Protein Cell 8 , 169177 (2017)
This absence of data means the pharmacokinetic interaction risk is genuinely unknown
Individuals considering this combination should be particularly cautious if they are taking: Immunosuppressants such as ciclosporin or tacrolimus (via CYP3A4/P-gp) Anticoagulants including warfarin (via CYP2C9) and potentially direct oral anticoagulants (via P-gp/CYP3A4) Diabetes medications , particularly insulin and sulfonylureas which carry hypoglycaemia risk Antihypertensive drugs , as berberine may have modest blood pressure-lowering effects in some studies Other medications metabolised by liver enzymes (certain statins, antidepressants) Berberine and milk thistle should be avoided during pregnancy and breastfeeding due to insufficient safety data
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Rather than continuous caloric limitation, fasting has proven to be a more effective means of harnessing the benefits of dietary restriction