NutriStack
Berberine HCl and Digoxin, a caution.
Berberine inhibits P-glycoprotein, increasing digoxin bioavailability. Digoxin has a narrow therapeutic index.
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
- Berberine HCl and Digoxin
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 3 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Berberine inhibits P-glycoprotein, increasing digoxin bioavailability. Digoxin has a narrow therapeutic index.
Mechanism. P-glycoprotein inhibition reduces intestinal efflux of digoxin, increasing absorption.
Recommendation. Avoid combining without medical supervision and digoxin level monitoring. Risk of digoxin toxicity.
Sources (1)
- Berberine drug interaction profile PMID 21870106
Caution · Emerging evidence
Caution
What is happening. Berberine HCl may increase oral digoxin exposure by inhibiting intestinal P-glycoprotein. Digoxin has a narrow therapeutic index, so even moderate changes in exposure can increase the risk of nausea, visual changes, bradycardia, or arrhythmia.
Mechanism. Digoxin is a P-glycoprotein substrate. Berberine inhibited intestinal P-glycoprotein in pharmacokinetic studies and increased oral digoxin AUC and Cmax in an animal model, creating a plausible exposure-increase risk in humans.
Recommendation. Do not combine berberine HCl with digoxin without prescriber approval. If both are used, monitor for digoxin toxicity and ask your clinician whether a digoxin level is needed after berberine HCl is started or stopped.
Sources (2)
- Qiu W, Jiang XH, Liu CX, et al. Effect of berberine on the pharmacokinetics of substrates of CYP3A and P-gp. Phytotherapy Research. 2009;23(11):1553-1558. PMID 19370549
- Coumau C, Csajka C. A Systematic Review and Classification of the Effects of P-glycoprotein Inhibitors and Inducers in Humans, Using Digoxin, Fexofenadine, and Dabigatran as Probe Drugs. Clinical Pharmacokinetics. 2025. PMID 40349292
Stack Score
How this pair moves the number.
Effect on the composite score
If both Berberine HCl and Digoxin 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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