Berberine
Natural Standard evidence-based flashcard. Copyright © 2008 (www.naturalstandard.com). Commercial distribution prohibited. This flashcard is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. 		Image
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Summary:
Berberine is a bitter-tasting, yellow, plant alkaloid with a long history of medicinal use in Chinese and Ayurvedic medicine. Berberine is present in the roots, rhizomes and stem bark of various plants including Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric). Berberine has also been used historically as a dye, due to its yellow color.

Uses
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Grade*
Heart failure B
Chloroquine-resistant malaria C
Diabetes (type 2) C
Glaucoma C
H. pylori C
Hypercholesterolemia C
Infectious diarrhea C
Parasitic infection (leishmania) C
Thrombocytopenia C
Trachoma C
*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

Safety:
Avoid if allergic or hypersensitive to berberine, to plants that contain berberine [Hydrastis canadensis (goldenseal), Coptis chinensis (coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric)], or to members of the Berberidaceae family. Avoid in newborns due to potential for increase in free bilirubin, jaundice, and development of kernicterus. Use cautiously with cardiovascular disease, gastrointestinal disorders, hematologic disorders, leucopenia, kidney disease, liver disease, respiratory disorders, cancer, hypertyraminemia, diabetes, or hypotension. Use cautiously in children due to lack of safety information. Use cautiously in individuals with high exposure to sunlight or artificial light. Use cautiously for longer than eight weeks due to theoretical changes in bacterial gut flora. Use cautiously if taking anticoagulants, antihypertensives, sedatives, anti-inflammatories, medications metabolized by CYP P450 3A4 including cyclosporin, or any prescription medications. Avoid if pregnant or breastfeeding.

Possible side effects:
Abdominal discomfort, abdominal distention, abortion, alterations in gut flora, bradycardia (slow heartbeat), cardiac arrest, cardiac damage, death, decrease in blood glucose, diarrhea, dyspnea (difficulty breathing), eye irritation, facial flushing, faintness, flu-like symptoms, giddiness, headache, hemorrhagic nephritis (inflammation of kidneys), hepatotoxicity (liver damage), hyperbilirubinemia, hypertension (high blood pressure), hypotension (low blood pressure), increased serum total and direct bilirubin concentrations, increased risk of bleeding, infertility, inhibited osteoclast-like cells, itching, kernicterus (bilirubin encephalopathy), kidney irritation, lethargy, nausea, nosebleed, painful swelling, paresthesias (abnormal touch sensations), permanent hyperpigmentation in the arm, platelet formation, renal irritation, respiratory failure, severe acute hemolysis in babies with glucose-6-phosphate, dehydrogenase deficiency, skin irritation, ventricular tachycardia (fast heartbeat), vomiting.

Possible interactions:
1,3-bis (2-chloroethyl)-1-nitosurea (BCNU), acetaminophen (Tylenol®), acetylcholine, antiarrhythmics, antibiotics, anticoagulants (blood thinning), antihyperglycemic drugs (blood sugar altering), antihyperlipidemic drugs (cholesterol altering), antihypertensives (blood pressure), anti-inflammatory drugs, antineoplastics (for cancer), COX-2 inhibitors, cyclosporine, drugs metabolized through cytochrome P450 3A4 enzymes, fluconazole, L-phenylephrine, neostigmine (Prostigmin®), p-glycoprotein inhibitors, sedatives, yohimbine, and herbs and supplements with similar effects.

Dosing:

Adults (18 years and older):

Oral (Taken by mouth):
Hypercholesterolemia: Berberine 0.5g twice daily for three months has been used.
Infectious diarrhea: Berberine sulfate 400mg as a single dose has been used.
Thrombocytopenia: Berberine bisulfate 5mg three times daily (20 minutes before meals) for 15 days has been used.

Intravenous/Intramuscular:
Heart failure: Berberine infusion 0.2mg/kg per minute intravenously for 30 minutes has been used.

Ophthalmics (Eye drops):
Trachoma: Berberine 0.2% eye drops for eight weeks have been used.

Children (younger than 18 years):
Not enough scientific data available.
Natural Standard Monograph (www.naturalstandard.com)
Copyright © 2008 Natural Standard Inc. Commercial distribution or reproduction prohibited.
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.