Supplement·Interactions·Reviewed June 9, 2026
Berberine interactions.
Berberine has 94 documented interactions in the NutriStack database: 2 to avoid or watch closely, 74 that need timing or caution, and 18 that work synergistically. The full list, with what each pairing does, is below.
In short
Berberine at a glance.
A quick, data-grounded summary. The full table is below.
Berberine has 94 documented interactions in the NutriStack database: 2 to avoid or watch closely, 74 that need timing or caution, and 18 that work synergistically. The full list, with what each pairing does, is below.
Interactions
Everything that interacts with berberine.
Every supplement and medication in the NutriStack database with a documented interaction with this substance, highest-severity first. Open any pair for the mechanism and sources.
| Substance | Interaction | What happens |
|---|---|---|
| IGF-1 LR3 (Long R3 IGF-1) | Contraindicated | Berberine can lower glucose and IGF-1 LR3 may cause insulin-like glucose lowering, increasing hypoglycemia risk. |
| Probiotics | Conflict | Berberine has significant antimicrobial properties and can reduce beneficial gut bacteria populations. Taking berberine with probiotics may reduce... details → |
| Acarbose | Caution | Berberine may lower glucose and add to the glucose-lowering effects of Acarbose. |
| Agmatine Sulfate | Caution | Both may affect glucose and blood pressure in susceptible users. |
| American Ginseng | Caution | Both American ginseng and berberine independently lower blood glucose, so combining them can produce an additive hypoglycemic effect, particularly... |
| Amlodipine | Caution | Berberine is a clinically demonstrated inhibitor of CYP3A4, the main enzyme that clears amlodipine. Co-administration can raise amlodipine plasma... details → |
| Andrographis | Caution | Both can cause GI upset and may lower glucose in susceptible users. |
| Atomoxetine | Caution | Atomoxetine exposure is highly sensitive to CYP2D6 inhibition. A clinical pharmacokinetic study showed potent CYP2D6 inhibition with paroxetine... |
| Atorvastatin | Caution | Berberine has human evidence of inhibiting CYP3A4 activity after repeated dosing, and atorvastatin is partly cleared through CYP3A4. This could... |
| Black Seed Oil | Caution | Both lower blood glucose, so combined use can produce additive hypoglycemic effects, particularly in people also taking diabetes medications. details → |
| Carnosine | Caution | Carnosine may modestly improve glycemic control and reduce AGE formation, while berberine is a potent glucose-lowering agent. Combined, they could... |
| Chaga | Caution | Both can lower blood glucose, so combining them may produce additive hypoglycemic effects, particularly in people taking antidiabetic medications. |
| Chromium | Caution | Both lower blood glucose through different mechanisms. Combined use may cause excessive blood sugar reduction, especially in non-diabetics. details → |
| Coenzyme Q10 | Caution | Berberine may inhibit mitochondrial Complex I, similar to metformin. CoQ10 supplementation may help offset potential mitochondrial effects. |
| Coenzyme Q10 Ubiquinol | Caution | Berberine may inhibit mitochondrial Complex I, similar to metformin. CoQ10 supplementation may help offset potential mitochondrial effects. |
| Cyclosporine | Caution | Berberine may affect P-glycoprotein and CYP3A pathways and could alter cyclosporine levels. |
| Dapagliflozin | Caution | Dapagliflozin and berberine both lower blood glucose through independent mechanisms. Combined use may increase hypoglycemia risk. |
| Digoxin | Caution | Berberine may increase oral digoxin exposure by inhibiting intestinal P-glycoprotein. Digoxin has a narrow therapeutic index, so even moderate... |
| Diltiazem | Caution | Diltiazem is itself a moderate CYP3A4 inhibitor that depends on the same enzyme for clearance. Adding berberine, which inhibits CYP3A4, CYP2D6, and... details → |
| Dulaglutide | Caution | Both dulaglutide and berberine can lower blood glucose through different mechanisms. Dulaglutide's insulin effect is glucose-dependent, so... details → |
| Empagliflozin | Caution | Both empagliflozin and berberine lower blood glucose through different mechanisms. Combined use may increase hypoglycemia risk, particularly when... |
| Erythromycin | Caution | Berberine inhibits CYP3A4 and P-glycoprotein. Erythromycin is itself a CYP3A4 substrate and inhibitor that can prolong the QT interval; adding... |
| Evolocumab | Caution | Berberine is taken by some patients to lower LDL cholesterol and improve glycemic measures. Mechanistically it is of interest here because berberine... |
| Fenugreek | Caution | Additive glucose-lowering effect that can increase the risk of hypoglycemia, especially in people also taking antidiabetic medication. details → |
| Fluconazole | Caution | Berberine inhibits CYP3A4 (and to a lesser extent CYP2D6), the same family of enzymes that fluconazole also inhibits. Stacking two CYP3A4 inhibitors... |
| Fucoxanthin | Caution | Both fucoxanthin and berberine may lower blood glucose. Berberine has well-documented hypoglycemic activity in humans, and fucoxanthin shows... |
| Gemfibrozil | Caution | Berberine has lipid-lowering and glucose-lowering activity and modulates several drug-metabolizing enzymes and transporters (including CYP3A4 and... |
| GHRP-2 | Caution | Berberine may lower glucose while GHRP-2 can affect glucose and appetite. |
| GHRP-6 | Caution | Berberine affects glucose while GHRP-6 may worsen glucose tolerance and increase appetite. |
| Glipizide | Caution | Both glipizide and berberine lower blood glucose. Glipizide stimulates insulin secretion; berberine activates AMPK. Combined use significantly... details → |
| Glyburide | Caution | Glyburide is a potent sulfonylurea with high hypoglycemia risk. Adding berberine's AMPK-mediated glucose lowering significantly increases this risk. details → |
| Green Tea Extract | Caution | Both can lower blood glucose, so combining them may produce an additive hypoglycemic effect, especially during fasting or when also taking... details → |
| Hesperidin | Caution | Both hesperetin and berberine inhibit intestinal and hepatic CYP3A4 and modulate efflux transporters, which could alter the metabolism of... |
| Hexarelin | Caution | Berberine may lower glucose while hexarelin can alter GH-axis glucose regulation. |
| HGH Fragment 176-191 | Caution | Berberine can lower glucose and may confound glucose interpretation if an unapproved metabolic peptide is used. |
| Holy Basil/Tulsi | Caution | Holy basil and berberine each lower blood glucose, and combining them produces an additive hypoglycemic effect. In people who are also fasting, on... details → |
| Humanin | Caution | Berberine can lower glucose and may add to possible humanin metabolic effects. |
| Insulin Aspart | Caution | Berberine can lower glucose through AMPK-linked metabolic effects and may improve insulin sensitivity. Because insulin aspart is rapid-acting... details → |
| Insulin Glargine | Caution | Berberine can lower glucose through AMPK-linked metabolic effects and may improve insulin sensitivity. Because insulin glargine provides basal... details → |
| Insulin Lispro | Caution | Berberine can lower glucose through AMPK-linked metabolic effects and may improve insulin sensitivity. Because insulin lispro is rapid-acting... details → |
| Itraconazole | Caution | Berberine may inhibit CYP3A4 or P-glycoprotein and could increase itraconazole intolerance in susceptible patients. |
| Labetalol | Caution | Berberine may lower glucose, while beta blockers can mask adrenergic warning signs of hypoglycemia such as tachycardia. |
| Liraglutide | Caution | Both liraglutide and berberine can lower blood glucose through different mechanisms. Liraglutide's insulin effect is glucose-dependent, so... details → |
| Losartan | Caution | Berberine can inhibit CYP2C9 activity and may alter losartan conversion to its active metabolite E-3174. Berberine may also lower blood pressure, so... details → |
| Lovastatin | Caution | Lovastatin is highly dependent on CYP3A4 metabolism, and berberine has human evidence of inhibiting CYP3A4 after repeated dosing. This creates a... |
| Metformin | Caution | Both metformin and berberine lower blood glucose through overlapping mechanisms including AMPK activation. Combined use creates a significant risk... details → |
| MK-677 (Ibutamoren) | Caution | Berberine may lower glucose while MK-677 can worsen insulin resistance and increase appetite. |
| Moringa | Caution | Both moringa and berberine independently lower blood glucose, so combining them can produce additive hypoglycemic effects, particularly in people... |
| MOTS-c | Caution | Berberine can lower glucose and may add to possible MOTS-c metabolic effects. |
| Moxifloxacin | Caution | Moxifloxacin prolongs the QT interval, and combining it with berberine adds theoretical additive risk. Berberine inhibits the hERG potassium channel... |
| Nebivolol | Caution | Berberine may lower glucose, while beta blockers can mask adrenergic warning signs of hypoglycemia such as tachycardia. |
| Niacin (Prescription) | Caution | Berberine may lower glucose, while prescription niacin can worsen glycemic control; combining them can make glucose response less predictable. |
| Nifedipine | Caution | Nifedipine relies on CYP3A4 for clearance, and berberine clinically inhibits CYP3A4 after repeated dosing in humans. Co-administration can raise... details → |
| Olive Leaf Extract | Caution | Both olive leaf extract and berberine can lower blood glucose and blood pressure, so combining them may produce additive hypoglycemic and... details → |
| Panax Ginseng | Caution | Panax ginseng can lower blood glucose, and combining it with berberine, a potent glucose-lowering agent, may produce additive hypoglycemic effects. |
| Pioglitazone | Caution | Berberine may lower glucose and add to the glucose-lowering effects of Pioglitazone. |
| Pramlintide | Caution | Berberine can lower glucose through AMPK-linked metabolic effects and may improve insulin sensitivity. Pramlintide is used with mealtime insulin and... details → |
| Pterostilbene | Caution | Both pterostilbene and berberine activate AMPK and can lower blood glucose. Used together, and especially alongside antidiabetic medication, they... |
| Red Yeast Rice | Caution | Both can lower lipids and may affect glucose; berberine also has CYP/P-gp interaction potential. |
| Repaglinide | Caution | Berberine may lower glucose and add to the glucose-lowering effects of Repaglinide, increasing hypoglycemia risk. |
| Roflumilast | Caution | Berberine may affect CYP enzymes and P-glycoprotein, creating theoretical exposure changes for roflumilast. |
| Semaglutide | Caution | Both semaglutide and berberine can lower blood glucose through different mechanisms. Semaglutide's insulin effect is glucose-dependent, so... details → |
| Sermorelin | Caution | Berberine may lower glucose while GH-axis stimulation may worsen glucose tolerance in susceptible users. |
| Simvastatin | Caution | Simvastatin is strongly affected by CYP3A4 inhibitors, and berberine has human evidence of inhibiting CYP3A4 activity with repeated dosing. This may... |
| Tacrolimus | Caution | Berberine may alter CYP3A or P-glycoprotein activity and make tacrolimus concentrations unpredictable. |
| Tangeretin | Caution | Tangeretin is a recognized inhibitor of cytochrome P450 enzymes (notably CYP1A2 and CYP3A4), and berberine also inhibits CYP3A4 and CYP2D6, so... |
| Tesamorelin | Caution | Berberine may lower glucose while tesamorelin can worsen glucose tolerance, complicating monitoring. |
| Tirzepatide | Caution | Both tirzepatide and berberine can lower blood glucose through complementary mechanisms, creating a clinically important hypoglycemia risk when... details → |
| Vanadium | Caution | Vanadium has insulin-mimetic glucose-lowering activity and berberine is a potent glucose-lowering compound, so combining them can additively reduce... |
| Verapamil | Caution | Verapamil is both a CYP3A4 substrate and a potent P-glycoprotein inhibitor, and berberine inhibits both CYP3A4 and P-gp. Combining the two raises... details → |
| Voriconazole | Caution | Berberine may inhibit CYP enzymes or P-glycoprotein and could increase voriconazole adverse effects in susceptible patients. |
| Bifidobacterium infantis 35624 | Timing Sensitive | Berberine has antimicrobial activity that may reduce live probiotic viability if taken simultaneously. |
| Bifidobacterium longum BB536 | Timing Sensitive | Berberine has antimicrobial properties that may reduce probiotic viability if taken together. |
| Lactobacillus acidophilus NCFM | Timing Sensitive | Berberine antimicrobial activity may reduce viability of live NCFM if taken together. |
| Lactobacillus plantarum 299v | Timing Sensitive | Berberine has antimicrobial activity and may reduce probiotic viability if taken at the same time. |
| Nicotinamide Riboside | Timing Sensitive | Both NR and berberine are promoted for metabolic and mitochondrial support, but they act through different mechanisms (NAD+ repletion versus AMPK... |
| Alpha-Lipoic Acid | Synergy | Both improve insulin sensitivity through AMPK activation. ALA also supports glucose uptake via GLUT4 translocation. |
| Artemisinin | Synergy | Berberine and artemisinin have shown complementary antiparasitic and antimicrobial activity in some preclinical studies, supporting a tentative... |
| Banaba Leaf (Corosolic Acid) | Synergy | Both may lower glucose and can increase hypoglycemia risk when stacked. |
| Bempedoic Acid | Synergy | Berberine may add modest lipid-lowering effects to Bempedoic Acid. |
| Bergamot (Citrus Bergamia) Extract | Synergy | Both may lower lipids and glucose, which can be useful but may increase hypoglycemia risk with diabetes medications. |
| Bitter Melon | Synergy | Both can lower glucose and may increase hypoglycemia risk. |
| Cinnamon Extract | Synergy | Both may lower glucose and can be useful together but increase hypoglycemia risk when diabetes medication is present. |
| Ezetimibe | Synergy | Berberine may add modest lipid-lowering effects to Ezetimibe. |
| Fenofibrate | Synergy | Berberine may add modest lipid-lowering effects to Fenofibrate. |
| Garlic Extract | Synergy | Garlic and berberine both lower LDL cholesterol and triglycerides through different mechanisms, giving additive lipid-lowering when combined. details → |
| Gymnema Sylvestre | Synergy | Both can lower glucose and may increase hypoglycemia risk. |
| Inositol | Synergy | Inositol improves insulin sensitivity in PCOS; berberine improves it via AMPK activation. Combined effect on HOMA-IR, fasting glucose, and ovulation... |
| Milk Thistle | Synergy | Milk thistle (silymarin) inhibits CYP enzymes that metabolize berberine, potentially increasing its bioavailability and duration of action. |
| Myo-Inositol & D-Chiro-Inositol | Synergy | Both may improve insulin resistance and can increase the chance of low-glucose symptoms when combined with diabetes medications or low calorie intake. |
| Plant Sterols (Phytosterols) | Synergy | Both can lower LDL-C through different mechanisms and may have additive glucose-lowering effects. |
| Psyllium Husk | Synergy | Psyllium fiber and berberine both lower postprandial glucose and LDL cholesterol through complementary mechanisms, and combining them can give... |
| Sodium Butyrate | Synergy | Berberine alters the gut microbiota and has been associated with shifts in short-chain fatty acid production, while supplemental butyrate provides a... |
| Turmeric/Curcumin | Synergy | Curcumin and berberine share overlapping anti-inflammatory pathways (NF-kB inhibition) and both have glucose-lowering effects. The combination may... |
Go deeper
The full berberine profile.
Benefits, dosing by goal, forms, and the cited evidence for this supplement.
FAQ
Common berberine questions.
Quick answers drawn from the table above.
What interacts with Berberine?
In the NutriStack database, Berberine has 94 documented interactions with other supplements and medications. The most notable include IGF-1 LR3 (Long R3 IGF-1), Probiotics, Acarbose, Agmatine Sulfate, and American Ginseng.
What should you not take with Berberine?
Berberine is flagged against 2 substances in the database, including IGF-1 LR3 (Long R3 IGF-1) and Probiotics. Review these with a clinician before combining, especially alongside prescription medications.
What works well with Berberine?
Berberine pairs synergistically with Alpha-Lipoic Acid, Artemisinin, Banaba Leaf (Corosolic Acid), Bempedoic Acid, and Bergamot (Citrus Bergamia) Extract in the NutriStack database. Synergy still depends on dose and timing; open any pair for the detail.
Can you take Berberine with IGF-1 LR3 (Long R3 IGF-1)?
NutriStack classifies the Berberine and IGF-1 LR3 (Long R3 IGF-1) pairing as contraindicated: Berberine can lower glucose and IGF-1 LR3 may cause insulin-like glucose lowering, increasing hypoglycemia risk. Do not combine; avoid human IGF-1 LR3 use altogether.
Check your whole stack
See how berberine fits your routine.
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