Medically reviewed by Drugs.com. Last updated on Sep 3, 2020.
Scientific Name(s): Berberis aristata Sims., Berberis vulgaris L., Mahonia aquifolium (Pursh) Nutt.
Common Name(s): Barberry, Berberis, Holly barberry, Jaundice berry, Oregon barberry, Oregon grape, Oregon grapeholly, Pepperidge bush, Sour-spine, Sowberry, Trailing mahonia, Woodsour
Clinical applications may include use in treating diabetes and dyslipidemia, although clinical trials are limited and are often of poor quality. Other activity includes antimicrobial, antioxidant, and anti-inflammatory effects. No clinical trials exist to support uses related to effects on the cardiovascular and central nervous systems or treating cancer.
Daily doses of 2 g of the berries and 1.5 to 3 g daily of dry bark have been used; however, there are limited clinical studies to substantiate barberry's varied uses.
Caution is warranted in the presence of cardiac arrhythmia. Use in children has not been validated.
Avoid use. There are documented adverse effects, including uterine stimulant effects.
Case reports are lacking; however, barberry exhibits anti-cytochrome P450 3A4 (CYP3A4) activity similar to that of grapefruit. Caution is warranted with coadministration of potentially toxic medicines such as cyclosporine.
GI symptoms (eg, nausea, vomiting, diarrhea), dizziness, and fainting have been reported. Effects on the cardiovascular system (eg, hypotension, decreased heart rate) and decreased respiration may occur with high dosages. The German Commission E reports that lower doses of berberine are well tolerated. Hypersensitivity has been documented.
Symptoms of poisoning are characterized by lethargy, stupor and daze, vomiting and diarrhea, and nephritis. A median lethal dose (LD50) for berberine was noted as 27.5 mg/kg in humans. Berberine showed mutagenicity in yeast cells and Ames test, while a phototoxic reaction between berberine alkaloid and ultraviolet A (UVA) light has been described.
- Berberidaceae (barberry)
Some 500 species of barberry are recognized, and plants within the genus Berberis and Mahonia have similar chemical composition. Barberry grows wild throughout Europe but has been naturalized to many regions of the eastern US. M. aquifolium is an evergreen shrub native to the northwestern US and Canada. Barberry grows to more than 3 m with branched, spiny, holly-like leaves and is widely planted as an ornamental. Its yellow flowers bloom from May to June and develop into red to blue/black oblong berries.1, 2, 3, 4
Barberry has a long history of use, dating back to the Middle Ages in Europe. Salishan tribe native elders of the Pacific Northwest used M. aquifolium to treat acne, and Native Americans utilized Mahonia berries to treat scurvy. The species B. aristata has been used in traditional Chinese and Nepalese medicine and in the Ayurvedic medical system for many years. The sundried fruits are eaten for antipyretic and diuretic effects in Turkey. A decoction of the plant has been used to treat GI ailments and coughs. The alkaloid berberine was included as an astringent in eye drops, but its use has become rare. The edible fruits have been used to prepare jams, jellies, and juices. The use of the plant in traditional medicine has been limited by the bitter taste of the bark and root. However, multiple medicinal uses for barberry have been listed and include treatments in cancer, cholera, and hypertension.2, 3, 5
Plant parts include the stem, root, fruit, flowers, and leaves. Alkaloids, tannins, phenolic compounds, sterols, and triterpenes have all been described. The isoquinoline alkaloids are of primary interest and include berberine, berbamine, and oxycanthine, among numerous others. Variation in content exists among the different species. Methods for identification and quantification have been established and berberine fingerprinting has been described.2, 4, 6, 7, 8
Uses and Pharmacology
Limited clinical studies have evaluated the efficacy of topical M. aquifolium in psoriasis. Efficacy was greater than with placebo but not as effective as with standard therapy; exacerbations have been described. Further studies are required. 9
Because of the association of Helicobacter pylori with gastritis, peptic ulcer, and gastric cancer, in vitro experimentation was conducted in H. pylori-infected gastric epithelial cells with 24 medicinal plants indigenous to Pakistan to evaluate their effect on secretion of interleukin (IL)-8 and generation of reactive oxygen species (ROS) in order to assess anti-inflammatory and cytoprotective effects. Although no significant direct cytotoxic effects on the gastric cells or bactericidal effects on H. pylori were found, root extract of barberry was observed to have mild and moderate inhibitory activity on IL-8 at 50 and 100 mcg/mL, respectively, and the most significant suppression on ROS generation in H. pylori-infected gastric cells of extracts tested.9
Antimicrobial effects have been described for Berberis spp. and berberine.2, 10, 11 In mice, a topical 20% root bark extract application was effective against cutaneous leishmaniasis,12 while chickens with severe diarrhea fed B. vulgaris root bark extract fared better through anticoccidal activity.13
Induction of apoptosis and cell cycle arrest, interference with tumor signalling, and tumor inhibition have been shown in vitro by B. vulgaris and B. aristata extracts, and berberine and berbamine constituents.7, 10, 16, 17
Research reveals no clinical data regarding the use of barberry for cancer. Berberine alone has been evaluated as an adjunct to prevent adverse effects of radiation.18
Experiments have shown berberine to exhibit effects on the cardiovascular system, although the mechanisms remain poorly understood. Positive inotropic and negative chronotropic effects, as well as vasodilatory, antiarrhythmic, and hypotensive effects, have been described.7, 19, 20
Research reveals no clinical data regarding the use of Berberis or Mahonia spp. for cardiovascular conditions. Caution is warranted in the presence of cardiac arrhythmia.
Anti-acetylcholinesterase activity has occurred for berberine and extracts of B. vulgaris in animal studies and in vitro experiments.10, 21, 22, 23, 24 In mice, neuroprotective effects have been demonstrated whereby berberine inhibited apoptosis in hippocampal tissue and prevented dopaminergic neuronal damage on histology. Improvements in short-term memory and enhanced motor balance and coordination were observed in a mouse model of Parkinson disease.24 An anticonvulsant effect was demonstrated in mice.21
Research reveals no clinical data regarding the use of Berberis or Mahonia spp. for CNS-related conditions.
Studies in rodents both normotensive and with induced diabetes have consistently demonstrated improved glycemic control with administration of berberine and Berberis extracts. Inhibition of alpha-glucosidase activity has been demonstrated; however, the precise mechanism of action remains unclear.10, 25, 26, 27, 28
Berberine exerted a hypoglycemic action in a small trial of patients with type 2 diabetes.29 In women with metabolic-associated polycystic ovary syndrome, berberine taken over 3 months decreased fasting blood glucose levels.30 Findings from a larger, multicenter clinical trial evaluating this effect have not been concluded.31 Small clinical trials examining the effect of consumption of the fruit in type 2 diabetes showed improvements in the lipid profile and glycemic control.28, 32 Data from trials in which Berberis extracts were used in combination with other plant extracts cannot be attributed to a single plant.33, 34, 35
Berberine alone improved the lipid profile in dyslipidemia in several clinical trials among participants with differing conditions, including familial hypercholesterolemia, obesity, and diabetes.37, 38, 39 Barberry taken over 6 weeks improved the lipid profile and influenced C-reactive protein in a randomized clinical study in 106 patients with metabolic syndrome; effect on blood pressure or other cardiovascular outcomes was not reported.40 Small clinical trials have been conducted examining the effect of barberry consumption in type 2 diabetes and demonstrated improvements in the lipid profile and glycemic control.28, 32 In 124 euglycemic, dyslipidemic patients intolerant to high doses of statins, administration of half the statin dose plus twice daily dosing of a B. aristata 588 mg/S. marianum 105 mg combination product significantly reduced fasting plasma glucose, insulin, insulin index and stabilized lipid levels compared to baseline and placebo in a 6-month double-blind, randomized, placebo-controlled trial. Lipid levels increased significantly during the study period in the placebo group. The intervention (a patented nutraceutical in Italy containing B. aristata extract standardized to 85% berberine plus S. marianum extract titrated to more than 60% flavanolignans) was well tolerated.53
Limited studies in rodents and when using homeopathic doses suggest B. vulgaris extracts possess activity against calcium oxalate deposition.41, 42 B. aristata improved benign prostatic hyperplasia in rats possibly by inhibition of androgen and anti-inflammatory effects.22, 43 A small clinical trial reported positive effects for B. vulgaris fruit extract in treating acne. The study was conducted for only 4 weeks, with results from a longer trial required.44 The American Academy of Dermatology/American Academy of Dermatology Association guidelines of care for the management of acne vulgaris (2016) states that oral barberry has been reported to have value in the treatment of acne (limited; moderate).55
Antioxidant effects have been documented.45, 46 Effects on the GI tract have been described in rodent studies. Protection against inflammatory-related damage and motility effects have been reported, suggesting therapeutic uses for inflammatory bowel conditions.47, 48
Further effects for berberine alone have been described in studies using Goldenseal (see Goldenseal monograph).
Barberry berries and root bark have been used as a source of berberine. Daily doses of 2 g of the berries and 1.5 to 3 g daily of dry bark have been used3; however, there are limited clinical studies to substantiate barberry's varied uses.2, 49 Berberine and related alkaloids are poorly absorbed when taken orally; in vitro and animal studies must be interpreted with care. Use in children has not been validated.
Pregnancy / Lactation
Case reports are lacking; however, Berberis exhibits anti-CYP3A4 activity similar to that of grapefruit. Caution is warranted with coadministration of potentially toxic medicines such as cyclosporine.19, 51 Berberine may also induce P-glycoprotein.56
GI symptoms (eg, nausea, vomiting, diarrhea), dizziness, and fainting have been reported. Effects on the cardiovascular system (eg, hypotension, decreased heart rate) and decreased respiration may occur with high dosages.2, 3 Hypersensitivity has been documented.9 The German Commission E reports that doses of berberine 500 mg are well tolerated.49
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