Barberry

Category

Herbs & Supplements

Synonyms

Agrecejo, almindelig berberis (Danish), alvo (Spanish), berbamine, Berberidaceae (family), berberidis cortex, Berberis aristata, Berberis dumetorum, berberidis radicis cortex, Berberis thunbergii, berberine bisulfate, berberitze, berberrubine, berberry, bervulcine, columbamine, crespino (Italian), curcuma, epine-vinette (French), European barberry, isotetrandine, jatorrhizine, jaundice berry, Lebanon barberry, mountain grape, oxyacanthine, palmatine, pipperidge bush, piprage, red barberry, sauerdorn (German), sowberry, uva-espin (Portuguese), vinettier, vulcracine.

Background

Barberry has been used in Indian folk medicine for centuries, and the Chinese have used berberine, a constituent of barberry, since ancient times. The first available documented use of berberine was in 1933 for trachoma (infectious eye disease).

Historically, barberry was commonly used for its antidiarrheal and antibiotic properties. Barberry is considered tonic, purgative, and antiseptic. As a bitter stomachic tonic, it proves an excellent remedy for dyspepsia and functional derangement of the liver, regulating the digestive powers, and if given in larger doses, acting as a mild purgative and removing constipation. Traditionally, it is used in cases of jaundice, general debility and biliousness (gastric distress), and for diarrhea.

Of most interest throughout history is berberine, an alkaloid found in barberry as well as goldenseal, tree turmeric and Oregon grape. The use of berberine is most commonly used for the management of diarrhea related to cholera and for the treatment of trachomas.

Berberine has promising anti-inflammatory, antineoplastic (anti-cancer), hypoglycemic (blood sugar lowering), and immunomodulating effects. Current investigations into berberine continue. However, the use of barberry as a whole plant has been left relatively unexplored.

Evidence

DISCLAIMER: 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.

Tradition

WARNING: DISCLAIMER: 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.
Antifungal, antihelminthic (expels worms), antihistamine, anti-inflammatory, antimicrobial, antimutagenic, antioxidant (free radical scavenging), antiprotozoal (kills protozoa), antiseptic, antiviral, appetite stimulant, arrhythmia (abnormal heart rates), arthritis, back pain (mid and low), cancer, cardiovascular disease, cholecystitis (inflammation of the gall bladder), cholera, cholagogue (bile flow stimulant), congestive heart failure, constipation, diarrhea, diabetes, eye infections, fever (typhus), gallbladder disorders, gallstones, gout (foot inflammation), heartburn, Helicobacter pylori infection, hemorrhoids, hepatoprotection (liver protection against acetaminophen toxicity), hypertension (high blood pressure), indigestion, infections (E. coli), jaundice, liver cirrhosis (hypertyraminemia), malaria, osteoporosis, parasitic infections (leishmania), psoriasis, respiratory disorders, rheumatism, scurvy, sexually transmitted disease (chlamydia), skin graft healing, sore throat, spleen disorders, stomach cramps, stomatitis (mouth sores), thrombocytopenia (low platelet count), tonic, tuberculosis, urinary tract disorders, wound healing (Berberis aristata).

Dosing

Adults (18 years and older)

There is no proven safe or effective dose for barberry. The root bark is typically used as a tincture (1:10) in a dose of 20-40 drops daily. A dry extract of 250-500 milligrams three times daily has also been used. 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 squashed berries in 150 milliliters of boiling water for 10-15 minutes and strain or steep 2 grams of root bark in 250 milliliters of boiling water for 5-10 minutes and strain. Root tea is not recommended.

Traditionally, a 10% extract of barberry in ointment has been applied to the skin three times daily.

Children (younger than 18 years)

There is no proven safe or effective dose for barberry in children, and use is not recommended.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Barberry should be avoided in patients with a known allergy or hypersensitivity to barberry, or its constituent, berberine.

Side Effects and Warnings

In general, most herbal experts purport that barberry is generally well tolerated in recommended doses. However, there is little available scientific evidence regarding the safety of barberry, and most adverse effects have been reported following administration of berberine (a constituent found in barberry, goldenseal and other herbs). Berberine has been reported to cause nausea, vomiting, abdominal discomfort, headache, hyper- and hypotension (increases and decreases in blood pressure), bradycardia (slowed heart rate), leucopenia (low white blood cell count), respiratory failure, giddiness, skin irritation, paresthesias (abnormal sensations), decreases in blood glucose, and delays in the small intestinal transit time. Berberine has been used as an abortifacient (to induce abortion) and antifertility agent. Although not well studied in humans, berberine may also inhibit osteoclast-like cells or cause excess levels of bilirubin in the blood.

High doses of berberine may cause diarrhea, cardiac damage, cardiac arrest, nosebleed, hemorrhagic nephritis, kidney irritation, dyspnea (difficulty breathing), respiratory spasms, lethargy, eye irritation and death. When injected subcutaneously (under the skin), berberine may cause permanent hyperpigmentation.

Berberine should be used cautiously in patients with diabetes, cardiovascular disease, hypotension (low blood pressure), gastrointestinal disorders, liver dysfunction or renal (kidney) dysfunction.

Pregnancy and Breastfeeding

Barberry is not recommended in pregnant or breastfeeding women due to lack of available scientific evidence. Barberry has exhibited uterine stimulant properties and berberine has been shown to have anti-fertility activity.

Interactions

Interactions with Drugs

Concurrent administration of barberry and anti-arrhythmic medication is not recommended due to the unpredictable results of combining two anti-arrhythmic therapies.

Theoretically, the concomitant use of barberry with tetracycline antibiotics may lead to a decrease in the antibiotic's effectiveness.

Barberry has displayed anticholinergic activity. Theoretically, combination use of barberry with anticholinergic agents may potentiate these effects. Examples include: acetophenenazine, atropine, belladonna, dicyclomine, diphenhydramine, hyosciamine, prochlorperazine, promethazine, scopolamine, trifluoperazine, triflupromazine, trihexyphenidyl.

Berberine may increase platelet formation. Caution is advised when using the medications that may have competing effects. Examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Although not well studied in humans, barberry may have antihistaminic activity. Theoretically, concurrent use of barberry with antihistaminic agents may result in additive effects.

There may be additive hypotensive (blood pressure lowering) effects and bradycardia (slowed heart rate) when combining barberry with blood pressure lowering medications, such as beta-blockers and calcium channel blockers. Caution is advised.

Although not well studied in humans, barberry's constituent, berberine, and berberine sulfate have anti-inflammatory effects and may interact with COX-2 inhibitors. COX-2 inhibitor drugs include celecoxib (Celebrex®) and rofecoxib (Vioxx®).

Barberry contains vitamin C and may have a mild diuretic effect due to the acid content. Theoretically, barberry may increase the effects of agents with potential diuretic effects. Caution is advised.

Preliminary evidence shows that 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 altered in the blood, and may cause different effects or potentially serious adverse reactions.

Barberry has been shown to decrease blood sugar levels. Patients taking diabetes medications by mouth or insulin should consult with a qualified healthcare professional, including a pharmacist, to check for interactions.

Theoretically, concomitant use of berberine may have additional effects with other sedative agents. Berberine may cause sedation and motor impairment. Caution is advised when using in combination with other medications that have sedative effects.

Berberine, an alkaloid purported to be an active ingredient of barberry, may interact with yohimbine. Berberine may also interact additively with L-phenylephrine. Caution is advised.

Interactions with Herbs and Dietary Supplements

The concurrent use of berberine (a constituent of barberry) and antibiotics may have additive effects. Consult with a qualified healthcare professional, including a pharmacist, before combining therapies.

Barberry has displayed anticholinergic activity. Theoretically, combination use of barberry with anticholinergic agents may increase these effects. Examples of anticholinergic herbs include bittersweet (Solanum dulcamara), henbane (Hyoscyamus niger), and Jimson weed (Datura stramonium).

Berberine may increase platelet formation, therefore caution is advised when using herbs or supplements that may have competing effects.

Berberine has been shown to decrease blood pressure. Patients taking blood pressure lowering medications should consult with a qualified healthcare professional, including a pharmacist.

Use with other herbs containing berberine may increase the risk of berberine toxicity. Examples of berberine-containing herbs include bloodroot, goldenseal and celandine.

Barberry contains vitamin C and may have a mild diuretic effect due to the acid content. Theoretically, barberry may increase the effects of other herbs with potential diuretic effects. Caution is advised.

Preliminary evidence shows that 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 altered in the blood, and may cause different effects or potentially serious adverse reactions.

Berberine may lower blood sugar levels. Caution is advised when combining with other herbs and supplements that may also lower blood sugar.

Theoretically, concomitant use of berbeine may have additional effects with other sedative agents. Berberine may cause drowsiness and motor impairment. Caution is advised when using in combination with other herbs or supplements that have sedative effects, such as chamomile.

Yohimbine, a constituent of yohimbe, and barberry competitively interact for binding sites. In addition, due to the anti-fertility properties of berberine, use of yohimbe for the purpose of procreation may not be effective.

Berberine may decrease the metabolism of vitamin B, and caution is advised.

Attribution

This patient information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Helena Kim, PharmD (Northeastern University); Mary McGarry, RPh (University of Kansas); Erica Rusie, PharmD (Nova Southeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods BS (Northeastern University).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Chung JG, Wu LT, Chang SH, et al. Inhibitory actions of berberine on growth and arylamine N-acetyltransferase activity in strains of Helicobacter Pylori from peptic ulcer patients. International Journal of Toxicology 1999;18:35.

Ckless K, Schlottfeldt JL, Pasqual M, et al. Inhibition of in-vitro lymphocyte transformation by the isoquinoline alkaloid berberine. J Pharm Pharmacol. 1995;47(12A):1029-1031.

Di DL, Liu YW, Ma ZG, et al. [Determination of four alkaloids in Berberis plants by HPLC]. Zhongguo Zhong.Yao Za Zhi. 2003;28(12):1132-1134.

Fatehi M, Saleh TM, Fatehi-Hassanabad Z, et al. A pharmacological study on Berberis vulgaris fruit extract. J Ethnopharmacol 10-31-2005;102(1):46-52.

Fatehi-Hassanabad Z, Jafarzadeh M, Tarhini A, et al. The antihypertensive and vasodilator effects of aqueous extract from Berberis vulgaris fruit on hypertensive rats. Phytother Res 2005;19(3):222-225.

Freile ML, Giannini F, Pucci G, et al. Antimicrobial activity of aqueous extracts and of berberine isolated from Berberis heterophylla. Fitoterapia 2003;74(7-8):702-705.

Fukuda K, Hibiya Y, Mutoh M, et al. Inhibition by berberine of cyclooxygenase-2 transcriptional activity in human colon cancer cells. J Ethnopharmacol. 1999;66(2):227-233.

Haupt H. [Poisonous and less poisonous plants. 63. Barberry (Berberidaceae) (Berberis vulgaris)]. Kinderkrankenschwester. 2003;22(12):538-539.

Khosla PK, Neeraj VI, Gupta SK, et al. Berberine, a potential drug for trachoma. Rev Int Trach.Pathol Ocul Trop Subtrop Sante Publique 1992;69:147-165.

Kostalova D, Bukovsky M, Koscova H, et al. [Anticomplement activity of Mahonia aquifolium bisbenzylisoquinoline alkaloids and berberine extract]. Ceska Slov.Farm. 2001;50(6):286-289.

Mahajan VM, Sharma A, Rattan A. Antimycotic activity of berberine sulphate: an alkaloid from an Indian medicinal herb. Sabouraudia 1982;20:79-81.

Pozniakovskii VM, Golub OV, Popova DG, et al. [The use of barberry berries in human nutrition]. Vopr.Pitan. 2003;72(4):46-49.

Rabbani GH, Butler T, Knight J, et al. Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. J Infect.Dis 1987;155(5):979-984.

Sack, R. B. and Froehlich, J. L. Berberine inhibits intestinal secretory response of Vibrio cholerae and Escherichia coli enterotoxins. Infect Immun. 1982;35(2):471-475.

Shamsa F, Ahmadiani A, Khosrokhavar R. Antihistaminic and anticholinergic activity of barberry fruit (Berberis vulgaris) in the guinea-pig ileum. J Ethnopharmacol 1999;64(2):161-166.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.