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?

Asked by Fritz On Feb 17, 2024

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Feb 19, 2024
Last updated Apr 11, 2024

Key points

  • Berberine may increase the risk of bleeding when combined with Xarelto, so caution is advised.


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
Xarelto Prescribing Information

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.



  • [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

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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