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.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Results from high-quality studies are currently lacking to support to use of barberry (Berberis vulgaris) in arthritis. Additional studies in this area are warranted.
Current preliminary research suggests a potentially beneficial effect of aqueous barberry extract on dental plaque and gingivitis. High-quality studies on the use of barberry for dental health are needed.
Preliminary research in humans suggests that barberry may improve the lipid profile (cholesterol levels, etc) in individuals with type 2 diabetes. High-quality studies are needed before a conclusion for the use of barberry on metabolic syndrome can be drawn.
* Key to grades
A: Strong scientific evidence for this use B: Good scientific evidence for this use C: Unclear scientific evidence for this use D: Fair scientific evidence for this use (it may not work) F: Strong scientific evidence against this use (it likley does not work)
Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. 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 healthcare provider. There may be other proposed uses that are not listed below.
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, 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.
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.
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.
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.
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.
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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.