Drug & supplement interaction

Goldthread + Letrozole, Ribociclib Succinate

Letrozole, Ribociclib Succinate brand name: Kisqali Femara Co-Pack.

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

Goldthread has a moderate interaction with Letrozole, Ribociclib Succinate. There's very preliminary evidence that berberine, a constituent of goldthread, might inhibit cytochrome P450 3A4 (CYP3A4) enzyme.

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

Goldthread and Letrozole, Ribociclib Succinate

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Letrozole, Ribociclib Succinate

Letrozole, Ribociclib Succinate falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Goldthread interacts with.

There's very preliminary evidence that berberine, a constituent of goldthread, might inhibit cytochrome P450 3A4 (CYP3A4) enzyme. So far, this interaction has not been reported in humans. However, watch for an increase in the levels of drugs metabolized by CYP3A4 in patients taking goldthread. Some drugs metabolized by CYP3A4 include lovastatin (Mevacor), clarithromycin (Biaxin), indinavir (Crixivan), sildenafil (Viagra), triazolam (Halcion), and numerous others. Use goldthread cautiously or avoid in patients taking these drugs.
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

This Kisqali Femara combo pairs ribociclib and letrozole, and both rely on the liver enzyme CYP3A4 to be broken down (ribociclib especially). Goldthread's main compound, berberine, may gently slow that enzyme down. The catch: this is only a theoretical concern from lab work, and it hasn't actually been seen in people. Neither drug is a prodrug, so if levels did rise, you'd expect more drug effect, not less.

For ribociclib that could mean more low blood counts, nausea, fatigue, or changes in your heart's QT rhythm, things your oncology team already watches closely. Because this is cancer therapy, please don't add goldthread or berberine without first checking with your oncologist or pharmacist.

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

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

Goldthread Also Interacts With Other Medications

Goldthread has 642 moderate known drug interactions in our database — the Letrozole, Ribociclib Succinate one above is one of them. If you take anything else, check it against the full list below.

Moderate 642 No known interaction 2,188 (incl. Letrozole, Ribociclib Succinate)
Taking anything else?

Check Another of Your Medications Against Goldthread

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

Everything else you take

See Every Supplement That Interacts With Letrozole, Ribociclib Succinate

This page covers Goldthread only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Letrozole, Ribociclib Succinate page lists 155 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Ephedra (major).

By severity: 8 major · 109 moderate · 38 minor.

From our pharmacist’s overview on the Letrozole, Ribociclib Succinate page

“Grapefruit tops my worry list for anyone taking the Kisqali Femara Co-Pack (letrozole and ribociclib), because it blocks the enzyme, CYP3A4, that clears ribociclib and can push levels of this breast cancer drug higher than intended. That enzyme thread runs through 121 of the 155 ingredients on this page, and with eight rated major, rea…”

Reviewed by 2 · Jul 18, 2026

Open the Letrozole, Ribociclib Succinate interaction page

One more smart check

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

We hold 25 real supplement products containing Goldthread, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Goldthread. Your product may carry other ingredients that interact with Letrozole, Ribociclib Succinate too, on top of Goldthread — 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 Goldthread and Letrozole, Ribociclib Succinate 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 Goldthread
Top 25%

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

29 days ago today
Medication Letrozole, Ribociclib Succinate
Top 25%

#404 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 Goldthread

What is Goldthread?

Goldthread
  • Digestive upset and diarrhea
  • Mouth sores and sore throat
  • Inflammation
  • Antimicrobial (fighting germs)
  • Blood sugar support
  • Skin and eye complaints

Goldthread is a traditional Chinese and East Asian herb whose root is rich in berberine, a compound being studied for blood sugar, cholesterol, and antimicrobial effects. Strong human evidence for goldthread itself is limited, and it should be avoided in pregnancy and breastfeeding. Talk with your pharmacist or doctor before using it, especially if you take other medicines.

Read the full Goldthread monograph & all interactions
Keep checking

Other Drugs & Goldthread

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

0Major
642Moderate
0Minor
2,187No known interaction
642 Moderate 2,187 No interaction
Moderate

642 interactions

Showing 60 of 642 moderate interactions — see all 642 on the Goldthread page.

No interaction 2,187 drugs checked — show the list

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

Showing the 60 most looked-up of 2,187 medications checked with no known interaction — see the full Goldthread list.

See the full Goldthread interactions page
See every supplement checked against Letrozole, Ribociclib Succinate, 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
Goldthread monograph › Uses, safety, and every drug interaction in one place Letrozole, Ribociclib Succinate supplement interactions › Every supplement checked against Letrozole, Ribociclib Succinate, 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 Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Goldthread and Letrozole, Ribociclib Succinate Together: Common Questions

Can you take Goldthread with Letrozole, Ribociclib Succinate?
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.
How serious is the Goldthread and Letrozole, Ribociclib Succinate 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 Letrozole, Ribociclib Succinate and Goldthread?

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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.