8 Berberine Interactions You Should Know About

With glucagon-like peptide-1 (GLP-1) medications surging in popularity, supplements like berberine are getting a lot of attention. Some people consider this supplement to be a nonprescription alternative for weight loss. It has even been dubbed “nature’s Ozempic.” But even though you can buy berberine over the counter, it can interact with other medications. If you’re considering adding berberine to your regimen, here’s what you should know about taking it alongside other medications.

How does berberine interact with medications?

Berberine has a wide range of potential benefits. It’s been studied as a possible treatment for various conditions, including cancer and diabetes. Berberine’s effects on your body are complex. This is why it can also interact with medications in multiple different ways. 

Berberine doesn’t usually interact directly with medications. But it can affect how some medications are processed by your body. Berberine may:

• Affect key enzymes that break down and remove certain medications from your body

• Enhance the effect of some medications, which can raise medication levels and increase the risk of side effects

• Slow down your digestive tract, which affect the absorption of other medications

That’s why it’s a good idea to tell your healthcare team about any medications and supplements you’re taking. This includes over-the-counter (OTC) supplements like berberine. This helps them check for possible interactions and make any needed changes to your medications.

Below are some of the medications that interact with berberine. This list doesn’t cover all potential interactions, but it’s a good place to start.

1. Metformin

Berberine and metformin have some similar effects. They can both:

• Lower blood sugar

• Help with weight loss in some people

• Increase insulin sensitivity

• Reduce inflammation in your body

So taking them together may increase these effects. But it may also cause increased side effects, including:

• Diarrhea

• Upset stomach

• Nausea

• Bloating

• Gas

Some research shows that berberine increases metformin levels in the body. This could further increase the side effects of metformin and may even lead to low blood sugar.

If you want to take metformin and berberine together, check with your healthcare team first. You may need to check your blood sugar more often or lower your metformin dose if needed.

2. Other diabetes medications

Since berberine can lower blood sugar, it may also interact with medications for diabetes like insulin and sulfonylureas. Taking these medications in combination with berberine may cause your blood sugar to get too low, resulting in hypoglycemia (low blood sugar). 

Symptoms of hypoglycemia include:

• Shakiness

• Dizziness

• Hunger

• Feeling tired

• Confusion

• Loss of consciousness

• Seizures

Hypoglycemia can be life-threatening. If you have diabetes, you should be particularly careful when taking berberine.

3. Antibiotics and antifungals

Berberine can interact with antibiotics and antifungal medications in surprising ways. 

Research suggests that berberine may actually enhance antibiotic activity by making the bacteria more sensitive to them. In one lab study, ciprofloxacin with berberine worked better when used together. And animal studies show that berberine may have the same effect with antifungals like ketoconazole. 

Still, hold off on reaching for berberine the next time you take a course of antibiotics. There are also possible downsides to combining berberine with these medications:

• Macrolide antibiotics: Avoid taking berberine with macrolide antibiotics, such as azithromycin and clarithromycin. Research suggests that this combination increases the risk of serious heart arrhythmias. 

• Certain antifungal medications: Taking certain antifungals with berberine may increase their levels of some antifungal medications in your body. Increased levels could lead to more side effects.

4. Blood thinners

If you take the blood thinner warfarin (Coumadin), it’s important to know which medications and supplements can interact with it. Berberine is a newer one to add to that list. It increases warfarin levels in your body, which increases the risk of serious bleeding. 

Berberine may also interact with another common blood thinner, aspirin. A study in mice found that this combination had mild toxic effects on the spleen. But more research is needed to determine the effects of combining berberine and aspirin in humans. 

5. Blood pressure medications

Combining berberine with blood pressure medications can lead to potential interactions. But not all of them are necessarily harmful. 

For example, there’s evidence from animal studies that berberine may interact with losartan. Taking the two together may lower the amount of active losartan in your bloodstream. But experts aren’t certain how this potential interaction affects humans. 

There’s also evidence that taking berberine with blood pressure medications can help lower blood pressure. Berberine by itself may also have a modest blood pressure-lowering effect. And while high blood pressure can be harmful, low blood pressure (hypotension) can also be a problem. 

Symptoms of low blood pressure include:

• Lightheadedness or dizziness

• Fainting

• A racing heart

• Extreme fatigue or weakness

• Blurry vision

• Nausea or vomiting

If you take berberine with blood pressure medications, it’s a good idea to monitor your blood pressure closely.

6. Statins

Berberine has a cholesterol-lowering effect. And it may work alongside a statin to improve cholesterol levels more than the statin alone.

But berberine may also increase the risk of side effects with certain statins. However, this initial research is based on animal studies. Current human studies show that berberine and statins are generally well tolerated when taken together. 

7. Dextromethorphan

Taking berberine alongside cough suppressants that contain dextromethorphan isn’t recommended. 

Dextromethorphan is the active ingredient found in many OTC cough suppressants. And researchers found that berberine can increase the levels of dextromethorphan in the body. 

High levels of dextromethorphan can cause some harmful symptoms, like:

• Shortness of breath

• Seizures

• Hallucinations

• Blurry vision

• Unsteady walking

8. Organ transplant medicines

Cyclosporine is an immune system suppressant that many people need after an organ transplant. 

There’s strong evidence from human studies that shows berberine interacts with cyclosporine. Berberine causes cyclosporine levels in the body to become much higher than they should be. Elevated levels of cyclosporine can cause serious side effects, such as:

• High blood pressure

• Abnormal heart rhythms

• Decreased kidney function

• Electrolyte abnormalities

• Increased risk of infections

Tacrolimus is another medication taken by people who have received organ transplants. And further evidence points to a similar interaction between berberine and tacrolimus.

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Written by:

Joanna Jan, MD

Joanna Jan, MD, is board-certified in internal medicine and licensed to practice medicine in the state of Pennsylvania. In 2017, she received her board certification from the American Board of Internal Medicine.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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