Berberine With Mirapex And Rytary

Barb asked

Does berberine interfere with taking Rytary or Mirapex . I have Parkinson's disease.

Answer

There are no known interactions between berberine, Mirapex, and Rytary. However, there is a lack of published data regarding interactions involving berberine and specific drugs.

As with any over the counter supplement or herbal product, it is important to let your doctor and pharmacist know everything you are taking so you can be appropriately monitored for both potential benefits and adverse reactions.

Theoretically, berberine may interact with a variety of medications as it is known to inhibit certain CYP liver metabolizing enzymes.

CYP liver enzyme inhibition (or induction) is the major mechanism behind the vast majority of drug interactions (1).

One well known drug-drug interaction example is between the cholesterol medication Zocor (simvastatin) and the antibiotic Biaxin (clarithromycin). Biaxin (clarithromycin) is a strong inhibitor of CYP3A4, which is primarily responsible for Zocor (simvastatin) metabolism.

Taking both together can result in increased concentrations of Zocor (simvastatin), increasing the risk of adverse reactions, such as rhabdomyolysis, a serious medical condition characterized by the breakdown of muscle tissue (2, 3).

Studies have reported that berberine may inhibit several CYP metabolizing enzymes, including (4):

• CYP2C9
• CYP3A4
• CYP2C19
• CYP1A2

Fortunately, neither Mirapex nor Rytary are metabolized by CYP enzymes and therefore an interaction with them is not expected.

Berberine Info

Berberine is an alkaloid found in various plants, including (5):

• Goldenseal
• Goldthread
• Oregon grape
• European barberry
• Phellodendron
• Tree turm

It is a popular over the counter (OTC) herbal supplement, used for a variety of indications such as:

• High blood sugar/Diabetes (6)
• Gastrointestinal infections
• High blood pressure (7)
• High cholesterol (8)
• Canker sores (9)

Most studies report that berberine is well-tolerated, with the most common side effects being diarrhea, constipation, flatulence and abdominal pain (10).

Although safe for most, berberine has a wide range of effects on the body and caution is recommended if you have:

• High blood pressure
• High cholesterol
• High blood sugar

The reason caution is recommended is because berberine may have additive effects to the medication you are currently taking.

For example, if you are taking medication to lower blood sugar, berberine can have the same effect, potentially increasing your risk for hypoglycemia.

As mentioned above, be sure to let your doctor know about everything you are taking.

Berberine With Mirapex

Berberine is not known to interact with Mirapex.

Mirapex is not metabolized via CYP metabolizing enzymes, so an interaction isn't thought to be likely.

Per the prescribing information for Mirapex:

"Inhibitors of cytochrome P450 enzymes would not be expected to affect pramipexole elimination because pramipexole is not appreciably metabolized by these enzymes in vivo or in vitro."

Berberine With Rytary

Rytary is a combination drug product, and contains two active ingredients:

• Carbidopa
• Levodopa

Like Mirapex, the two active ingredients in Rytary are not metabolized via CYP enzymes and therefore, are not expected to interact with berberine.