Can You Take Berberine With Paroxetine?

Answer

Thanks for reaching out to us! We recently wrote an in-depth article examining potential drug interactions with berberine, which can be found here. Nevertheless, let's take a close look at paroxetine specifically.

How Paroxetine Is Metabolized

Paxil (paroxetine) is an SSRI antidepressant used for a variety of indications, such as anxiety disorders and depression. Our bodies metabolize the drug via two main enzymes:

• CYP2D6
• CYP3A4

If you take another drug, or supplement that affects these enzymes (i.e. inhibit or induce them), it could influence drug levels in the body.

For example, if the activity of CYP2D6 and/or CYP3A4 is inhibited, paroxetine won't be broken down (i.e. metabolized) as quickly or as efficiently as it would otherwise be. This would increase levels of paroxetine in the body, potentially increasing the risk of side effects.

This type of interaction is what we are potentially worried about with berberine.

Berberine Interaction

There is some clinical evidence that shows berberine can inhibit the CYP2D6 metabolizing enzyme (and others as well). While no large-scale trials have been completed, there are several small scales that have reached this conclusion. One such study concluded:

Repeated administration of berberine (300 mg, t.i.d., p.o.) decreased CYP2D6, 2C9, and CYP3A4 activities. Drug-drug interactions should be considered when berberine is administered.

Therefore, in theory, the use of berberine with drugs metabolized by CYP2D6 (such as paroxetine) might increase drug levels, and, in turn, increase the risk of side effects. Side effects of paroxetine include:

• Headache
• Dizziness
• Weakness
• Difficulty concentrating
• Nervousness
• Confusion
• Sleepiness
• Nausea
• Heartburn
• Decreased sex drive
• Sweating

A more comprehensive list of side effects can be found here.

Now, there are no studies that have specifically evaluated the use of berberine with paroxetine, so it's tough to say how significant this interaction is.

Additionally, it is important to note that paroxetine has a somewhat complex metabolism profile. It is metabolized by multiple enzymes, and partial inhibition of one, or both, of these enzymes, may not result in as significant an interaction as compared to if paroxetine were only metabolized by one.

Be Cautious

The bottom line with this potential interaction is that you have to be cautious. The best course of action is to avoid the combination since we just don't know definitively how paroxetine and berberine affect each other specifically or to what degree.

However, due to paroxetine being metabolized by multiple enzymes, as mentioned above, it may be less susceptible to being affected in a clinically significant manner when taken with berberine and some people may benefit from the combination.

I'd highly recommend speaking with your doctor first before combining paroxetine and berberine as they know your complete medical situation. If you do decide to take them together, having your doctor be aware is important so you can be appropriately monitored.