Related Terms

• Agracejo (Spanish), agrecejo, almindelig berberis (Danish), alvo (Spanish), anthocyanins, berbamine, Berberidaceae (family), Berberidis cortex, Berberidis radicis cortex, berberine, berberine bisulfate, berberine chloride, Berberis amurensis, Berberis aristata, Berberis asiatica, Berberis chitria, Berberis croatica, Berberis dumetorum, Berberis heterophylla, Berberis koreana, Berberis lycium, Berberis × ottawensis, Berberis thunbergii spp., Berberis vulgaris, berberitze, berberrubine, berberry, bervulcine, cannabisin G, columbamine, crespino (Italian), Croatian barberry, curcuma, Daruharidra, épine-vinette (French), European barberry, flavonols, green barberry, green hornet barberry, isotetrandine, Japanese barberry, jatorrhizine, jaundice berry, Korean barberry, kotsakhuri, Lebanon barberry, (+/-)-lyoniresinol, mountain grape, orange rocket barberry, oxyacanthine, oxycanthine, palmatine, pipperidge bush, piprage, -(p-trans-coumaroyl)tyramine, purple barberry, red barberry, Sauerdorn (German), sowberry, tannins, uva-espin (Portuguese), vinettier (French), vulcracine.

• Note: For further information regarding barberry's constituent berberine, please see the Berberine monograph.

Background

• Barberry (Berberis vulgaris) has been used in Indian folk medicine for centuries, and the Chinese have used berberine, a component of barberry, since ancient times. Barberry is also popular in Iran and is included in both British and Indian pharmacopoeias. The first documented use of berberine was in 1933 for trachoma (a bacterial eye infection).

• Barberry is widely grown in North America and is found in 31 American states and four Canadian provinces, particularly those along the Eastern Seaboard and in the Midwest.

• Historically, barberry was commonly used for its antidiarrheal and antibiotic properties. In traditional medicinal practices, it has been used to treat metabolic disorders, diabetes, cystitis, joint pain, and symptoms of menopause. It is used in the form of a liquid extract or consumed as component of spices (i.e., kotsakhuri). In general, a salt of the alkaloid berberine is administered.

• Early studies have shown berberine to have promising anti-inflammatory and blood sugar-lowering effects, and future clinical research is warranted in these areas.

• Many clinical trials have been conducted using berberine, but none have investigated the actions of barberry as a whole plant. There is strong evidence to support berberine's use in the treatment of trachoma (an eye infection), diarrhea, and leishmaniasis (a disease spread by the bite of the female sandfly), but there is a lack of evidence indicating that barberry itself has efficacy and safety equivalent to that of berberine.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Acetaminophen toxicity, anticonvulsant (treats seizures), antidepressant, antifungal, antihelminthic (expels parasitic worms), antihistamine (treats seasonal allergies), anti-inflammatory, antimicrobial (antiprotozoal), antimutagenic (reduces the rate of genetic mutations), antioxidant (free radical scavenging), antiseptic, antiviral, appetite stimulant, autoimmune disorders (conditions in which the immune system mistakenly attacks and destroys healthy body tissue), cancer, cardiac conditions (heart rate, contractility), cholagogue (promotes the discharge of bile), cholecystitis (inflammation of the gallbladder), cholera (infection of the small intestine that causes watery diarrhea), colitis (colon inflammation), congestive heart failure, constipation, cystitis (bladder inflammation), diabetes, diarrhea, eczema (skin rashes), eye infections, fever (typhus), gallbladder disorders, gallstones, gout, heart disease, heartburn, Helicobacter pylori infection, hemorrhoids, high blood pressure, immunomodulation, indigestion (upset stomach), infections, irregular heartbeat, jaundice (yellow color of the skin or eyes), kidney stones, liver cirrhosis (scarring of the liver and poor liver function), low back pain, lung disorders, malaria, osteoporosis, pain (kidney), parasitic infections, post-traumatic stress disorder (PTSD), psoriasis (skin redness and irritation), rheumatism (joint and connective tissue disorders), scurvy (disease due to vitamin C deficiency), sexually transmitted disease (chlamydia), skin graft healing, sore throat, spleen disorders, stomach cramps, stomatitis (inflammation of the mucous lining of any of the structures in the mouth), thrombocytopenia (low platelet count), tonic, tuberculosis, urinary tract disorders, urolithiasis (stones in the urinary system), uveitis (eye swelling), wound healing.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

• General: Traditionally, root bark is typically used as a tincture (1:10), 20-40 drops daily. Also reported is use of a dry extract of 250-500 milligrams three times daily. For sore throats, bladder infections, bronchitis, or yeast infections, a typical dose is one cup of tea, prepared by steeping 1-2 teaspoons of whole or crushed berries in 150 milliliters of boiling water for 10-15 minutes and straining, or by steeping two grams of root bark in 250 milliliters of boiling water for 5-10 minutes and straining. Root tea is not suggested.

• For skin disorders, a 10% extract of barberry in ointment has been traditionally applied to the skin three times daily.

Children (under 18 years old)

• For dental plaque and gingivitis, a dental gel containing an aqueous alkaloid extract of the root and bark of Berberis vulgaris (1% berberine) has been used for three minutes, three times daily, over a three-week period.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Barberry should be avoided in patients with known allergy or hypersensitivity to barberry, any of its constituents, including berberine, or any member of the Berberidaceae family.

Side Effects and Warnings

• Berberine may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

• Berberine may lower blood sugar levels. Caution is advised in patients with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

• Berberine may alter blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.

• Barberry may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased or decreased in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Caution is advised in patients taking drugs metabolized by the cytochrome P450 enzyme system.

• Use cautiously in patients with gastrointestinal disorders, as barberry may irritate the gastrointestinal tract.

• Use cautiously in patients with liver or kidney disease, as berberine may cause kidney irritation and inflammation.

• Use cautiously in patients using anticholinergic (acetylcholine inhibitor) agents, as barberry has displayed anticholinergic activity.

• Use cautiously in patients with constipation, as barberry or its constituent berberine may worsen constipation.

• Use cautiously in patients using central nervous system (CNS) depressants, as berberine may cause sedation or drowsiness. Use caution if driving or operating heavy machinery.

• Use cautiously in patients using diuretics, as barberry contains vitamin C, which may have a mild diuretic effect (increasing urination).

• Use cautiously in patients with hyperbilirubinemia (an excess of bilirubin in the blood) or those using agents that damage the liver, as berberine may increase bilirubin concentrations.

• Use cautiously in patients with autoimmune disorders (conditions in which the immune system mistakenly attacks and destroys healthy body tissue) or those using immunosuppressants, as berberine may have immunomodulatory effects.

• Use cautiously with L-phenylephrine, as concurrent use may have additive effects.

• Use cautiously in patients using laxatives, as berberine has been shown to exert antidiarrheal effects.

• Use cautiously in patients using yohimbe, as berberine has been shown to have anti-yohimbine effects.

• Use cautiously with B vitamins, as berberine may decrease the metabolism of vitamin B.

• Use cautiously in children, due to a lack of sufficient available evidence.

• Avoid in patients with known allergy or hypersensitivity to barberry, any of its constituents, including berberine, or any member of the Berberidaceae family.

• Avoid use with tyramine-containing foods, due to research suggesting that barberry decreases tyramine levels. Particular caution should be taken to avoid barberry with consumption of tyramine-containing foods in high-tyramine individuals receiving berberine therapy.

• Avoid in women who are pregnant or who are trying to become pregnant, as barberry has exhibited uterine-stimulating properties, and berberine has been shown to affect fertility.

• Berberine may also cause abdominal distention (fullness, bloating and gas), cardiac arrest (abrupt loss of heart function), darkening of skin color, delayed small intestinal transit time, diarrhea, dyspnea (shortness of breath), eye irritation, giddiness, headache, heart damage, kidney inflammation and bleeding, lethargy (fatigue), low white blood cell count, lung spasms or failure, nausea, nosebleed, paresthesias (sensations of tingling, burning, pricking, or numbness in the skin), rapid heartbeat (life-threatening), skin irritation, slow heartbeat, vomiting, or death.

Pregnancy and Breastfeeding

• Barberry use is not suggested in pregnant or breastfeeding women, due to a lack of sufficient available data. Barberry has exhibited uterine-stimulant properties, and berberine has been shown to affect fertility.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Berberine may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

• Berberine may affect blood sugar levels. Caution is advised in patients with diabetes or low blood sugar and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

• Barberry may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased or decreased in the blood and may cause increased or decreased effects or potentially serious adverse reactions. Patients using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

• Berberine may alter blood pressure. Caution is advised in patients taking drugs that affect blood pressure.

• Berberine may also interact with acetaminophen, antibiotics (such as ciprofloxacin), anticancer agents, anticholinergics, antidepressants, antidiarrheals, antifungals, anti-inflammatory agents, antiparasitics, calcium salts, central nervous system (CNS) depressants (such as pentobarbitone and hexobarbitone), cholesterol-lowering agents, cholinergic agonists (such as neostigmine), COX-2 inhibitors (such as celecoxib (Celebrex®) and rofecoxib (Vioxx®)), dental agents, drugs for osteoporosis, drugs for seasonal allergies, drugs for the heart, drugs that damage the liver, drugs that increase urination, drugs that suppress the immune system, gastrointestinal agents, interferons (including interferon-gamma), laxatives, L-phenylephrine, and seizure drugs.

Interactions with Herbs and Dietary Supplements

• Berberine may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

• Berberine may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

• Berberine may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the cytochrome P450 system.

• Berberine may alter blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.

• Berberine may also interact with antibacterials, anticancer herbs and supplements, anticholinergics, antidepressants, antifungals, antidiarrheals, anti-inflammatories, antioxidants, antiparasitics, B vitamins, berberine-containing herbs and supplements (including bloodroot, goldenseal, celandine, Chinese goldthread, goldthread, Oregon grape (Mahonia species), Amur cork tree, and Chinese cork tree), calcium, cholesterol-lowering herbs and supplements, dental herbs and supplements, gastrointestinal herbs and supplements, herbs and supplements for osteoporosis, herbs and supplements for seasonal allergies, herbs and supplements for seizures, herbs and supplements for the heart, herbs and supplements that alter the immune system, herbs and supplements that damage the liver, herbs and supplements that increase urination, laxatives, phosphorus, tyramine-containing foods (such as wine, cheese, and chocolate), and yohimbe bark extract.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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