What is it?
Berberine is most commonly taken for diabetes, high levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia), and high blood pressure. It is also used for burns, canker sores, liver disease, and many other conditions but there is no good scientific evidence to support many of these uses.
How effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for BERBERINE are as follows:
Possibly effective for...
- Canker sores. Research shows that applying a gel containing berberine can reduce pain, redness, oozing, and the size of ulcers in people with canker sores.
- Diabetes. Berberine seems to slightly reduce blood sugar levels in people with diabetes. Also, some early research shows that taking 500 mg of berberine 2-3 times daily for up to 3 months might control blood sugar as effectively as metformin or rosiglitazone.
- High levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia). Berberine might help lower cholesterol levels in people with high cholesterol. Taking berberine for up to 2 years seems to reduce total cholesterol, low-density lipoprotein (LDL or "bad") cholesterol, and triglyceride levels in people with high cholesterol. When compared with standard cholesterol-lowering medications, berberine appears to cause similar changes in total cholesterol, LDL cholesterol, and high-density lipoprotein (HDL or "good") cholesterol, and it might be better at reducing triglyceride levels.
- High blood pressure. Taking 0.9 grams of berberine per day along with the blood pressure-lowering drug amlodipine reduces systolic blood pressure (the top number) and diastolic blood pressure (the bottom number) better than taking amlodipine alone in people with high blood pressure.
- A hormonal disorder that causes enlarged ovaries with cysts (polycystic ovary syndrome or PCOS). Research shows that berberine can lower blood sugar, improve cholesterol and triglyceride levels, reduce testosterone levels, and lower waist-to-hip ratio in women with PCOS. Berberine may even lower blood sugar levels similarly to metformin and may improve cholesterol levels better than metformin. It is unclear if berberine increases pregnancy rates or live birth rates in women with PCOS.
Insufficient evidence to rate effectiveness for...
- Burns. Early research shows that applying an ointment that contains berberine and beta-sitosterol can treat second-degree burns as effectively as conventional treatment with silver sulfadiazine.
- An infection of the intestines that causes diarrhea (cholera). Some early research shows that taking berberine sulfate can decrease diarrhea by a small amount in people with cholera. However, berberine does not seem to improve the effects of the antibiotic tetracycline in treating diarrhea related to cholera infection.
- Non-cancerous growths in the large intestine and rectum (colorectal adenoma). Early research shows that taking berberine for 2 years seems to prevent regrowth of colorectal adenomas in people who have already been treated for these growths.
- Heart failure and fluid build up in the body (congestive heart failure or CHF). Early research shows that berberine can reduce some of the symptoms and lower the death rate in some people with congestive heart failure.
- Heart disease. Research shows that taking a specific product containing berberine and other ingredients for 3 months lowers cholesterol levels in people with heart disease who had a procedure called a percutaneous intervention (PCI). This product seems to lower cholesterol levels more than the standard medication ezetimibe, which is used to lower cholesterol. Also taking this product in combination with low doses of medicines called "statins" seems to work better than taking low-dose statins alone. It's unclear if the effects of this product are due to berberine, other ingredients, or the combination. It's also unknown whether this product reduces the risk of major adverse heart-related events in people with heart disease.
- Diarrhea. Some early research shows that taking berberine sulfate can decrease diarrhea in people with an E. coli infection.
- A group of eye disorders that can lead to vision loss (glaucoma). Early research shows that using eye drops containing berberine and tetrahydrozoline does not reduce eye pressure in people with glaucoma better than eye drops containing tetrahydrozoline alone.
- A digestive tract infection that can lead to ulcers (Helicobacter pylori or H. pylori). Early research shows that taking berberine is more effective than the drug ranitidine at treating H. pylori infection. But berberine seems less effective at healing ulcers in people with stomach ulcers due to H. pylori. Other research shows that berberine might treat H. pylori infection as well as the medication bismuth when taken in combination with a standard three-drug regimen for H. pylori infection.
- Swelling (inflammation) of the liver caused by the hepatitis B virus (hepatitis B). Early research shows that berberine decreases blood sugar, blood fats called triglycerides, and markers of liver damage in people with diabetes and hepatitis B.
- Swelling (inflammation) of the liver caused by the hepatitis C virus (hepatitis C). Early research shows that berberine decreases blood sugar, blood fats called triglycerides, and markers of liver damage in people with diabetes and hepatitis C.
- A long-term disorder of the large intestines that causes stomach pain (irritable bowel syndrome or IBS). Early research shows taking that berberine twice daily for 8 weeks might reduce diarrhea and stomach pain and might improve quality of life in people with IBS with diarrhea.
- Symptoms of menopause. Early research shows that taking a combination of berberine and soy isoflavones can reduce menopausal symptoms. However, it's not clear if berberine reduces menopausal symptoms if used alone.
- A grouping of symptoms that increase the risk of diabetes, heart disease, and stroke (metabolic syndrome). Early research shows that berberine reduces body mass index (BMI), systolic blood pressure (the top number), blood fats called triglycerides, and blood sugar levels in people with metabolic syndrome. It also seems to improve insulin sensitivity. Other early research suggests that taking a combination product containing berberine, policosanol, red yeast rice, folic acid, coenzyme Q10, and astaxanthin improves blood pressure and blood flow in people with metabolic syndrome.
- Build up of fat in the liver in people who drink little or no alcohol (nonalcoholic fatty liver disease or NAFLD). Early research shows that berberine reduces fat in the blood and markers of liver injury in people with diabetes and NAFLD. Other early research shows that berberine might reduce fat in the liver, markers of liver injury, and weight in people with this condition. Berberine seems to work about as well as the medication pioglitazone.
- Obesity. Early research shows that taking berberine can reduce weight in obese people by about 5 pounds.
- Diarrhea caused by radiation therapy. Some early research shows that taking berberine during radiation therapy can reduce intestinal injury from radiation in patients being treated for cancer.
- Scarring of tissue caused by radiation therapy. Some early research shows that taking berberine during radiation therapy can reduce lung injury from radiation in patients being treated for cancer.
- Low levels of platelets in the blood (thrombocytopenia). Blood platelets are important for blood clotting. Early research shows that taking berberine either alone or with prednisolone, can increase the number of blood platelets in people with low blood platelet counts.
- An eye infection caused by Chlamydia trachomatis (trachoma). There is some evidence that eye drops containing berberine might be useful for treating trachoma, a common cause of blindness in developing countries.
- A type of inflammatory bowel disease (ulcerative colitis). Early research shows that taking berberine does not seem to improve symptoms in people with ulcerative colitis who take the drug mesalamine.
- Other conditions.
How does it work?
Are there safety concerns?
When applied to the skin: Berberine is POSSIBLY SAFE for most adults when used short-term.
Special precautions & warnings:Pregnancy and breast-feeding: It's LIKELY UNSAFE to take berberine by mouth if you are pregnant. Researchers believe berberine can cross the placenta and might cause harm to the fetus. Kernicterus, a type of brain damage, has developed in newborn infants exposed to berberine.
It's also LIKELY UNSAFE to take berberine if you are breast-feeding. Berberine can be transferred to the infant through breast milk, and it might cause harm.
Children: It's LIKELY UNSAFE to give berberine to newborns. It can cause kernicterus, a rare type of brain damage that can occur in newborns who have severe jaundice. Jaundice is yellowing of the skin caused by too much bilirubin in the blood. Bilirubin is a chemical that is produced when the old red cells break down. It is normally removed by the liver. Berberine may keep the liver from removing bilirubin fast enough. There isn't enough reliable information to know if berberine is safe in older children.
Diabetes: Berberine can lower blood sugar. Theoretically, berberine may cause blood sugar to become too low if taken by diabetics who are controlling their blood sugar with insulin or medications. Use with caution in people with diabetes.
High bilirubin levels in the blood in infants: Bilirubin is a chemical that is produced when the old red blood cells break down. It is normally removed by the liver. Berberine may keep the liver from removing bilirubin fast enough. This can cause brain problems, especially in infants with high levels of bilirubin in the blood. Avoid using.
Low blood pressure: Berberine can lower blood pressure. Theoretically, berberine might increase the risk of blood pressure becoming too low in people who already have low blood pressure. Use with caution.
Are there interactions with medications?
- Cyclosporine (Neoral, Sandimmune)
- The body breaks down cyclosporine to get rid of it. Berberine might decrease how fast the body breaks down cyclosporine and it might build up in the body and could possibly cause side effects.
- Dextromethorphan (Robitussin DM, others)
- The body breaks down dextromethorphan to get rid of it. Berberine might decrease how quickly the body breaks it down and might increase the effects and side effects of dextromethorphan.
- Losartan (Cozaar)
- The liver activates losartan to make it work. Berberine might decrease how quickly the body activates it, and might decrease its effects.
- Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
- Some medications are changed and broken down by the liver. Berberine might decrease how quickly the liver breaks down these medications and increase their effects and side effects.
Some medications changed by the liver include celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), and S-warfarin (Coumadin).
- Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)
- Some medications are changed and broken down by the liver. Berberine might decrease how quickly the liver breaks down these medications and increase their effects and side effects. Some medications changed by the liver include amitriptyline (Elavil), codeine, desipramine (Norpramin), flecainide (Tambocor), haloperidol (Haldol), imipramine (Tofranil), metoprolol (Lopressor, Toprol XL), ondansetron (Zofran), paroxetine (Paxil), risperidone (Risperdal), tramadol (Ultram), venlafaxine (Effexor), and others.
- Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4)
- Some medications are changed and broken down by the liver. Berberine might decrease how quickly the liver breaks down these medications and increase their effects and side effects. Some medications changed by the liver include cyclosporin (Neoral, Sandimmune), lovastatin (Mevacor), clarithromycin (Biaxin), indinavir (Crixivan), sildenafil (Viagra), triazolam (Halcion), and many others.
- Medications for diabetes (Antidiabetes drugs)
- Berberine might lower blood sugar. Diabetes medications are also used to lower blood sugar. Taking berberine along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (Diabeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.
- Medications for high blood pressure (Antihypertensive drugs)
- Berberine might decrease blood pressure in some people. Taking berberine along with medications used to lower high blood pressure might cause your blood pressure to go too low.
Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochlorothiazide (HydroDIURIL), furosemide (Lasix), and many others.
- Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
- Berberine might slow blood clotting. Taking berberine along with medications that also slow clotting might increase the chances of bruising and bleeding.
Some medications that slow blood clotting include aspirin, cilostazol (Pletal), clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), and others.
- Metformin (Glucophage)
- Berberine might increase the amount of metformin in the body. This may increase its effects and side effects. This interaction seems to occur when berberine is taken around 2 hours before metformin. Taking berberine and metformin at the same time doesn't appear to increase the amount of metformin in the body.
- Midazolam (Versed)
- The body breaks down midazolam to get rid of it. Berberine can decrease how quickly the body breaks it down and might increase the effects and side effects of midazolam.
- Pentobarbital (Nembutal)
- Pentobarbital is a medication that can cause sleepiness. Berberine might also cause sleepiness and drowsiness. Taking berberine with pentobarbital might cause too much sleepiness.
- Sedative medications (CNS depressants)
- Berberine might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking berberine along with sedative medications might cause too much sleepiness.
Some sedative medications include benzodiazepines, pentobarbital (Nembutal), phenobarbital (Luminal), secobarbital (Seconal), thiopental (Pentothal), fentanyl (Duragesic, Sublimaze), morphine, propofol (Diprivan), and others.
- Tacrolimus (Prograf)
- Tacrolimus is an immunosuppressant drug. It is removed from the body by the liver. Berberine might decrease how quickly the body removes it and this might increase the effects and side effects of tacrolimus.
Are there interactions with herbs and supplements?
- Herbs and supplements that might lower blood pressure
- Berberine might lower blood pressure. Using it along with other herbs and supplements that have this same effect might increase the risk of blood pressure dropping too low in some people. Some of these products include andrographis, casein peptides, cat's claw, coenzyme Q-10, fish oil, L-arginine, lycium, stinging nettle, theanine, and others.
- Herbs and supplements that might lower blood sugar
- Berberine might lower blood sugar. Using it along with other herbs and supplements that have the same effect might cause blood sugar to drop too low in some people. Some of these products include alpha-lipoic acid, bitter melon, chromium, devil's claw, fenugreek, garlic, guar gum, horse chestnut seed, Panax ginseng, psyllium, Siberian ginseng, and others.
- Herbs and supplements that might slow blood clotting
- Berberine might slow blood clotting. Taking berberine along with other herbs that might slow blood clotting might increase the chances of bruising and bleeding. These herbs include angelica, clove, danshen, garlic, ginger, ginkgo, Panax ginseng, and others.
- Herbs and supplements with sedative properties
- Berberine can cause sleepiness or drowsiness. Using it along with other herbs and supplements that have the same effect might make you overly drowsy. Some of these herbs and supplements include calamus, California poppy, catnip, hops, Jamaican dogwood, kava, L-tryptophan, melatonin, sage, SAMe, St. John's wort, sassafras, skullcap, and others.
- Probiotic supplements contain bacteria that are thought to be beneficial to health. Berberine might kill certain probiotic strains. If taken together, berberine might reduce how well probiotic supplements work.
Are there interactions with foods?
- There are no known interactions with foods.
What dose is used?
- For diabetes: 0.9-1.5 grams of berberine has been taken in divided doses daily for 2-4 months.
- For high levels of cholesterol or other fats (lipids) in the blood (hyperlipidemia): 0.6-1.5 grams of berberine has been taken in divided doses daily for 6 to 24 months. Combination products containing 500 mg of berberine, 10 mg of policosanol, and 200 mg of red yeast rice, along with other ingredients, have been taken daily for up to 12 months.
- For high blood pressure: 0.9 grams of berberine has been taken daily for 2 months.
- For a hormonal disorder that causes enlarged ovaries with cysts (polycystic ovary syndrome or PCOS): 1.5 grams of berberine has been taken daily for 3-6 months.
- For canker sores: Gel containing 5 mg of berberine per gram has been applied four times per day for 5 days.
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.
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- Cianci, A., Cicero, A. F., Colacurci, N., Matarazzo, M. G., and De, Leo, V. Activity of isoflavones and berberine on vasomotor symptoms and lipid profile in menopausal women. Gynecol.Endocrinol. 2012;28:699-702. View abstract.
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- 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;39:406-411. View abstract.
- Kim, H. S., Kim, M. J., Kim, E. J., Yang, Y., Lee, M. S., and Lim, J. S. Berberine-induced AMPK activation inhibits the metastatic potential of melanoma cells via reduction of ERK activity and COX-2 protein expression. Biochem.Pharmacol 2-1-2012;83:385-394. View abstract.
- Marazzi, G., Cacciotti, L., Pelliccia, F., Iaia, L., Volterrani, M., Caminiti, G., Sposato, B., Massaro, R., Grieco, F., and Rosano, G. Long-term effects of nutraceuticals (berberine, red yeast rice, policosanol) in elderly hypercholesterolemic patients. Adv.Ther 2011;28:1105-1113. View abstract.
- 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 syndrome. Eur J Endocrinol. 2012;166:99-105. View abstract.
- Wang, Q., Zhang, M., Liang, B., Shirwany, N., Zhu, Y., and Zou, M. H. Activation of AMP-activated protein kinase is required for berberine-induced reduction of atherosclerosis in mice: the role of uncoupling protein 2. PLoS.One. 2011;6:e25436. View abstract.
- 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;68:213-217. View abstract.
- Lamb, J. J., Holick, M. F., Lerman, R. H., Konda, V. R., Minich, D. M., Desai, A., Chen, T. C., Austin, M., Kornberg, J., Chang, J. L., Hsi, A., Bland, J. S., and Tripp, M. L. Nutritional supplementation of hop rho iso-alpha acids, berberine, vitamin D, and vitamin K produces a favorable bone biomarker profile supporting healthy bone metabolism in postmenopausal women with metabolic syndrome. Nutr Res 2011;31:347-355. View abstract.
- Holick, M. F., Lamb, J. J., Lerman, R. H., Konda, V. R., Darland, G., Minich, D. M., Desai, A., Chen, T. C., Austin, M., Kornberg, J., Chang, J. L., Hsi, A., Bland, J. S., and Tripp, M. L. Hop rho iso-alpha acids, berberine, vitamin D3 and vitamin K1 favorably impact biomarkers of bone turnover in postmenopausal women in a 14-week trial. J Bone Miner.Metab 2010;28:342-350. View abstract.
- 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 receptor expression. Metabolism 2010;59:285-292. View abstract.
- Wang, Y., Jia, X., Ghanam, K., Beaurepaire, C., Zidichouski, J., and Miller, L. Berberine and plant stanols synergistically inhibit cholesterol absorption in hamsters. Atherosclerosis 2010;209:111-117. View abstract.
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- Affuso, F., Ruvolo, A., Micillo, F., Sacca, L., and Fazio, S. Effects of a nutraceutical combination (berberine, red yeast rice and policosanols) on lipid levels and endothelial function randomized, double-blind, placebo-controlled study. Nutr Metab Cardiovasc.Dis 2010;20:656-661. View abstract.
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