Can you take berberine with metformin?

In this article:

• Can you take berberine and metformin together?
• How to take berberine with metformin
• Is berberine or metformin better?
• Berberine vs. metformin: Comparison chart

In this article

• Can you take berberine and metformin together?
• How to take berberine with metformin
• Is berberine or metformin better?
• Berberine vs. metformin: Comparison chart

An idea to use berberine along with metformin would not be unusual. Metformin forms the foundation of treatment for Type 2 diabetes mellitus. It is a first-line drug for diabetes because it not only controls blood glucose levels but also assists with weight loss and obesity management efforts. By helping our bodies be more sensitive to insulin, this generic pill can make a world of difference for those with diabetes and has been put to use off-label for prediabetes, polycystic ovary syndrome (PCOS), and metabolic syndrome.

Berberine may not have the rock star role that metformin carries within the medical world. However, it does have a fan base built on proven effectiveness for lowering blood glucose levels and cholesterol. The dietary supplement pill has evidence showing that it reduces glucose levels by increasing insulin secretion and sensitivity partly via an amp-activated protein kinase (AMPK). It also reduces levels of low-density lipoprotein (LDL), which is sometimes called the “bad” cholesterol, by increasing LDL receptors in the liver and decreasing LDL uptake in the intestinal tract. Berberine may also help with weight loss, but research is limited.

High cholesterol and Type 2 diabetes are two bad actors that often run together. Collectively, they compound people’s risk of cardiovascular disease and stroke. Addressing both conditions is essential. Oftentimes, controlling diabetes requires multiple meds. Hence, taking metformin and berberine for diabetes care and lipid management could be a combination to consider. Digging into this duo a bit more will give you the information needed to make a decision in consultation with your team of healthcare professionals.

Can you take berberine and metformin together?

Berberine and metformin can be taken together in most cases, but there is a drug interaction to keep in mind. Berberine was associated with a reduction in metformin concentrations in one study. As a result, people may not get as much benefit from metformin if they take berberine with it.

Monitoring of blood sugar levels when adding berberine to metformin is worthwhile. Hopefully, the added beneficial effects of berberine will result in a net benefit of lower glucose numbers, even if metformin potency is reduced. Regardless, this type of interaction between berberine and metformin is an excellent example of why you need to be sure that your healthcare provider knows about all the prescription drugs, over-the-counter (OTC) medicines, and supplements that you take.

The combination of berberine and metformin has been looked at in animal studies, and the findings have been favorable so far in terms of less insulin resistance and lower cholesterol numbers. As part of a review of the two drugs for diabetes, a human study was called out for showing promise of better efficacy using berberine with metformin compared to metformin alone.

Lower cholesterol numbers are a frequent objective of Type 2 diabetes mellitus management. Statins like Crestor (rosuvastatin) and Lipitor (atorvastatin) are commonly chosen to achieve this reduction, but they are not always tolerated due to side effects like muscle pain. Zetia (ezetimibe), bempedoic acid, and PCSK-9 inhibitors like Repatha are alternative prescription drugs for high cholesterol if statins cannot be used. Although berberine could also be an option, there’s less evidence to support it. 

How to take berberine with metformin

Your healthcare provider will be needed for medical advice on whether to take the combo and how to do so since they have a direct interaction. Your healthcare provider will also need to review your other meds and health conditions to see if any would react negatively to the addition of berberine or metformin.

Taking the two drugs at different times may help prevent berberine from inhibiting metformin absorption. However, more research is needed before evidence-based advice can be given. 

RELATED: When is the best time to take metformin?

Is berberine or metformin better?

Berberine and metformin can both be used to lower blood sugar in the setting of Type 2 diabetes, particularly when it comes to preventing postprandial glucose spikes after meals. Metformin can lower HbA1C values, which are a marker of three-month average blood sugar, by about 1% compared to placebo. Berberine has been shown to do so by about 0.6%, but the evidence from clinical trials is lacking. Although berberine seems to be less potent, we have to keep in mind that it may have the added benefit of lowering LDL cholesterol and triglycerides, too.

RELATED: 8 benefits of berberine

Besides efficacy, there are other factors to account for when comparing berberine and metformin. For one, metformin is a prescription biguanide drug that has standardized doses and is typically taken as a 500 milligram (mg) or 1,000 mg regular or extended-release tablet once or twice daily. Your medical provider will determine the right dose for you.

Berberine is an OTC alkaloid product derived from the root, fruit, or bark of different plants, such as goldenseal. As a result, berberine dosing is not as standardized, which results in less consistency. A dose-response study indicated that a berberine dose of 1.8 grams per day was optimal for effects on diabetes and total cholesterol. With fewer published studies and guidelines, you will need to rely on your healthcare provider to determine berberine dosing.

Side effects can be another differentiating point. Metformin is a known commodity with well-established adverse effects, like diarrhea in 53% of patients, nausea in 25%, and flatulence in 12%. There have also been rare occurrences of serious lactic acidosis. 

In comparison, berberine is an herbal supplement, so it’s not approved by the Food and Drug Administration like metformin is. And it doesn’t have a well-defined side effect profile, which can be disconcerting. Diarrhea and constipation have been reported with its use, and one review mentioned no serious side effects.

The looming fact that much is unknown about berberine extends to contraindications, too. We know that metformin should not be used in the setting of severe kidney or liver disease or heart failure. Although it can be used in pregnancy and while breastfeeding, other options are typically preferred for diabetes management during pregnancy. Conversely, we do not have conclusions on when to avoid berberine.

Cost is an important consideration when comparing metformin and berberine. As a readily available generic drug, metformin can be purchased at a retail price of $170 for 60, 500 mg tablets or just $4 with a SingleCare coupon. Berberine complex costs $41 for 90 capsules or $31 with a SingleCare coupon. 

RELATED: Berberine vs. metformin for diabetes treatment

Bottom line

Berberine and metformin both could have a role in the treatment of Type 2 diabetes mellitus, and they may be able to work well together. As an herbal supplement, berberine carries with it a lot of unknowns in regards to optimal dosing, side effects, and contraindications. It may reduce metformin levels, but this may not prohibit the combination from being used. Given the promise but uncertainty about berberine, you must get the medical advice of your healthcare provider to determine if taking berberine and metformin is worthwhile and safe for you.