The short answer
Check with your transplant team before taking berberine. An interaction with tacrolimus is plausible, but its size and the risk of kidney injury or infection are not well established from the original evidence available here.
What this answer covers
This article concerns oral berberine with oral tacrolimus. Results from cyclosporine, goldenseal or other plant mixtures cannot establish the effect of this exact combination.
- Supplement or preparation
- Berberine
- Medication ingredient
- tacrolimus
Why is an interaction possible?
Tacrolimus depends on CYP3A enzymes for its metabolism. In a human study, berberine taken three times daily for two weeks reduced CYP3A4 activity measured with another medicine. That creates a reason for caution, but the measured increase belongs to the test medicine, not tacrolimus.
What direct evidence is available?
A published report describes berberine and tacrolimus in a child with nephrotic syndrome. Its citation was accessible, but the original case details were not. The dose, blood-level change and outcome therefore cannot be reliably described here or generalized to transplant recipients.
Have kidney injury and infection been proven?
Excess tacrolimus can harm the kidneys, and tacrolimus suppresses immune defenses. Those known effects explain the concern if berberine raises exposure. They do not demonstrate how often this combination causes kidney injury or an infection, or prove that every berberine product raises tacrolimus levels.
How should I handle a berberine product?
Show the transplant pharmacist the label and daily amount before starting. If you already take it, tell the team when you began and whether the product or dose changed. They can decide whether levels and kidney function need checking. Do not adjust tacrolimus or assume taking berberine a few hours later removes the uncertainty.
Evidence and practical considerations
Absorption & effectiveness
Berberine inhibits a human CYP3A probe, but accessible original evidence does not quantify its tacrolimus interaction.
- Exact scope
- Oral berberine; no goldenseal or cyclosporine result transfer. with Tacrolimus, exact RxCUI 42316, inventory name tacrolimus, TTY IN. Oral systemic tacrolimus only. The US PROGRAF label describes tacrolimus capsules and anhydrous-equivalent strength; the UK capsule SmPC section 2 explicitly states tacrolimus as monohydrate. This bridges labeled monohydrate capsules to the IN, without merging different release formulations or transferring exposure results to topical or intravenous tacrolimus. No cyclosporine or other immunosuppressant evidence is substituted for tacrolimus evidence.
- Medication form and route
- oral
What remains uncertain
- Direct case content unavailable; enzyme-probe extrapolation is explicit and unquantified.
Read the supporting source summaries
Source 1: original human clinical study
link.springer.com · Source check Sep 10, 2026
Population: Healthy male volunteers in a two-phase randomized crossover study; sample count not stated in the accessible abstract.
Midazolam total exposure rose 40% and peak concentration 38%, consistent with inhibition of CYP3A4 activity.
How this applies: Mechanistic human support for a possible tacrolimus interaction because tacrolimus uses CYP3A metabolism; an explicit inference only.
Tacrolimus was not administered. Probe-drug changes cannot supply a tacrolimus effect size or prove transplant toxicity. Full article methods were not accessible on the publisher page.
Source 2: original case report, bibliographic access only
link.springer.com · Source check Sep 10, 2026
Population: One child with idiopathic nephrotic syndrome, as identified by the title; not a transplant cohort.
The record verifies that a pair-specific case report exists. It does not expose the case results, so no numerical effect or toxicity event is asserted from it.
How this applies: Relevant unavailable original identified transparently. Insufficient for outcome adjudication until its content can be inspected.
Bibliographic access only. Do not infer clinical findings from indexing terms, a title, citation lists or secondary summaries.
Source 3: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients receiving systemic tacrolimus for transplant immunosuppression; oral capsules and granules discussed separately from injection.
Requires drug-level monitoring and individualized dosing. Warns of nephrotoxicity, infections, neurotoxicity, QT prolongation and hyperkalemia. Avoid grapefruit and juice; CBD needs close monitoring and possible dose reduction.
How this applies: Medication-specific safety and monitoring context. Additional supplement-specific findings and explicit formulation boundaries are required.
Label warnings do not quantify the added clinical-event risk from each supplement. The oral products are not freely interchangeable; topical use is outside these data.
Research assessment: · Open full citations ↗
Side effects & toxicity
Kidney injury and infection are plausible consequences of excess tacrolimus, not established pair-specific berberine outcomes in the inspected evidence.
- Exact scope
- Oral berberine. with Tacrolimus, exact RxCUI 42316, inventory name tacrolimus, TTY IN. Oral systemic tacrolimus only. The US PROGRAF label describes tacrolimus capsules and anhydrous-equivalent strength; the UK capsule SmPC section 2 explicitly states tacrolimus as monohydrate. This bridges labeled monohydrate capsules to the IN, without merging different release formulations or transferring exposure results to topical or intravenous tacrolimus. No cyclosporine or other immunosuppressant evidence is substituted for tacrolimus evidence.
- Medication form and route
- oral
What remains uncertain
- No accessible direct original outcome series or verified event rate.
Read the supporting source summaries
Source 1: regulatory prescribing information
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Patients receiving systemic tacrolimus for transplant immunosuppression; oral capsules and granules discussed separately from injection.
Requires drug-level monitoring and individualized dosing. Warns of nephrotoxicity, infections, neurotoxicity, QT prolongation and hyperkalemia. Avoid grapefruit and juice; CBD needs close monitoring and possible dose reduction.
How this applies: Medication-specific safety and monitoring context. Additional supplement-specific findings and explicit formulation boundaries are required.
Label warnings do not quantify the added clinical-event risk from each supplement. The oral products are not freely interchangeable; topical use is outside these data.
Source 2: original case report, bibliographic access only
link.springer.com · Source check Sep 10, 2026
Population: One child with idiopathic nephrotic syndrome, as identified by the title; not a transplant cohort.
The record verifies that a pair-specific case report exists. It does not expose the case results, so no numerical effect or toxicity event is asserted from it.
How this applies: Relevant unavailable original identified transparently. Insufficient for outcome adjudication until its content can be inspected.
Bibliographic access only. Do not infer clinical findings from indexing terms, a title, citation lists or secondary summaries.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original evidence and current product information inspected; article distinguishes observed results, product limits and remaining uncertainty. | |
| Research summary published |
Article revision: 862aa1bbb65e1443
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.