The short answer
A harmful low-blood-pressure interaction between berberine and enalapril has not been established. The concern is plausible, but evidence from other medicines should not be treated as a direct test of this combination. Discuss berberine with your pharmacist, especially if your readings are already low.
What this answer covers
Oral berberine products with oral enalapril. Salt, formulation, dose and other active ingredients must be identified. Results with benazepril, amlodipine or mixed botanical products are not assigned to enalapril.
- Supplement or preparation
- Berberine
- Medication ingredient
- enalapril
Why does this warning appear?
Berberine is sometimes discussed as a product that may add to the effects of blood-pressure medicines. Enalapril itself can cause low blood pressure. Combining those facts raises a question worth checking, but it does not measure the extra risk from taking these particular products together.
What did the human add-on study test?
A two-year study gave berberine to people with hypertension and type 2 diabetes already receiving several medicines. Those included benazepril and amlodipine, not enalapril. The groups had similar blood-pressure results. Its findings cannot be reassigned to enalapril simply because benazepril is also an ACE inhibitor.
Does the study prove there is no problem?
No. The study was small and focused mainly on kidney-related measurements. It used 100 milligrams of berberine three times daily with planned breaks and multiple background medicines. It cannot establish the safety of a different dose, formulation or enalapril regimen, and a normal average pressure does not exclude an individual adverse reaction.
What should I do before adding berberine?
Have a pharmacist review your exact supplement and all medicines, especially diuretics and other blood-pressure treatments. Mention dizziness, dehydration or low readings. No evidence-based spacing interval was found for this pair. Keep prescribed therapy unchanged while arranging advice, and obtain urgent assessment for fainting or severe weakness.
Evidence and practical considerations
Side effects & toxicity
A harmful low-blood-pressure interaction between berberine and enalapril has not been established. The concern is plausible, but evidence from other medicines should not be treated as a direct test of this combination. Discuss berberine with your pharmacist, especially if your readings are already low.
- Exact scope
- Oral berberine products with oral enalapril. Salt, formulation, dose and other active ingredients must be identified. Results with benazepril, amlodipine or mixed botanical products are not assigned to enalapril. with Enalapril, RxCUI 3827, IN. Oral enalapril maleate tablets are an explicitly identified salt formulation of enalapril in the label. This bridge applies to the labeled oral prodrug; injected enalaprilat, other ACE inhibitors and combination products are not assigned this evidence automatically.
- Medication form and route
- oral
- Timing or duration
- Limited to the exposure durations described in the sources; no untested duration or timing rule is inferred.
What remains uncertain
- No exact-pair human study was identified. A two-year study used benazepril plus amlodipine rather than enalapril and showed no significant pressure difference; it neither establishes nor excludes enalapril-specific harm.
Factors that may matter: exact preparation and dose; baseline blood pressure; kidney function; diuretics and other medicines; dehydration.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients prescribed oral enalapril maleate for hypertension or heart failure.
Potassium products can substantially increase serum potassium; when indicated for documented low potassium, use cautiously with frequent testing. Dehydration and intensive diuretic treatment increase hypotension risk.
How this applies: The maleate formulation is explicitly identified as a salt of enalapril. Applies to oral enalapril, RxCUI 3827 IN; does not transfer to injected enalaprilat or another ACE inhibitor.
A drug label supports named warnings, not every botanical combination. Trial hyperkalemia rates are for enalapril treatment and do not quantify the incremental risk of potassium supplements. The inspected US label has no antacid-specific paragraph.
Source 2: primary randomized clinical study
spandidos-publications.com · Source check Sep 10, 2026
Population: 69 adults with controlled hypertension and type 2 diabetes randomized to baseline treatment or added berberine.
At two years, pressure was 125/83 mmHg in the add-on group versus 127/86 in controls; differences were not significant.
How this applies: Documents why an ACE-inhibitor-related berberine study cannot be reassigned to enalapril. No claim of enalapril benefit or safety is drawn.
This is not enalapril exposure. Multiple background medicines and a study focused on renal markers do not isolate an interaction or exclude rare harm. Salt/form of berberine is not clearly specified.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original sources checked and a new article prepared, distinguishing the exact medicine and supplement preparation from related studies. No independent clinical review is recorded. | |
| Research summary published |
Article revision: 5ae66d5911502234
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.