Berberis aristata · PhytoNexus

01 Identity and provenance

Accepted binomial: Berberis aristata
Common names: Daruharidra
Family (APG IV): Berberidaceae
Part used: Root
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): Chan E. Biol Neonate 1993;63:201-8 (displacement of bilirubin from albumin by berberine). PubMed 8513024 | NCCIH berberine safety communication | LactMed, goldenseal/berberine | MotherToBaby berberine fact sheet | CORRECTED batch 7: my batch 2 verification of this entry recorded the antidiabetic and CYP interactions but MISSED the bilirubin-displacement / kernicterus contraindication that applies to every berberine-bearing species. Now added. CORRECTED - F:M: Chemical class cell duplicated the plant part; every field from composition onward sat one column right of its header
Reference not supplied - claim unverified against primary literature. | HOST FACTOR

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
Berberine, Palmatine, Jatrorrhizine, Berbamine	Berberine Root	Metformin (functional similarity)

The analogue column is what makes the interaction reasoning tractable: where a constituent has a marketed structural counterpart, the counterpart's interaction profile is the starting hypothesis for the plant.

Looking up structures and physicochemical properties from PubChem…

03 Stated application

Reported activity: Antidiabetic, antimicrobial, anti-inflammatory, hepatoprotective
Marketed in: Daruharidra Churna, Rasanjana, Ayurvedic antidiabetic & eye-care formulations
Reported adverse effects: CORRECTED 2026 (batch 7) - the batch 2 record OMITTED the neonatal risk. NEONATAL KERNICTERUS - THE DEFINING RISK, AND IT IS NOT DOSE-RELATED IN THE USUAL SENSE. Berberine displaces bilirubin from albumin; in vitro it is about TENFOLD more potent as a displacer than phenylbutazone and about a hundredfold more than papaverine. Displaced free bilirubin crosses the blood-brain barrier and can cause kernicterus - permanent injury with hearing loss, movement disorder and developmental delay. Berberine also appears to slow bilirubin clearance. CONTRAINDICATED IN NEONATES, IN PREGNANCY (crosses the placenta; possible uterine stimulation) AND IN BREASTFEEDING (transfers into milk). PARTICULARLY RELEVANT IN SOUTH ASIA: neonatal jaundice affects a large share of term babies, G6PD deficiency is prevalent and independently raises kernicterus risk, and berberine-containing herbs are given traditionally. Other effects: GI upset, hypoglycaemia when stacked on antidiabetic therapy.
Previously recorded: Nausea, diarrhea, stomach upset, constipation, hypoglycemia (with antidiabetic drugs

04 Interaction matrix

Source column, verbatim: CLINICAL: additive hypoglycaemia with metformin, sulfonylureas, insulin and GLP-1 agonists. Berberine inhibits CYP3A4 and P-glycoprotein - interaction with ciclosporin is documented, and narrow-therapeutic-index CYP3A4 substrates need caution. ABSOLUTE: do not co-administer with anything else that displaces bilirubin (e.g. sulfonamides) in a jaundiced neonate.
Normalised onto 3 canonical drug classes below.

Curated from the reviewed source

Drug class	Severity	Mechanism type	Provenance	Expected effect
Antidiabetic drugs (insulin, sulfonylureas, biguanides, GLP-1, SGLT2) Endocrine	4Contraindicated	PD-additive	curated B	Symptomatic hypoglycaemia, sweating, tremor, confusion; severe events rep…	why ▾
Chemistry of this pair. Berberine inhibits CYP3A4 and P-glycoprotein, lowers glucose through AMPK activation, and displaces bilirubin from albumin. Class mechanism. Hypoglycaemic botanicals act through insulin secretagogue, insulin-sensitising, alpha-glucosidase-inhibiting or glucose-transport routes. Added to a titrated pharmacological regimen the effects summate rather than plateau. Expected Symptomatic hypoglycaemia, sweating, tremor, confusion; severe events reported with insulin and sulfonylureas. Management Increase self-monitoring frequency for 2 weeks after starting or stopping. Anticipate a downward dose adjustment of insulin or sulfonylurea. Onset rapid Evidence B - reviewed clinical column, source pending Matched on “glp-1 agonists” Find evidence for this pair Map this mechanism
Immunosuppressants (ciclosporin, tacrolimus, mycophenolate) Transplant	4Contraindicated	PK-CYP3A4/P-gp + PD-antagonistic	curated B	Acute graft rejection with inducers; nephrotoxicity, neurotoxicity and hy…	why ▾
Chemistry of this pair. Berberine inhibits CYP3A4 and P-glycoprotein, lowers glucose through AMPK activation, and displaces bilirubin from albumin. Class mechanism. These are narrow-therapeutic-index CYP3A4 and P-glycoprotein substrates. Botanical induction collapses trough levels; inhibition causes toxic accumulation. Immunostimulant botanicals separately oppose the therapeutic goal. Expected Acute graft rejection with inducers; nephrotoxicity, neurotoxicity and hypertension with inhibitors; autoimmune flare with immunostimulants. Management Treat as contraindicated in transplant recipients. Any exposure requires immediate trough level measurement and transplant team notification. Onset unspecified Evidence B - reviewed clinical column, source pending Matched on “ciclosporin” Find evidence for this pair Map this mechanism
Narrow-therapeutic-index CYP3A4 substrates Pharmacokinetic	4Contraindicated	PK-CYP3A4	curated B	Toxic accumulation or subtherapeutic failure of the co-prescribed drug, s…	why ▾
Chemistry of this pair. Berberine inhibits CYP3A4 and P-glycoprotein, lowers glucose through AMPK activation, and displaces bilirubin from albumin. Class mechanism. Furanocoumarins, bergamottin, piperine, glabridin and berberine inhibit CYP3A4; hyperforin, andrographolide and several diterpenes induce it through PXR. Because CYP3A4 handles roughly half of marketed drugs, the affected list is broad and the direction is product-specific. Expected Toxic accumulation or subtherapeutic failure of the co-prescribed drug, sometimes fatal for antiarrhythmics, immunosuppressants and oncology agents. Management Screen the full regimen for 3A4 substrates. Where the substrate has a narrow index, avoid rather than monitor. Onset unspecified Evidence B - reviewed clinical column, source pending Matched on “cyp3a4 substrates” Find evidence for this pair Map this mechanism

05 Hazard register

contraindication - Berberine displaces bilirubin from albumin -

06 Confusable material

These entries could be mistaken for this one in trade, in the herbarium, or in a prescription. Powdered material is often indistinguishable, so the check is macroscopic, microscopic and chromatographic rather than nominal.

Berberis vulgaris

Barberry

Berberidaceae

Same genus (Berberis)

07 Mechanism map

Chemistry sorts to the left, pharmacology to the right. Dashed edges are predicted. Drag nodes, scroll to zoom, export at 3× for a figure.

species

chemical class

marker compound

drug class

expected effect

hazard

08 Open literature

Abstract-scoped query built from this binomial, its common names and its marker compounds, run live against Europe PMC, PubMed and OpenAlex, then ranked locally against an evidence hierarchy.

Checking openFDA spontaneous reports…

09 Isomechanistic neighbours

Species whose interaction profile overlaps this one, ranked by shared severity weight rather than by count — a shared contraindication counts for more than a shared minor signal. Practical use: these are the plants you should not stack with this one, because the mechanisms summate.

Species	Family	Shared classes	Jaccard
Hydrastis canadensis Goldenseal	Ranunculaceae	3	0.50
Berberis vulgaris Barberry	Berberidaceae	3	0.75
Coptis chinensis Chinese Goldthread	Ranunculaceae	3	0.75
Tinospora cordifolia Giloy	Menispermaceae	3	0.75
Stephania tetrandra Han Fang Ji	Menispermaceae	3	0.75
Corydalis yanhusuo Yan Hu Suo	Papaveraceae	3	0.75

10 References and notes

No citation is on record for this entry. That is itself the finding: the audit flagged it, and it is why the entry does not carry an A evidence grade.

Curator notes

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