Berberine and medications.
Berberine is in the Distil supplement database, evidence Grade A. The page below lists every medication we have explicitly assessed it against.
Berberine is a plant alkaloid with Grade A evidence for blood glucose control and insulin sensitivity, and Grade B for cardiovascular markers, where it tends to lower LDL cholesterol by around 20 to 25%. It works partly by activating AMPK, an energy-sensing pathway, and by supporting the gut microbiome. AMPK is often described as a longevity pathway, and we do not recommend berberine for longevity on that basis: a pathway is a mechanism, not a result, and no study we cite measures ageing, healthspan or mortality. There is a further use it does support. In polycystic ovary syndrome, four independent reviews of the randomised trials agree that it tends to lower testosterone and improve insulin resistance and lipids, which is Grade B, and it is one of the compounds most often paired with myo-inositol. That evidence covers hormonal and metabolic markers only: Xie's review of the randomised trials found no solid evidence that it improves live birth, and reported a lower live-birth rate than letrozole, so it should not be taken as a fertility treatment. Plain berberine HCl is poorly absorbed at about 5%, so phytosome or dihydroberberine forms are worth preferring; the usual standard dose is 500mg two to three times daily with meals. The interactions are the headline here. Combined with metformin it can stack hypoglycaemia risk, so GP review is essential before pairing them. It inhibits the CYP3A4 enzyme, which means it can raise levels of many medications cleared by that pathway. Warfarin needs separate mention, and we hold an amber caution on it: the more powerful half of warfarin is cleared by CYP2C9 rather than CYP3A4, and a study in people found berberine slows CYP2C9 at doses people commonly take, which could raise your INR. Our literature search found no study of the two together, so keep to your usual INR checks and tell whoever manages your warfarin that you are taking berberine, rather than reading it as either safe or a known clash. Two combinations go beyond caution to a firm exclusion: the transplant immunosuppressants tacrolimus, ciclosporin, sirolimus and everolimus are cleared by CYP3A4, and so are many HIV antiretrovirals, so berberine should not be taken alongside either: it can push an immunosuppressant into its toxic range, and it can shift antiretroviral levels on a regimen that depends on steady ones. Separate it by two hours from antibiotics. GI upset on starting is common and usually settles in a few weeks. A typical pattern is eight weeks on, four weeks off.
Below are the 24 documented pairs we have explicitly assessed for Berberine: 4 red and 20 amber. The pairs cluster around 7 mechanisms: CYP3A4 inhibition, Additive blood-pressure lowering, Additive lipid lowering, CYP-mediated metabolism, CYP2C9 inhibition, Additive glucose lowering, and P-glycoprotein inhibition (raises drug levels). Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Last reviewed 27 August 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
CYP3A4 inhibition
Red Does Berberine interact with Ciclosporin?
Berberine raises ciclosporin blood levels by slowing how the body clears it. A trial in transplant patients showed roughly a 30 percent rise in ciclosporin levels, which can push the drug into the toxic range. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: Supported by human study data.
Red Does Berberine interact with Everolimus?
Berberine can slow how the body clears everolimus, which may push everolimus blood levels higher than intended. We treat this as a do-not-combine pair outside direct transplant-team or oncology supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Berberine interact with Sirolimus?
Berberine can slow how the body clears sirolimus, which may push sirolimus blood levels higher than intended. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Red Does Berberine interact with Tacrolimus?
Berberine can slow how the body clears tacrolimus, which may push tacrolimus blood levels higher than intended. We treat this as a do-not-combine pair outside direct transplant-team supervision.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive blood-pressure lowering
Amber Does Berberine interact with Amlodipine?
Berberine can lower blood pressure modestly. Added to amlodipine the effect may stack, which is sometimes helpful but can occasionally cause dizziness or a blood pressure that runs lower than your GP intended. Check your blood pressure when you start berberine and tell your GP.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Berberine interact with Losartan?
Berberine can lower blood pressure modestly. Added to losartan the effect may stack. This is usually helpful but can occasionally cause dizziness or a blood pressure that runs lower than intended. Check your blood pressure when you start berberine and tell your GP.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Berberine interact with Ramipril?
Berberine can lower blood pressure modestly. Added to ramipril the effect may stack. This is usually helpful but can occasionally cause dizziness or a blood pressure that runs lower than intended. Check your blood pressure when you start berberine and tell your GP.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive lipid lowering
Amber Does Berberine interact with Atorvastatin?
Berberine lowers LDL cholesterol and triglycerides on its own. Combined with atorvastatin the effect is additive, which is sometimes useful and sometimes pushes lipids lower than your GP intended. If you take both, ask for a lipid panel sooner than usual after starting.
Evidence: Limited human data, from small studies or case reports.
Amber Does Berberine interact with Simvastatin?
Berberine lowers LDL cholesterol on its own. Combined with simvastatin the effect is additive. If you take both, ask for a lipid panel sooner than usual after starting so your GP can confirm you are not pushing lipids lower than intended.
Evidence: Limited human data, from small studies or case reports.
CYP-mediated metabolism
Amber Does Berberine interact with Efavirenz?
If you take efavirenz, tell your HIV team before starting berberine. No study has tested this combination in people, so the caution rests on how berberine behaves with other medicines rather than on any measured effect on efavirenz, and the main enzyme that clears efavirenz has never been tested with berberine in a person. What berberine is known to do in people is slow certain liver enzymes rather than speed them up, so if anything it may nudge efavirenz levels up rather than down; this is not the pattern seen with St John's Wort or ginkgo, which have been linked to efavirenz levels falling and the virus rebounding.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP2C9 inhibition
Amber Does Berberine interact with Warfarin sodium?
Berberine may increase the effect of warfarin and with it your risk of bleeding, so tell whoever manages your warfarin before you start taking it. The reason for the caution is that berberine has been shown in people to slow the liver enzyme that clears the more powerful half of warfarin, which could raise your INR. No study has ever tested the two together, and other evidence puts berberine's effects on different enzymes, so this is a reason to keep to your usual INR checks and mention the supplement rather than a known problem. Do not stop or change your warfarin dose yourself.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive glucose lowering
Amber Does Berberine interact with Dapagliflozin?
Berberine lowers blood sugar, and dapagliflozin does too. It is worth monitoring your glucose when you start berberine and letting your GP know; the combination is usually well tolerated because dapagliflozin rarely causes low blood sugar on its own.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Berberine interact with Gliclazide?
Berberine lowers blood sugar on its own, and gliclazide can already cause low blood sugar, so together they can push your glucose too low. If you take both, monitor your glucose closely when starting berberine, and your GP may need to reduce your gliclazide dose. Do not change your gliclazide dose yourself.
Evidence: Supported by human study data.
Amber Does Berberine interact with Glimepiride?
Berberine lowers blood sugar on its own, and glimepiride can already cause low blood sugar, so together they can push your glucose too low. If you take both, monitor your glucose closely when starting berberine, and your GP may need to reduce your glimepiride dose. Do not change your glimepiride dose yourself.
Evidence: Supported by human study data.
Amber Does Berberine interact with Insulin glargine?
Berberine lowers blood sugar on its own, and insulin can already cause low blood sugar, so together they can push your glucose too low. If you take both, monitor your glucose closely when starting berberine and tell your diabetes team, who may need to reduce your insulin dose. Do not change your insulin dose without your diabetes team's advice.
Evidence: Supported by human study data.
Amber Does Berberine interact with Metformin?
Berberine and metformin both lower blood sugar through similar pathways. The combination can work but needs careful glucose monitoring, especially in the first few weeks, to avoid hypoglycaemia.
Evidence: Supported by human study data.
Amber Does Berberine interact with Pioglitazone hydrochloride?
Berberine lowers blood sugar, and pioglitazone improves how your body uses insulin. Taken together the glucose-lowering effect adds up, though pioglitazone rarely causes low blood sugar by itself. Monitor your glucose when you start berberine and tell your GP.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Berberine interact with Sitagliptin?
Berberine lowers blood sugar, and sitagliptin does too. It is worth monitoring your glucose when you start berberine and letting your GP know; the combination is usually well tolerated because sitagliptin rarely causes low blood sugar on its own.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
P-glycoprotein inhibition (raises drug levels)
Amber Does Berberine interact with Digoxin?
Berberine may raise digoxin blood levels by slowing how the gut pumps it back out. Digoxin has a narrow safe range, so if you take both, watch for nausea, visual changes or an irregular pulse and ask your GP whether a digoxin level check is worthwhile.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
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How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologyA full supplement review, built around you, not a generic stack.
The free checker answers one interaction question at a time. A Distil report reviews the bigger picture: your goals, diet, medications, current supplements and any blood results you provide, then shows what appears worth keeping, changing, adding or leaving out.
- what your diet already covers, so you are not adding a capsule for something food is already handling
- which evidence-graded compounds are worth considering for your goals, and which were considered but left out
- what to keep, change or stop from what you already take, plus the order to introduce anything new
- how your medications and complete supplement stack fit together, with daily timing and a clear point for reassessment
The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
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