Berberine, an active ingredient in several plants, shows good effects in managing high blood sugar and excess body weight, plus lower risk of colorectal cancer.

Safety and precautions

Interactions with cancer treatments

Preclinical (cell line) studies have found that low-dose berberine reduces gastric cancer cell response to paclitaxel (Taxol), fluorouracil (5-FU), and camptothecin.1Bao J, Huang B et al. Hormetic effect of berberine attenuates the anticancer activity of chemotherapeutic agents. PLoS One. 2015 Sep 30;10(9):e0139298; Lin HL, Liu TY, Wu CW, Chi CW. Berberine modulates expression of MDR1 gene product and the responses of digestive track cancer cells to Paclitaxel. British Journal of Cancer. 1999 Oct;81(3):416-22. Also see studies finding an increased response to these drugs in Are you a health professional? ›

With a lack of evidence of berberine’s influence on the effectiveness of these chemotherapy drugs in humans or clarity regarding the effects of berberine at various doses and with different types of cancer, we recommend that you be sure your oncologist knows if you are taking berberine while using any of these chemotherapy drugs and follow their recommendations. 

Side effects or adverse events

Few serious adverse events have been seen in studies using berberine.2Fang S, Guo S et al. Efficacy and safety of berberine in preventing recurrence of colorectal adenomas: a systematic review and meta-analysis. Journal of Ethnopharmacology. 2022;282:114617; Qiu Y, Li M et al. Berberine treatment for weight gain in patients with schizophrenia by regulating leptin rather than adiponectin. Asian Journal of Psychiatry. 2022;67:102896; Zhao JV, Yeung WF et al. Effect of berberine on cardiovascular disease risk factors: a mechanistic randomized controlled trial. Nutrients. 2021;13(8):2550; Mirzaee F, Razmjouei P et al. The effect and safety of berberine on polycystic ovary syndrome: a systematic review. Journal of Obstetrics and Gynaecology. 2021;41(5):684-689; Meng S, Wang LS et al. Berberine ameliorates inflammation in patients with acute coronary syndrome following percutaneous coronary intervention. Clinical and Experimental Pharmacology and Physiology. 2012 May;39(5):406-11; Chan M, Qin Z et al. Adjunctive berberine reduces antipsychotic-associated weight gain and metabolic syndrome in patients with schizophrenia: a randomized controlled trial [published correction appears in Psychiatry and Clinical Neurosciences. 2022 Oct;76(10):536]. Psychiatry and Clinical Neurosciences. 2022;76(3):77-85; Chen C, Tao C et al. A randomized clinical trial of berberine hydrochloride in patients with diarrhea-predominant irritable bowel syndrome. Phytotherapy Research. 2015;29(11):1822-1827; Rabbani GH, Butler T, Knight J, Sanyal SC, Alam K. Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. Journal of Infectious Diseases. 1987;155(5):979-984; Cicero AF, Tartagni E et al. Combined nutraceutical approach to postmenopausal syndrome and vascular remodeling biomarkers. Journal of Alternative and Complementary Medicine. 2013;19(6):582-587; Zhang J, Han C et al. A randomized, multicenter and noninferiority study of amoxicillin plus berberine vs tetracycline plus furazolidone in quadruple therapy for Helicobacter pylori rescue treatment. Journal of Digestive Diseases. 2020;21(5):256-263; An Y, Sun Z et al. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clinical Endocrinology (Oxford). 2014;80(3):425-431; Chen XX, Chen YX et al. Efficacy and safety of triple therapy containing berberine hydrochloride, amoxicillin, and rabeprazole in the eradication of Helicobacter pylori. Journal of Digestive Diseases. 2022;23(10):568-576. The most common side effects are gastrointestinal, including nausea, abdominal distension, constipation, or diarrhea.3Di Pierro F, Bertuccioli A, Giuberti R, Saponara M, Ivaldi L. Role of a berberine-based nutritional supplement in reducing diarrhea in subjects with functional gastrointestinal disorders. Minerva Gastroenterologica e Dietologica. 2020;66(1):29-34; Zhang Y, Gu Y et al. Gut microbiome-related effects of berberine and probiotics on type 2 diabetes (the PREMOTE study). Nature Communications. 2020;11(1):5015; Harrison SA, Gunn N et al. A phase 2, proof of concept, randomised controlled trial of berberine ursodeoxycholate in patients with presumed non-alcoholic steatohepatitis and type 2 diabetes. Nature Communications. 2021;12(1):5503; Dong H, Wang N, Zhao L, Lu F. Berberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysis. Evidence-based Complementary and Alternative Medicine. 2012;2012:591654; Yan HM, Xia MF et al. Efficacy of berberine in patients with non-alcoholic fatty liver disease. PLoS One. 2015;10(8):e0134172.e. One case of a rash was reported.4Zhang BY, Chen M et al. Berberine reduces circulating inflammatory mediators in patients with severe COVID-19. British Journal of Surgery. 2021;108(1):e9-e11.

Effects on hormone levels

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) shows a possible link between berberine use and higher testosterone among men with high blood lipids. The researchers note that “higher testosterone may be associated with more unfavorable cardiac function.”

Effects on the gut microbiome

Preliminary evidence shows less gene diversity (richness) in gut microbiota among people newly diagnosed with hyperglycemia treated with berberine. The researchers point out that treatment with probiotics may reduce this effect.

Interactions with other therapies

A case studya descriptive and exploratory analysis of a person, group, or event regarding changes observed over time; because changes due to treatment are not compared to similar changes over time without treatment, a case study is considered a weak study design described a man who presented to an emergency department with a 3-day history of jaundice and vomiting and high concentrations of rivaroxaban—a drug to treat blood clots in the veins— which may have been due to an interaction with his recent use of berberine.7Bonnichsen M, Stoklosa T, Bowen D, Majumdar A. Safety first, a harmful interaction between rivaroxaban and berberine. Internal Medicine Journal. 2022;52(5):887-888.

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Nancy Hepp, MS

Lead Researcher
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher


Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Last update: May 8, 2024

Last full literature review: February 2023

We are grateful for research assistance from Adriana Rocio Gutierrez Galvis.

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care, and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocialtherapy, and acupuncture therapies and self carelifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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