was run — it is not a safety guarantee.

Keep it in perspective

Goldenseal Does Interact With Other Medications

Goldenseal has 1,236 moderate, 1 minor known drug interactions in our database — Tocilizumab isn’t one of them. If you take anything else, check it against the full list below.

Moderate 1,236 Minor 1 No known interaction 1,593 (incl. Tocilizumab)

Taking anything else?

Check Another of Your Medications Against Goldenseal

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

What to actually watch for

No Interaction Found — But Data Suggests Goldenseal and Tocilizumab May Share Several of the Same Side Effects

This is not an interaction. Neither one changes how your body handles the other, and nothing here says they react together. What our sources do show is that each has separately been linked to the effects below — so taking both can make those effects more likely to turn up, and harder to pin on one or the other if they do.

Constipation / Stomach pain / Diarrhea Additional detail
Goldenseal
“Orally, berberine, a constituent of goldenseal, may cause diarrhea, constipation, flatulence, vomiting, abdominal pain, abdominal distention, and bitter taste. Theoretically, these effects may occur in patients taking goldenseal. However, this hasn't been reported in clinical research or case reports.”

Goldenseal · Natural Medicines adverse-effect record, reported in constipation.
6 sources cited

33648. Choudhry, V. P., Sabir, M., and Bhide, V. N. Berberine in giardiasis. Indian Pediatr. 1972;9(3):143-146.

33689. Sharda DC. Berberine in the treatment of diarrhoea of infancy and childhood. J Indian M A 1970;54(1):22-24.

34245. 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. PubMed

34247. Yin, J., Xing, H., and Ye, J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism 2008;57(5):712-717. PubMed

34285. 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 PubMed

91953. 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. PubMed
Tocilizumab

Listed in the ADVERSE REACTIONS section of the FDA label for Tocilizumab. Read the label on DailyMed ›
Headache Additional detail
Goldenseal
“Orally, berberine, a constituent of goldenseal, may cause headache when taken in a dose of 5 mg/kg daily. Theoretically, this may occur with goldenseal, but this hasn't been reported in clinical research or case reports.”

Goldenseal · Natural Medicines adverse-effect record, reported in cluster headache.
1 source cited

33648. Choudhry, V. P., Sabir, M., and Bhide, V. N. Berberine in giardiasis. Indian Pediatr. 1972;9(3):143-146.
Tocilizumab

Listed in the ADVERSE REACTIONS section of the FDA label for Tocilizumab. Read the label on DailyMed ›
Nausea Additional detail

Goldenseal

Recorded for Goldenseal in the same Natural Medicines adverse-effect record shown under Constipation / Stomach pain / Diarrhea above.

Tocilizumab

Listed in the ADVERSE REACTIONS section of the FDA label for Tocilizumab. Read the label on DailyMed ›

Reported for Goldenseal but not commonly for Tocilizumab: bloating or gas, a change in taste and vomiting.

Effects for Tocilizumab come from the ADVERSE REACTIONS section of its FDA label; effects for Goldenseal come from the Natural Medicines adverse-effect record, quoted above. Where a percentage is shown, it is the share of 112,048 voluntary FDA FAERS reports for Tocilizumab that mention that effect — a reporting proportion, not an incidence rate and not evidence the drug caused it. Wording is matched across sources by our own clinical vocabulary, so treat this as a prompt to pay attention, not a diagnosis.

Special populations

Goldenseal in Pregnancy & Breastfeeding

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 goldenseal.

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

Everything else you take

See Every Supplement That Interacts With Tocilizumab

This page covers Goldenseal only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Tocilizumab page lists 89 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Beer (major), Siberian Cocklebur (major), Wine (major), Active Hexose Correlated Compound (ahcc) (moderate) and Alfalfa (moderate).

By severity: 3 major · 85 moderate · 1 minor.

From our pharmacist’s overview on the Tocilizumab page

“Tocilizumab (Actemra) calms an overactive immune system in conditions like rheumatoid arthritis, and it is also known to strain the liver, which is exactly where its supplement interactions concentrate. This page deserves genuine care.”

Reviewed by 2 · Jul 18, 2026

Open the Tocilizumab interaction page

One more smart check

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

We hold 1,726 real supplement products containing Goldenseal, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Goldenseal. Even though Goldenseal itself has no known interaction with Tocilizumab, another ingredient on your label might. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Goldenseal and Tocilizumab 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 Goldenseal

Top 10%

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

29 days ago today

Medication Tocilizumab

Steady interest

#1,890 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.

Where does our data come from?

Source: the Natural Medicines (TRC Healthcare) clinical database — the evidence-graded professional reference for herb & supplement interactions.
Citation library: 103,510 references behind our interaction content, 65,311 of them resolved to verified PubMed/DOI sources. See every Goldenseal reference on this page ↓
Freshness: we automatically re-check this combination every week — this pair was last verified September 20, 2026. The Goldenseal and Tocilizumab records this page draws on were last updated July 11, 2026.
What “no known interaction” means: no documented interaction in the sources above — not a guarantee of safety. Supplements are studied far less than prescription drugs, so we say exactly what the evidence supports, and nothing more.

Data structure & sourcing designed and verified by Dr. Brian Staiger, PharmD, BCPS.

Supplement

About Goldenseal

What is Goldenseal?

Digestive upset and diarrhea
Colds and respiratory infections
Sore throat and mouth sores
Skin and eye irritation (topical/traditional)
Antimicrobial support

Goldenseal is a popular North American herb that contains berberine, a compound studied for antimicrobial effects. However, strong human evidence for its many traditional uses is largely lacking, and it should be avoided during pregnancy and breastfeeding. Talk to a pharmacist or doctor before using it.

Hydrastis canadensis · Ranunculaceae · Root and rhizome (underground stem) · Capsules, tablets, dried root, liquid extracts, tinctures, teas, and topical preparations

An interaction check asks whether these two react with each other — it does not ask whether Goldenseal is a good idea for someone in your situation. Here is what our Goldenseal record says about it on its own.

Goldenseal: dosing

There is no well-established standardized dose for goldenseal. Studies have used different products, extracts, and amounts, making it hard to recommend a single dose.The safest approach is to follow the directions on the product label and not exceed the recommended amount. Because supplements are not tightly regulated, the actual berberine content can vary a lot between brands.Goldenseal is best used short-term rather than continuously.

From our Goldenseal monograph — the full record covers uses, side effects and every documented interaction.

Read the full Goldenseal monograph & all interactions

Medication

About Tocilizumab Injection

What Is Tocilizumab Injection Used For?

Brand name: Actemra

Tocilizumab injection is used to treat several serious inflammatory and immune-related conditions. Actemra (tocilizumab) is indicated for moderately to severely active rheumatoid arthritis in adults who haven't responded well to other disease-modifying drugs, giant cell arteritis in adults, systemic sclerosis-associated interstitial lung disease (SSc-ILD) to slow lung function decline, polyarticular and systemic juvenile idiopathic arthritis in patients 2 years and older, and severe or life-threatening cytokine release syndrome (CRS) caused by CAR T-cell therapy in adults and children 2 and older.

Actemra is also approved for hospitalized adults and children aged 2 and older with COVID-19 who are on corticosteroids and need supplemental oxygen or mechanical breathing support. Not every brand or route is approved for every use — your prescriber will choose the right form for your specific condition.

Most-Reported Side Effects for Tocilizumab

From FAERS, the FDA’s public side-effect reporting system (113,819 reports, all brands). Reports are voluntary and are not proof the drug caused the effect.

Rheumatoid arthritis 22,747 reports

Arthralgia 17,322 reports

Joint swelling 16,327 reports

Fatigue 15,391 reports

Rash 13,781 reports

See full Tocilizumab Injection drug information

Keep checking

Other Drugs & Goldenseal

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

0Major

1,236Moderate

1Minor

1,592No known interaction

1,236 Moderate 1 Minor 1,592 No interaction

Moderate

1,236 interactions

Showing 60 of 1,236 moderate interactions — see all 1,236 on the Goldenseal page.

Minor

1 interaction

Oseltamivir Phosphate ›

No interaction 1,592 drugs checked — show the list

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

Showing the 60 most looked-up of 1,592 medications checked with no known interaction — see the full Goldenseal list.

See the full Goldenseal interactions page

See every supplement checked against Tocilizumab, ranked by severity

Evidence & sources

Goldenseal References

The 34 references that drive our Goldenseal 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.

Chan E. Displacement of bilirubin from albumin by berberine. Biol Neonate 1993;63:201-8. PubMed
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
Sandhu RS, Prescilla RP, Simonelli TM, Edwards DJ. Influence of goldenseal root on the pharmacokinetics of indinavir. J Clin Pharmacol 2003;43:1283-8.. PubMed
Janbaz KH, Gilani AH. Studies on preventive and curative effects of berberine on chemical-induced hepatotoxicity in rodents. Fitoterapia 2000;71:25-33.. PubMed
Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77:415-26. PubMed
Gurley BJ, Swain A, Barone GW, et al. Effect of goldenseal (Hydrastis canadensis) and kava kava (Piper methysticum) supplementation on digoxin pharmacokinetics in humans. Drug Metab Dispos 2007;35:240-5. PubMed
Gurley BJ, Swain A, Hubbard MA, et al. Clinical assessement of CYP2D6-mediated herb-drug interactions in humans: Effects of milk-thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Mol Nutr Food Res 2008;52:755-63.
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
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
Choudhry, V. P., Sabir, M., and Bhide, V. N. Berberine in giardiasis. Indian Pediatr. 1972;9(3):143-146.
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
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.
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
Sharda DC. Berberine in the treatment of diarrhoea of infancy and childhood. J Indian M A 1970;54(1):22-24.
Sabir M and Bhide NK. Study of some pharmacological actions of berberine. Ind J Physiol & Pharmac 1971;15(3):111-132.
Tripathi YB and Shukla SD. Berberis artistata inhibits PAF induced aggregation of rabbit platelets. Phytotherapy Research 1996;10:628-630.
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. PubMed
Yin, J., Xing, H., and Ye, J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism 2008;57(5):712-717. PubMed
Zhang, H., Wei, J., Xue, R., Wu, J. D., Zhao, W., Wang, Z. Z., Wang, S. K., Zhou, Z. X., Song, D. Q., Wang, Y. M., Pan, H. N., Kong, W. J., and Jiang, J. D. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin re
Guo, Y., Chen, Y., Tan, Z. R., Klaassen, C. D., and Zhou, H. H. Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 2012;68(2):213-217. PubMed
Wei, W., Zhao, H., Wang, A., Sui, M., Liang, K., Deng, H., Ma, Y., Zhang, Y., Zhang, H., and Guan, Y. A clinical study on the short-term effect of berberine in comparison to metformin on the metabolic characteristics of women with polycystic ovary syndro
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 PubMed
Chun YT, Yip TT, Lau KL, and et al. A biochemical study on the hypotensive effect of berberine in rats. Gen Pharmac 1979;10:177-182. PubMed
Sevior, D. K., Hokkanen, J., Tolonen, A., Abass, K., Tursas, L., Pelkonen, O., and Ahokas, J. T. Rapid screening of commercially available herbal products for the inhibition of major human hepatic cytochrome P450 enzymes using the N-in-one cocktail. Xeno PubMed
Bhowmick, S. K., Hundley, O. T., and Rettig, K. R. Severe hypernatremia and hyperosmolality exacerbated by an herbal preparation in a patient with diabetic ketoacidosis. Clin Pediatr (Phila) 2007;46(9):831-834. PubMed
Gurley BJ, et al. Supplementation with goldenseal (Hydrastis canadensis), but not kava kava (Piper methysticum), inhibits human CYP3A activitiy In Vivo. Clin Pharmacol Ther. 2008;83(1):61-69.
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. PubMed
Hou Q, Han W, Fu X. Pharmacokinetic interaction between tacrolimus and berberine in a child with idiopathic nephrotic syndrome. Eur J Clin Pharmacol 2013;69(10):1861-2. PubMed
Lan J, Zhao Y, Dong F, et al. Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension. J Ethnopharmacol. 2015;161:69-81. PubMed
Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
Yamaura K, Shimada M, Nakayama N, Ueno K. Protective effects of goldenseal (Hydrastis canadensis L.) on acetaminophen-induced hepatotoxicity through inhibition of CYP2E1 in rats. Pharmacognosy Res. 2011;3(4):250-5. PubMed
Nguyen JT, Tian DD, Tanna RS, et al. Assessing transporter-mediated natural product-drug interactions via in vitro-in vivo extrapolation: clinical evaluation with a probe cocktail. Clin Pharmacol Ther 2021;109(5):1342-52.
Liu R, Tam TW, Mao J, et al. The effect of natural health products and traditional medicines on the activity of human hepatic microsomal-mediated metabolism of oseltamivir. J Pharm Pharm Sci 2010;13(1):43-55. PubMed
Nguyen JT, Tian DD, Tanna RS, et al. An Integrative Approach to Elucidate Mechanisms Underlying the Pharmacokinetic Goldenseal-Midazolam Interaction: Application of In Vitro Assays and Physiologically Based Pharmacokinetic Models to Understand Clinical Ob

Medication overviews come from MedlinePlus (NIH); supplement label data from the NIH Dietary Supplement Label Database. Content is written and reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

Pharmacist Counseling Corner

Taking Goldenseal and Tocilizumab Together: Common Questions

Is it safe to take Goldenseal with Tocilizumab?

We do not list a known interaction between Goldenseal and Tocilizumab. That does not guarantee the combination is risk-free, so confirm with your pharmacist or doctor — especially if you take other medications or have a health condition.

Do Goldenseal and Tocilizumab have any of the same side effects?

Yes — our sources link each of them separately to 5 of the same effects. That is not an interaction: neither changes how your body handles the other. It does mean that if one of those effects turns up, it can be harder to tell which one is behind it. They are listed on this page with the source behind each.

How was the Goldenseal and Tocilizumab combination checked?

Interactions in our licensed database are recorded against drug classes. Tocilizumab is filed under 2 classifications, and Goldenseal has documented interactions with 16 drug classes — none of Tocilizumab's classifications are among them. A medication can belong to classes beyond those recorded in our dataset, so this describes how the check was run rather than guaranteeing safety.

Does Goldenseal interact with any other medications?

Yes. Goldenseal has 1,237 documented drug interactions in our database — Tocilizumab is simply not one of them. If you take anything else, it is worth checking each one; they are all listed on this page.

Does Tocilizumab interact with any supplements?

Yes. Tocilizumab has documented interactions with 89 supplements in our database — Goldenseal is not one of them. The Tocilizumab interaction page linked on this page lists every one, ranked by severity.

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

Where next

Keep Exploring

Goldenseal monograph Uses, safety profile, and every drug interaction in one place Tocilizumab Injection drug information The full plain-English guide to this medication Tocilizumab supplement interactions Every supplement checked against Tocilizumab, ranked by severity Supplement interaction checker Check any supplement or product against your medications Browse medications A–Z Every drug we’ve checked against herbs & supplements References The 34 citations behind this page Ask a pharmacist Free, personal answer from our licensed team

Still Have a Question About Tocilizumab and Goldenseal?

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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.