NutriStack
Atomoxetine and Berberine, a caution.
Atomoxetine exposure is highly sensitive to CYP2D6 inhibition. A clinical pharmacokinetic study showed potent CYP2D6 inhibition with paroxetine markedly increased atomoxetine exposure. Berberine has human clinical evidence of CYP2D6 inhibition after repeated dosing, so berberine could raise atomoxetine exposure even though the exact atomoxetine-berberine combination has not been directly tested.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Atomoxetine and Berberine
- Pair type
- Caution
- Evidence (highest tier)
- Emerging
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Emerging evidence
Caution
What is happening. Atomoxetine exposure is highly sensitive to CYP2D6 inhibition. A clinical pharmacokinetic study showed potent CYP2D6 inhibition with paroxetine markedly increased atomoxetine exposure. Berberine has human clinical evidence of CYP2D6 inhibition after repeated dosing, so berberine could raise atomoxetine exposure even though the exact atomoxetine-berberine combination has not been directly tested.
Mechanism. Atomoxetine is primarily cleared by CYP2D6-mediated metabolism. Repeated berberine dosing decreased CYP2D6 activity in healthy volunteers, shown by a higher dextromethorphan/dextrorphan metabolic ratio, which could reduce atomoxetine clearance and increase concentration-dependent adverse effects.
Recommendation. Ask your prescriber or pharmacist before starting berberine while taking atomoxetine, especially if you are on a higher atomoxetine dose, have CYP2D6 poor-metabolizer status, or also take CYP2D6 inhibitors. Monitor for new insomnia, appetite loss, dry mouth, palpitations, higher blood pressure, urinary hesitation, or unusual irritability.
Sources (2)
- Belle DJ, Ernest CS, Sauer JM et al.. Effect of potent CYP2D6 inhibition by paroxetine on atomoxetine pharmacokinetics. Journal of clinical pharmacology. 2002 Nov;42(11):1219-27. PMID 12412820
- Guo Y, Chen Y, Tan ZR et al.. Repeated administration of berberine inhibits cytochromes P450 in humans. European journal of clinical pharmacology. 2012 Feb;68(2):213-7. PMID 21870106
Stack Score
How this pair moves the number.
Effect on the composite score
If both Atomoxetine and Berberine are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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