Does Berberine Interact With Xarelto?
In our latest question and answer, the pharmacist discusses the potential interaction between Xarelto and berberine.
Can berberine supplements and 20mg of Xarelto be taken together?
Feb 17, 2024- Berberine can increase levels of Xarelto in your body by slowing how your body breaks down the medication, which may raise your bleeding risk.
- Berberine itself may have mild blood-thinning effects, and combining it with Xarelto—which already increases bleeding risk—requires caution.
- You should talk to your doctor before taking berberine with Xarelto to determine if the combination is safe for you.
Answer
Thank you for contacting us! There is a potential interaction between berberine and Xarelto, so it's important to consult your doctor before combining them.
Our 'Drug-Herbal Interaction Checker' provides detailed information on the interaction between Berberine and Xarelto. I've shared some of the key details in the sections below.
Interaction Details
Several factors contribute to the interaction between berberine and Xarelto.
First, research indicates that berberine moderately inhibits CYP3A4, an enzyme involved in metabolizing various drugs, including Xarelto. This inhibition can lead to increased levels of Xarelto in the body, potentially raising the risk of adverse effects like bleeding.
The prescribing information for Xarelto states this clearly:
Concomitant use of drugs that are known combined P-gp and strong CYP3A inhibitors increases rivaroxaban exposure and may increase bleeding risk
Additionally, berberine itself has been associated with anticoagulant effects, inhibiting platelet aggregation in animal studies. While evidence of berberine's blood-thinning effects in humans is lacking, the risk is plausible.
Xarelto already carries a bleeding risk on its own, which is why it's often recommended to avoid other drugs that carry a bleeding risk too, like NSAIDs (e.g., ibuprofen) and aspirin.
While berberine is not typically linked to a bleeding risk like NSAIDs and aspirin, it should still be used cautiously with blood-thinning medications such as Xarelto for similar reasons.
Final Words
Given the potential interaction between berberine and Xarelto, it's advisable to consult with your doctor before taking them together so you can be appropriately monitored.
The combination may be safe for some individuals but it is important to know of the potential risks.
References & sources
- [Effects of berberine on platelet aggregation and plasma levels of TXB2 and 6-keto-PGF1 alpha in rats with reversible middle cerebral artery occlusion] — PubMed
- Repeated administration of berberine inhibits cytochromes P450 in humans — PubMed
- An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures — PubMed
- Xarelto Prescribing Information — Janssen
Glossary — Terms in This Answer
- CYP3A4
- An enzyme in your body responsible for breaking down many medications, including Xarelto.
- Inhibits
- To block or slow down a process, in this case the enzyme's ability to break down drugs.
- Rivaroxaban
- The active drug ingredient in Xarelto, a blood thinner used to prevent blood clots.
- P-gp
- A protein in your body that helps transport drugs out of cells and affects how much of a medication stays in your system.
- Anticoagulant
- A substance that thins the blood and helps prevent blood clots from forming.
- Platelet aggregation
- The clumping together of blood cells that help form blood clots.
- NSAIDs
- Over-the-counter pain relievers like ibuprofen that can increase bleeding risk when combined with blood thinners.
- Concomitant
- Occurring or existing at the same time, such as taking two medications together.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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