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Berberine is a plant alkaloid sold as an unregulated food supplement in the UK, not a licensed medicine approved by the MHRA It may enhance blood glucose-lowering effects of diabetes medications, increasing hypoglycaemia risk, particularly with insulin and sulphonylureas Potential interactions with anticoagulants (warfarin, DOACs) require specialist advice and may necessitate more frequent INR monitoring Berberine may increase blood levels of statins, immunosuppressants, and other CYP3A4-metabolised drugs, raising toxicity risks Always consult your GP before starting berberine if taking any prescription medications, pregnant, breastfeeding, or have liver or kidney disease Stop berberine at least 2 weeks before planned surgery and report any suspected side effects via the MHRA Yellow Card Scheme Table of Contents What Is Berberine and How Does It Work

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Table 1: There were no statistically significant differences between groups at baseline for any of the variables shown above