Barberry

Barberry/Drug Interactions:

  • AcetaminophenAcetaminophen: In vitro research suggests that pretreatment with berberine is hepatoprotective against toxic doses of acetaminophen (47).
  • AntibioticsAntibiotics: In vitro research has demonstrated the susceptibility of numerous bacterial microorganisms (i.e., Shigella, Bacillus cereus, Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Vibrio cholera) to Berberis extracts (56; 84; 58; 57; 142; 143; 89). Based on tests of minimum inhibitory concentration (MIC) and minimum bacterial concentration (MBC) against all strains of Shigella, the toxicological profile of berberine is purported to be similar to that of ciprofloxacin (84). One double-blind study found that 100mg of berberine decreased the efficacy of tetracycline in the treatment of cholera (77).
  • AnticholinergicsAnticholinergics: Barberry has displayed anticholinergic activity (118). Theoretically, combination use of barberry with anticholinergic agents may cause additive effects. It has also been shown to improve scopolamine-induced amnesia (144).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Both in vitro and in vivo animal research suggests that berberine, or certain berberine derivatives, effectively inhibited platelet aggregation (119; 120; 55; 121). Berberine bisulfate demonstrated the ability to stimulate platelet formation in patients with thrombocytopenia in an equivalence trial (101). Barberry may decrease the efficacy of oral anticoagulants by increasing the formation of platelets. Therefore, concomitant use of barberry and anticoagulants or antiplatelets, such as warfarin, heparin, aspirin, and clopidogrel, should be used with caution.
  • AnticonvulsantsAnticonvulsants: Animal research suggests that berberine exerted anticonvulsant effects via the moderation of various convulsion-modulating neurotransmitter systems, such N-methyl-D-aspartate, nitric oxide, and serotonin (49).
  • Antidepressant agentsAntidepressant agents: In animal research, intraperitoneal administration of 5mg/kg of berberine resulted in an increase in norepinephrine, serotonin, and dopamine (51; 50). It may also inhibit monoamine oxidase-A (50).
  • Antidiabetic agentsAntidiabetic agents: Barberry has been shown to decrease blood sugar levels in animals (39; 8). Theoretically, concurrent use with antidiabetic agents may increase the risk of hypoglycemia (40).
  • AntidiarrhealsAntidiarrheals: Both preclinical (cell and animal) and clinical research suggests that the antidiarrheal effects of barberry, or its constituent berberine, are due at least in part to its ability to delay intestinal motility (122; 123; 84; 13). Theoretically, concurrent use may have additive effects.
  • AntihistaminesAntihistamines: Barberry has displayed antihistaminic activity in animals (118).
  • AntihypertensivesAntihypertensives: Several animal studies have found that barberry extract may reduce arterial blood pressure (91; 90; 124; 125). Theoretically, concurrent use with antihypertensive agents may increase the risk of hypotension (90). Additionally, propranolol inhibited the increase in slow-response action potential seen with berberine in vitro (145).
  • Anti-inflammatoriesAnti-inflammatories: In pharmacological activity and in vitro research, berberine and berberine sulfate had anti-inflammatory effects, and may they interact with COX-2 inhibitors such as celecoxib (Celebrex?) and rofecoxib (Vioxx?) (20; 18; 14). In vitro research suggests that berberine inhibited lymphocyte transformation, prostaglandin-2 (PGE-2) production, leukotriene formation, and activator protein-1, cyclooxygenase-2 (COX-2), and interleukin-1 (IL-1) activity (17; 18; 19; 20; 22).
  • AntifungalsAntifungals: In vitro research has demonstrated the susceptibility of numerous fungal microorganisms (i.e., Alternaria, Curvularia, Drechslera, Fusarium, Mucor, Pythium) to Berberis extracts (56; 52; 54; 143).
  • AntilipemicsAntilipemics: In human research, barberry significantly decreased LDL and the total:HDL cholesterol ratio, and increased HDL cholesterol (146).
  • AntineoplasticsAntineoplastics: Preclinical research in both cell culture and animal models have demonstrated berberine's antineoplastic potential for mitigating the synthesis, differentiation, expression, proliferation, functional activity, and apoptosis of various cancers (24; 25; 18; 29; 30; 31; 32; 33; 34; 35; 36; 37; 38; 26; 27; 23; 28). Berberine and 1,3-bis(2-chloroethyl)-1-nitosurea (BCNU) were shown to have additive effects against six human brain tumor cell lines in vitro, which may also apply to the use of barberry in humans (34). Liu et al. conducted an animal study to observe the effects of cyclophosphamide 2.5mg/kg for three days, berbamine 20mg/kg once daily for seven days, a combination of cyclophosphamide and berbamine, and placebo on a Walker tumor (27) When compared to the control group on day 8, cyclophosphamide monotherapy had significantly decreased the activity of the tumor, by 39.6% (p<0.05), berbamine monotherapy decreased the activity by 44.9% (p<0.05), and the combination of the two decreased the activity by 61.8% (p<0.01).
  • AntiparasiticsAntiparasitics: In vitro research has demonstrated the ability of berberine to inhibit the growth of various parasitic microorganisms at the nucleic acid (DNA) level (147; 148; 149). In animal research, berberine has been shown to be effective at treating amebiasis in a dose-dependent manner (150) and in preventing the development of hepatic amebiasis (151).
  • Calcium saltsCalcium salts: Animal research suggests that Berberis aristata increases the level of calcium in serum but reduces it in urine (11).
  • Cardiovascular agentsCardiovascular agents: Berberine research in cell culture and animal models has demonstrated its various effects on the contraction (152; 153; 154; 155; 156; 68), rhythm (157; 156; 65; 64; 158), rate (159; 67), output (69; 159), peripheral resistance (69; 159), and stress response (i.e., to occlusions, ischemia) (160; 161) of the myocardium. Concurrent administration of barberry and antiarrhythmic medication is not suggested, due to the unpredictable results of combining two antiarrhythmic therapies.
  • Cholinergic agonistsCholinergic agonists: Barberry has been shown to reverse the secretory properties of neostigmine in animals (130).
  • CNS depressantsCNS depressants: In animal research, berberine produced sedation, potentiated the sedative effects of pentobarbitone when administered via the intraperitoneal or intraventricular routes, and prolonged hexobarbitone-induced sleep time (126; 91). Theoretically, concomitant use may cause additive sedation.
  • Cytochrome P450-modifying agentsCytochrome P450-modifying agents: In vitro, barberry extract was shown to moderately inhibit CYP3A4, and it should be used cautiously when taken with other medications metabolized by the CYP3A4 enzyme system (127).
  • Dental agentsDental agents: Results from human research of aqueous barberry extract suggest that its repeated use as a dental gel reduces the mean change of both plaque and gingival indices over time compared to a placebo dental gel, but not to a commercial Colgate? dental gel (135).
  • DiureticsDiuretics: According to secondary sources, barberry contains vitamin C and may have a mild diuretic effect. Theoretically, concurrent use may cause additive effects.
  • Drugs used for osteoporosisDrugs used for osteoporosis: Berberine has been shown to prevent a decrease in bone mineral density, inhibit parathyroid hormone-stimulated bone resorption, and induce apoptosis of osteoclastic cells (94).
  • Gastrointestinal agentsGastrointestinal agents: Animal research suggests that berberine significantly increases the latent period of purging and decreases its frequency (122), protects against colonic but not mucosal inflammation (70), and diminishes the ulcer index (70). Research in animal intestines further suggests that berberine inhibits intestinal secretory activity following exposure to various toxins, such as V. cholera and E. coli, and cholera (162; 163).
  • HepatotoxinsHepatotoxins: Berberine has been shown to increase total and direct bilirubin concentrations in the serum by increasing its secretion in rats (128) and by displacing it from albumin in both cell cultures and animals (129). Caution is warranted with hepatotoxic agents.
  • ImmunosuppressantsImmunosuppressants: Research in numerous animal models has shown berberine to have immunosuppressant potential via its inhibitory effects on the production and activity of various immune system mediators, such as leukocytes (45), lymphocytes (41; 42), neutrophils (42), and T cells (43; 44; 46).
  • InterferonsInterferons: In animal models of experimental autoimmune encephalomyelitis (EAE), berbamine was shown to selectively inhibit the production and activity of interferon (IFN)-gamma (46).
  • LaxativesLaxatives: Both preclinical (cell and animal) and clinical research suggests that the antidiarrheal effects of barberry, or its constituent berberine, are due at least in part to its ability to delay intestinal motility (122; 123; 84; 13). Theoretically, barberry may interfere or reduce the effectiveness of laxatives.
  • L-phenylephrineL-phenylephrine: Berberine and L-phenylephrine demonstrated additive effects in animals when administered concurrently (130).

    • Barberry/Herb/Supplement Interactions:

  • AntibacterialsAntibacterials: In vitro research has demonstrated the susceptibility to Berberis extracts of numerous bacterial (56; 84; 58; 57; 142; 143; 89) and fungal microorganisms (56; 52; 54; 143). Based on tests of minimum inhibitory concentration (MIC) and minimum bacterial concentration (MBC) against all strains of Shigella, the toxicological profile of berberine is purported to be similar to that of ciprofloxacin (84). One double-blind study found that 100mg of berberine decreases the efficacy of tetracycline in the treatment of cholera (77).
  • AnticholinergicsAnticholinergics: Barberry has displayed anticholinergic activity (118). Theoretically, combination use of barberry with anticholinergic agents may cause additive effects. It has also been shown to improve scopolamine-induced amnesia (144).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Both in vitro and in vivo animal research suggests that berberine, or certain berberine derivatives, effectively inhibited platelet aggregation (119; 120; 55; 121). Berberine bisulfate demonstrated the ability to stimulate platelet formation in patients with thrombocytopenia in an equivalence trial (101). Barberry may decrease the efficacy of oral anticoagulants by increasing the formation of platelets. Therefore, concomitant use of barberry and anticoagulants or antiplatelets, such as warfarin, heparin, aspirin, and clopidogrel, should be used with caution.
  • AnticonvulsantsAnticonvulsants: Animal research suggests that berberine exerts anticonvulsant effects via the moderation of various convulsion-modulating neurotransmitter systems such N-methyl-D-aspartate, nitric oxide, and serotonin (49).
  • AntidepressantsAntidepressants: In animal research, intraperitoneal administration of 5mg/kg of berberine resulted in an increase in norepinephrine, serotonin, and dopamine (51; 50). It may also inhibit monoamine oxidase-A (50).
  • AntifungalsAntifungals: In vitro research has demonstrated the susceptibility of numerous fungal microorganisms (i.e., Alternaria, Curvularia, Drechslera, Fusarium, Mucor, Pythium) to Berberis extracts (56; 52; 54; 143).
  • AntihistaminesAntihistamines: Barberry has displayed antihistaminic activity in animals (118). Theoretically, concurrent use of barberry with antihistaminic herbs and supplements may result in additive effects.
  • AntidiarrhealsAntidiarrheals: Both preclinical (cell and animal) and clinical research suggests that the antidiarrheal effects of barberry, or its constituent berberine, are due at least in part to its ability to delay intestinal motility (122; 123; 84; 13). Theoretically, concurrent use may have additive effects.
  • Anti-inflammatoriesAnti-inflammatories: In pharmacological activity and in vitro research, berberine and berberine sulfate had anti-inflammatory effects (20; 18; 14). In vitro research suggests that berberine inhibited lymphocyte transformation, prostaglandin-2 (PGE-2) production, leukotriene formation, and activator protein-1, cyclooxygenase-2 (COX-2), and interleukin-1 (IL-1) activity (17; 18; 19; 20; 22).
  • AntilipemicsAntilipemics: In human research, barberry significantly decreased LDL and the total:HDL cholesterol ratio, and increased HDL cholesterol (146).
  • AntineoplasticsAntineoplastics: Preclinical research in both cell culture and animal models has demonstrated berberine's antineoplastic potential for mitigating the synthesis, differentiation, expression, proliferation, functional activity, and apoptosis of various cancers (24; 25; 18; 29; 30; 31; 32; 33; 34; 35; 36; 37; 38; 26; 27; 23; 28). Liu et al. conducted an animal study observing the effects of cyclophosphamide 2.5mg/kg for three days, berbamine 20mg/kg once daily for seven days, a combination of cyclophosphamide and berbamine, and placebo on a Walker tumor (27) When compared to the control group on day 8, cyclophosphamide monotherapy had significantly decreased the activity of the tumor, by 39.6% (p<0.05), berbamine monotherapy decreased the activity by 44.9% (p<0.05), and the combination of the two decreased the activity by 61.8% (p<0.01).
  • AntioxidantsAntioxidants: In preclinical research, barberry and certain barberry isolates have demonstrated antioxidant and radical-scavenging potential (8; 63; 15; 60; 164; 61; 62; 12). The antioxidant potential of barberry is purportedly correlated with the level of constituent polyphenols present (63; 12).
  • AntiparasiticsAntiparasitics: In vitro research has demonstrated the ability of berberine to inhibit the growth of various parasitic microorganisms at the nucleic acid (DNA) level (147; 148; 149). In animal research, berberine has been shown to be effective at treating amebiasis in a dose dependent manner (150) and in preventing the development of hepatic amebiasis (151).
  • B vitaminsB vitamins: According to secondary sources, berberine may decrease the metabolism of vitamin B; therefore, the concomitant use of barberry with vitamin B should be used with caution.
  • Berberine-containing agentsBerberine-containing agents: Concomitant use may increase the risk of berberine toxicity. Berberine-containing herbs include bloodroot, goldenseal, celandine, Chinese goldthread, goldthread, Oregon grape (Mahonia species), amur cork tree, and Chinese corktree.
  • CalciumCalcium: Animal research suggests that Berberis aristata increases the level of calcium in serum but reduces it in urine (11).
  • Cardiovascular agentsCardiovascular agents: Berberine research in cell culture and animal models has demonstrated its various effects on the contraction (152; 153; 154; 155; 156; 68), rhythm (157; 156; 65; 64; 158), rate (159; 67), output (69; 159), peripheral resistance (69; 159), and stress response (i.e., to occlusions, ischemia) (160; 161) of the myocardium. Concurrent administration of barberry and antiarrhythmic herbs and supplements is not suggested, due to the unpredictable results of combining two antiarrhythmic therapies.
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: In vitro, barberry extract was shown to moderately inhibit CYP3A4 and should be used cautiously when taken with other herbs and supplements metabolized by the CYP3A4 enzyme system (127).
  • Dental agentsDental agents: Results from human research of aqueous barberry (Berberis vulgaris) extract suggests that repeated use as a dental gel reduces the mean change of both plaque and gingival indices over time compared to a placebo dental gel, but not to a commercial Colgate? dental gel (135).
  • DiureticsDiuretics: According to secondary sources, barberry contains vitamin C and may have a mild diuretic effect. Theoretically, concurrent use may cause additive effects.
  • Gastrointestinal agentsGastrointestinal agents: Animal research suggests that berberine significantly increases the latent period of purging and decreases its frequency (122), protects against colonic but not mucosal inflammation (70), and diminishes the ulcer index (70). Research in animal intestines further suggests that berberine inhibits intestinal secretory activity following exposure to various toxins, such as V. cholera and E. coli, and cholera (162; 163).
  • HepatotoxinsHepatotoxins: Berberine has been shown to increase total and direct bilirubin concentrations in the serum by increasing its secretion in rats (128) and by displacing it from albumin in both cell cultures and animals (129). Caution is warranted with hepatotoxic agents.
  • HypoglycemicsHypoglycemics: Barberry has been shown to decrease blood sugar levels in animals (39; 8). Theoretically, concurrent use with antidiabetic agents may increase the risk of hypoglycemia (40).
  • HypotensivesHypotensives: Several animal studies have found that barberry extract may reduce arterial blood pressure (91; 90; 124; 125). Theoretically, concurrent use with antihypertensive agents may increase the risk of hypotension (90).
  • ImmunomodulatorsImmunomodulators: Research in numerous animal models has shown berberine to have immunosuppressant potential via its inhibitory effects on the production and activity of various immune system mediators, such as leukocytes (45), lymphocytes (41; 42), neutrophils (42), and T cells (43; 44; 46).
  • LaxativesLaxatives: Both preclinical (cell and animal) and clinical research suggests that the antidiarrheal effects of barberry, or its constituent berberine, are due at least in part to its ability to delay intestinal motility (122; 123; 84; 13). Theoretically, barberry may interfere or reduce the effectiveness of laxatives.
  • Osteoporosis agentsOsteoporosis agents: Berberine has been shown to prevent a decrease in bone mineral density, inhibit parathyroid hormone-stimulated bone resorption, and induce apoptosis of osteoclastic cells (94).
  • PhosphorusPhosphorus: Animal research suggests that Berberis aristata increases the level of phosphorus in serum but reduces it in urine (11).
  • Yohimbe bark extractYohimbe bark extract: Berberine has been shown to competitively inhibit the binding of yohimbine, which may or may not affect its pharmacologic actions when the two agents are administered concurrently (131). This interaction may also occur in humans ingesting both barberry and yohimbine together.

    • Barberry/Food Interactions:

  • Tyramine-containing foodsTyramine-containing foods: Theoretically, tyramine-containing foods, such as wine, cheese, and chocolate, may have an interaction with barberry due to berberine's effect on decreasing levels of tyramine. It may also inhibit monoamine oxidase-A (50). While treating patients with hypertyraminemia with berberine, tyramine-containing foods are not suggested (92).

    • Barberry/Lab Interactions:

  • BilirubinBilirubin: Berberine was shown to displace bilirubin from albumin in both in vitro and animal studies, resulting in an increase in serum total and direct bilirubin concentrations (129).
  • Blood pressureBlood pressure: Berberine has been shown to decrease blood pressure in animals (91; 125; 124; 90; 145).
  • CalciumCalcium: Animal research suggests that Berberis aristata increases the level of calcium in serum but reduces it in urine (11).
  • Coagulation panelCoagulation panel: Both in vitro and in vivo animal research suggests that berberine, or certain berberine derivatives, effectively inhibited platelet aggregation (119; 120; 55; 121). Berberine bisulfate demonstrated the ability to stimulate platelet formation in patients with thrombocytopenia in an equivalence trial (101).
  • GlucoseGlucose: Barberry has been shown to decrease blood sugar levels in animals (39; 8).
  • Heart rateHeart rate: Several preclinical studies have suggested that barberry extract decreases heart rate (91; 90; 124; 125).
  • Interferon-gammaInterferon-gamma: In animal models of experimental autoimmune encephalomyelitis (EAE), berbamine was shown to selectively inhibit the production and activity of IFN-gamma (46).
  • InterleukinsInterleukins: Berberine has been shown to inhibit interleukin-1 (IL-1) (19). Berberine has also been shown to decrease IL-8 production (21).
  • Lipid profileLipid profile: In human research, barberry significantly decreased LDL and the total:HDL cholesterol ratio, and increased HDL cholesterol (146).
  • PhosphorusPhosphorus: Animal research suggests that Berberis aristata increases the level of phosphorus in serum but reduce it in urine (11).
  • White blood cellsWhite blood cells: Research in numerous animal models has shown berberine to inhibit the production of leukocytes (45), lymphocytes (41; 42), neutrophils (42), and T cells (43; 44; 46).