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Goldenseal (Hydrastis canadensis L.)
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Goldenseal/Drug Interactions:- Antiarrhythmic agentsAntiarrhythmic agents: In animal study, berberine, an alkaloid constituent in goldenseal, restored ventricular arrhythmias and atrial fibrillation to normal sinus rhythm (7). However, in human study, patients with congestive heart failure developed ventricular tachycardia after intravenous berberine was administered at a rate of 0.2mg/kg/min (52).
- AntibioticsAntibiotics: Berberine, an alkaloid constituent in goldenseal, has been found in vitro and in animals to have antimicrobial properties (24; 81).
- Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In in vitro and animal study, goldenseal and its constituent berberine inhibited platelet aggregation, which may increase the risk of bleeding when used with anticoagulant/antiplatelet agents (53; 54). However, goldenseal may reduce the anticoagulant effects of warfarin due to antagonist properties, and theoretically, may increase the risk of blood clots. Currently the effects are unclear.
- Antidiabetic agentsAntidiabetic agents: Based on animal and in vitro study, berberine, an alkaloid constituent in goldenseal, may improve insulin resistance (25), lower blood sugar concentrations (26), and decrease glucose absorption (28).
- AntidiarrhealsAntidiarrheals: Based on clinical study, berberine, an alkaloid constituent in goldenseal, may have antidiarrheal effects (55; 56; 57; 58).
- AntihistaminesAntihistamines: In animal study, subcutaneous administration of berberine (an alkaloid constituent of goldenseal) sulfate in doses of 20-50mg/kg decreased vascular permeability induced by histamine (82).
- AntihypertensivesAntihypertensives: In clinical study of patients with refractory congestive heart failure, no significant circulatory changes occurred with the lower dose of berberine (a 0.02mg/kg/minute intravenous infusion of berberine), but at the higher dose (a 0.2mg/kg/minute intravenous infusion of berberine), a 48% decrease in systemic vascular resistance, 41% decrease in pulmonary vascular resistance, 28% decrease in right atrial pressures, and a 32% decrease in left ventricular end-systolic pressures were reported (52). In animal study, intravenous berberine caused a significant decrease in systolic and diastolic blood pressure at doses of 2-8mg/kg (76).
- Anti inflammatory agentsAnti inflammatory agents: Based on animal study, the goldenseal constituent berberine may have anti inflammatory properties (16; 82).
- Antilipemic agentsAntilipemic agents: In clinical study, berberine, an alkaloid constituent in goldenseal, reduced triglycerides, serum cholesterol, and LDL cholesterol (83; 84). However, HDL cholesterol was not affected.
- Antimalarial agentsAntimalarial agents: In clinical study evaluating treatments for chloroquine-resistant malaria, a clearance of asexual parasitemia was seen after four days of treatment with berberine (an alkaloid constituent of goldenseal) in combination with pyrimethamine, which was greater than that seen with pyrimethamine plus tetracycline or pyrimethamine plus cotrimoxazole, respectively (60).
- Antineoplastic agentsAntineoplastic agents: Based on animal study, berberine, an alkaloid constituent in goldenseal, may have antineoplastic effects (85; 86).
- Beta blockersBeta blockers: In animal study, timolol has been shown to partially inhibit the smooth muscle relaxant activity of a goldenseal alcoholic extract (87). Propranolol inhibits the increase in slow-response action potentials seen with berberine, an alkaloid constituent in goldenseal, in vitro (88).
- CarmustineCarmustine: Berberine, an alkaloid constituent in goldenseal, and carmustine have been shown to have additive effects against human brain tumor cell lines in vitro (18).
- CyclosporineCyclosporine: Berberine may increase serum levels of cyclosporine by reducing the metabolism of cyclosporine through cytochrome P450 3A4 inhibition (89)
- Cytochrome P450 2D6 substratesCytochrome P450 2D6 substrates: In vitro, botanical supplements that contain goldenseal have been shown to strongly inhibit CYP2D6 activity (4).
- Cytochrome P450 3A(4,5,7) substratesCytochrome P450 3A(4,5,7) substrates: In vitro, goldenseal extract has been shown to inhibit CYP 3A4 (90; 91; 92; 93). This interaction has not been sufficiently evaluated in humans, although limited available study has not found significant interaction between goldenseal root and the pharmacokinetics of the antiretroviral drug indinavir, which is metabolized by CYP 3A4 (94).
- Heart rate regulating agentsHeart rate regulating agents: Based on animal study, berberine, an alkaloid constituent in goldenseal, may have inotropic and chronotropic activity (95).
- ImmunosuppressantsImmunosuppressants: In human study, leukocyte counts increased to >4,000 in patients with leucopenia with administration of 50mg berberine, an alkaloid constituent in goldenseal, three times daily for 1-4 weeks (33).
- LaxativesLaxatives: Based on clinical study, berberine, an alkaloid constituent in goldenseal, may have antidiarrheal effects (55; 56; 57; 58). Theoretically, berberine may counteract the effects of laxatives.
- Neostigmine (Prostigmin®)Neostigmine (Prostigmin®): In animal study, administration of the goldenseal constituent berberine has been shown to reverse the secretory effects of neostigmine (96).
- Neurologic agentsNeurologic agents: In human study, headache was experienced by subjects taking 5mg/kg of berberine, an alkaloid constituent in goldenseal, daily (36). Based on secondary sources, paresthesias have been reported in association with large doses of goldenseal.
- PhenylephrinePhenylephrine: In animal study, the goldenseal constituent berberine and L-phenylephrine have demonstrated additive effects when administered concurrently (96).
- Photosensitizing agentsPhotosensitizing agents: In case study, photosensitivity has been reported in a woman taking a combination herbal preparation containing goldenseal, as well as ginseng and bee pollen (79). The contribution of goldenseal or any of its constituents to this reaction is not clear, and this is not a commonly reported adverse effect of goldenseal.
- SedativesSedatives: Based on animal study, berberine, an alkaloid constituent in goldenseal, may have sedative effects (70; 97; 98).
- TetracyclinesTetracyclines: In clinical study, 100mg of berberine, an alkaloid constituent in goldenseal, was reported to decrease the efficacy of tetracycline in the treatment of cholera (56).
- VasopressorsVasopressors: The constituent hydrastine may theoretically induce vasoconstriction, possibly resulting in hypertension. In animal study, dose-dependent vasoconstriction was observed beginning at a concentration of 50mcL/mL of goldenseal, although neither berberine, an alkaloid constituent in goldenseal, nor hydrastine alone, demonstrated this effect (78).
- WarfarinWarfarin: Goldenseal may reduce the anticoagulant effects of warfarin due to antagonist properties, and theoretically, may increase the risk of blood clots.
- YohimbineYohimbine: Berberine, an alkaloid present in goldenseal, has been shown to competitively inhibit the binding of yohimbine, which may or may not affect its pharmacologic actions when the two agents are administered concurrently (99).
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Goldenseal/Herb/Supplement Interactions:- Alkaloid agentsAlkaloid agents: The active ingredients of goldenseal include isoquinoline alkaloids, such as berberine, canadine, and hydrastine.
- AntiarrhythmicsAntiarrhythmics: In animal study, berberine, an alkaloid constituent in goldenseal, restored ventricular arrhythmias and atrial fibrillation to normal sinus rhythm (7). However, in human study, patients with congestive heart failure developed ventricular tachycardia after intravenous berberine was administered at a rate of 0.2mg/kg/min (52).
- AntibacterialsAntibacterials: The goldenseal constituent berberine has been found in vitro and in animals to possess antimicrobial properties (24; 81).
- Anticoagulants and antiplatelets Anticoagulants and antiplatelets : In in vitro and animal study, goldenseal and its constituent berberine inhibited platelet aggregation, which may increase the risk of bleeding when used with anticoagulant/antiplatelet agents (53; 54). However, goldenseal may reduce the anticoagulant effects of warfarin due to antagonist properties, and theoretically, may increase the risk of blood clots. Currently the effects are unclear.
- AntidiarrhealsAntidiarrheals: Based on clinical study, berberine, an alkaloid constituent in goldenseal, may have antidiarrheal effects (55; 56; 57; 58).
- AntihistaminesAntihistamines: In animal study, subcutaneous administration of berberine (an alkaloid constituent of goldenseal) sulfate in doses of 20-50mg/kg decreased vascular permeability induced by histamine (82).
- Anti inflammatory herbsAnti inflammatory herbs: Based on animal study, the goldenseal constituent berberine may have anti inflammatory properties (16; 82).
- AntilipemicsAntilipemics: In clinical study, berberine, an alkaloid constituent in goldenseal, reduced triglycerides, serum cholesterol, and LDL cholesterol (83; 84). However, HDL cholesterol was not affected.
- Antimalarial herbs and supplementsAntimalarial herbs and supplements: In clinical study evaluating treatments for chloroquine-resistant malaria, a clearance of asexual parasitemia was seen after four days of treatment with berberine (an alkaloid constituent of goldenseal) in combination with pyrimethamine, which was greater than that seen with pyrimethamine plus tetracycline or pyrimethamine plus cotrimoxazole, respectively (60).
- AntineoplasticsAntineoplastics: Based on animal study, berberine, an alkaloid constituent in goldenseal, may have antineoplastic effects (85; 86).
- Berberine containing herbs and supplementsBerberine containing herbs and supplements: The active ingredients of goldenseal include the isoquinoline alkaloid berberine.
- Chronotropic herbs and supplementsChronotropic herbs and supplements: Based on animal study, berberine, an alkaloid constituent in goldenseal, may have inotropic and chronotropic activity (95).
- Cytochrome P450 2D6 inhibitorsCytochrome P450 2D6 inhibitors: In vivo research has shown that botanical supplements that contain goldenseal strongly inhibit CYP2D6 activity (4).
- Cytochrome P450 3A(4,5,7) substratesCytochrome P450 3A(4,5,7) substrates: In vitro, goldenseal extract has been shown to inhibit CYP 3A4 (90; 91; 94). This interaction has not been sufficiently evaluated in humans, although limited available study has not found significant interaction between goldenseal root and the pharmacokinetics of the antiretroviral drug indinavir, which is metabolized by CYP 3A4 (94).
- Gastrointestinal herbs and supplementsGastrointestinal herbs and supplements: Based on clinical study, berberine, an alkaloid constituent in goldenseal, may have antidiarrheal effects (55; 56; 57; 58). In case study, nausea and vomiting have been reported with the use of goldenseal (59; 60).
- HypoglycemicsHypoglycemics: Based on animal and in vitro study, berberine, an alkaloid constituent in goldenseal, may improve insulin resistance (25), lower blood sugar concentrations (26), and decrease glucose absorption (28).
- HypotensivesHypotensives: In clinical study of patients with refractory congestive heart failure, no significant circulatory changes occurred with the lower dose of berberine (a 0.02mg/kg/minute intravenous infusion of berberine), but at the higher dose (a 0.2mg/kg/minute intravenous infusion of berberine), a 48% decrease in systemic vascular resistance, 41% decrease in pulmonary vascular resistance, 28% decrease in right atrial pressures, and a 32% decrease in left ventricular end-systolic pressures were reported (52). In animal study, intravenous berberine caused a significant decrease in systolic and diastolic blood pressure at doses of 2-8mg/kg (76).
- ImmunosuppressantsImmunosuppressants: In human study, leukocyte counts increased to >4,000 in patients with leucopenia with administration of 50mg berberine, an alkaloid constituent in goldenseal, three times daily for 1-4 weeks (33).
- Neurologic herbs and supplementsNeurologic herbs and supplements: In human study, headache was experienced by subjects taking 5mg/kg berberine, an alkaloid constituent in goldenseal, daily (36). Based on secondary sources, paresthesias have been reported in association with large doses of goldenseal.
- PhotosensitizersPhotosensitizers: In case study, photosensitivity has been reported in a woman taking a combination herbal preparation containing goldenseal, as well as ginseng and bee pollen (79). The contribution of goldenseal or any of its constituents to this reaction is not clear, and this is not a commonly reported adverse effect of goldenseal.
- SedativesSedatives: Based on animal study, berberine, an alkaloid constituent in goldenseal, may have sedative effects (70; 97; 98).
- Vasoconstrictor herbs and supplementsVasoconstrictor herbs and supplements: The constituent hydrastine may theoretically induce vasoconstriction, possibly resulting in hypertension. In animal study, dose-dependent vasoconstriction was observed beginning at a concentration of 50mcL/mL of goldenseal, although neither berberine, an alkaloid constituent in goldenseal, nor hydrastine alone, demonstrated this effect (78).
- YohimbeYohimbe: Berberine, an alkaloid in goldenseal, has been shown to competitively inhibit the binding of yohimbine, which may or may not affect its pharmacologic actions when the two agents are administered concurrently (99).
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Goldenseal/Food Interactions:- Insufficient available evidence.
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Goldenseal/Lab Interactions:- BilirubinBilirubin: Berberine, a constituent of goldenseal, has been shown to displace bilirubin from albumin both in vitro and in animal studies, resulting in an increase in serum total and direct bilirubin concentrations (61).
- Blood glucoseBlood glucose: Based on animal and in vitro study, berberine, an alkaloid constituent in goldenseal, may improve insulin resistance (25), lower blood sugar concentrations (26), and decrease glucose absorption (28).
- Blood pressureBlood pressure: In clinical study of patients with refractory congestive heart failure, no significant circulatory changes occurred with the lower dose of berberine, an alkaloid constituent in goldenseal, (a 0.02mg/kg/minute intravenous infusion of berberine). But at the higher dose (a 0.2mg/kg/minute intravenous infusion of berberine), a 48% decrease in systemic vascular resistance, 41% decrease in pulmonary vascular resistance, 28% decrease in right atrial pressures, and a 32% decrease in left ventricular end-systolic pressures were reported (52). In animal study, intravenous berberine caused a significant decrease in systolic and diastolic blood pressure at doses of 2-8mg/kg (76).
- Coagulation panelCoagulation panel: In in vitro and animal study, goldenseal and its constituent berberine inhibited platelet aggregation, which may increase the risk of bleeding when used with anticoagulant/antiplatelet agents (53; 54). However, goldenseal may reduce the anticoagulant effects of warfarin due to antagonist properties, and theoretically, may increase the risk of blood clots
- Lipid profileLipid profile: In clinical study, berberine, an alkaloid constituent in goldenseal, reduced triglycerides, serum cholesterol, and LDL cholesterol (83; 84). However, HDL cholesterol was not affected.
- Sodium levelsSodium levels: Goldenseal may cause elevated sodium levels in the blood (hypernatremia) (80).
- Urinalysis (THC detection)Urinalysis (THC detection): Goldenseal may interfere with THC detection in urinalysis (100). Urine containing goldenseal may give a brownish color (100).
- White blood cell countWhite blood cell count: In human study, leukocyte counts increased to >4,000 in patients with leucopenia with administration of 50mg berberine, an alkaloid constituent in goldenseal, three times daily for 1-4 weeks (33).
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Copyright © 2011 Natural Standard (www.naturalstandard.com)
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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.
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