Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal is available in liquid, tablet, and capsule forms standardized to the active components.
(See also Overview of Dietary Supplements Overview of Dietary Supplements Dietary supplements are the most commonly used of all integrative, complementary, and alternative therapies, primarily because they are widely available, relatively inexpensive, and can be bought... read more and National Institutes of Health (NIH): Goldenseal.)
Claims
Various preparations of goldenseal are used as an antiseptic wash for mouth sores, inflamed and sore eyes, and irritated skin and as a douche for vaginal infections. It has been combined with echinacea as a cold remedy. Goldenseal is also used as a remedy for indigestion and diarrhea.
Evidence
Efficacy of goldenseal alone as a cold remedy has not been supported (1 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ). In 2 relatively well-designed but small studies, berberine, the major alkaline constituent isolated from goldenseal, reduced diarrhea (2-3 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ). Berberine has also reduced symptoms in diarrhea-predominant irritable bowel syndrome (4 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ). There are few, if any, recent, large, randomized, blinded clinical trials of goldenseal extract.
Emerging evidence shows that in patients with diabetes, berberine can decrease fasting and postprandial glucose and hemoglobin A1C. A meta-analysis of berberine in 28 studies (2313 subjects) compared berberine to lifestyle modifications, diabetes medication monotherapy, or berberine combined with diabetes medications. In this analysis, berberine significantly lowered fasting glucose, postprandial glucose, and hemoglobin A1C and was more effective in combination with oral diabetes medications than the diabetes medications or berberine used as monotherapy (5 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ). However, effects were attenuated with treatment duration > 90 days and in people older than 60 years.
For hyperlipidemia, a meta-analysis of 16 studies (2417 subjects) found that compared to placebo berberine significantly lowered total and low-density lipoprotein cholesterol and triglycerides, and increased high-density lipoprotein cholesterol (6 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ). However, there was a high degree of heterogeneity in results and risk of bias.
Adverse Effects
Goldenseal can have many adverse effects, including nausea, anxiety, dyspepsia, uterine contractions, and jaundice in neonates. If taken in large amounts, goldenseal can cause seizures and respiratory failure and may affect contraction of the heart. Women who are pregnant or breastfeeding, neonates, and people who have seizure disorders or problems with blood clotting should not take goldenseal. A recent in vitro study of the active ingredients of goldenseal, specifically berberine, indicates an increased risk of DNA damage leading to tumorigenic effects (7 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ).
Drug Interactions
Goldenseal may interact with warfarin, and berberine may enhance the anticoagulant effect of heparin. In addition, berberine inhibits CYP 450 isoenzymes and may increase serum concentrations of drugs such as midazolam, omeprazole, dextromethorphan, losartan, tacrolimus, and caffeine (8 References Goldenseal, an endangered US plant, is related to the buttercup (Hydrastis canadensis). Its active components are hydrastine and berberine, which have antiseptic activity. Goldenseal... read more ).
Goldenseal may increase levels of cyclosporine. Goldenseal may decrease the blood levels of metformin, potentially hindering glucose control in people with type 2 diabetes taking metformin. The berberine in goldenseal may also increase the hypoglycemic effects of antihyperglycemic drugs.
(See also table .)
References
1. Rehman J, Dillow JM, Carter SM, et al: Increased production of antigen-specific immunoglobulins G and M following in vivo treatment with the medicinal plants Echinacea angustifolia and Hydrastis canadensis. Immunol Lett 68(2-3):391-395, 1999. doi: 10.1016/S0165-2478(99)00085-1
2. Khin-Maung-U, Myo-Khin, Nyunt-Nyunt-Wai, et al: Clinical trial of berberine in acute watery diarrhoea. Br Med J (Clin Res Ed) 291(6509):1601-1605, 1985. doi:10.1136/bmj.291.6509.1601
3. Rabbani GH, Butler T, Knight J, et al: Randomized controlled trial of berberine sulfate therapy for diarrhea due to enterotoxigenic Escherichia coli and Vibrio cholerae. J Infect Dis 155(5):979-984, 1987. doi:10.1093/infdis/155.5.979
4. Chen C, Tao C, Liu Z, et al: A randomized clinical trial of berberine hydrochloride in patients with diarrhea-predominant irritable bowel syndrome. Phytother Res 29(11):1822-7, 2015. doi: 10.1002/ptr.5475
5. Liang Y, Xu X, Yin M, et al: Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis. Endocr J 66(1):51-63, 2019. doi:10.1507/endocrj.EJ18-0109
6. Ju J, Li J, Lin Q, et al: Efficacy and safety of berberine for dyslipidaemias: a systematic review and meta-analysis of randomized clinical trials. Phytomedicine 50:25-34, 2018. doi:10.1016/j.phymed.2018.09.212
7. Chen S, Wan L, Couch L, et al: Mechanism study of goldenseal-associated DNA damage. Toxicol Lett 221(1):64-72, 2013. doi: 10.1016/j.toxlet.2013.05.641
8. Guo Y, Chen Y, Tan ZR, Klaassen CD, Zhou HH: Repeated administration of berberine inhibits cytochromes P450 in humans. Eur J Clin Pharmacol 68(2):213‐217, 2012. doi:10.1007/s00228-011-1108-2
More Information
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
National Institutes of Health (NIH), National Center for Complementary and Integrative Health: General information on the use of goldenseal as a dietary supplement
Drugs Mentioned In This Article
| Drug Name | Select Trade |
|---|---|
echinacea |
No brand name available |
warfarin |
Coumadin, Jantoven |
heparin |
Hepflush-10 , Hep-Lock, Hep-Lock U/P, Monoject Prefill Advanced Heparin Lock Flush, SASH Normal Saline and Heparin |
midazolam |
Nayzilam, Versed, Versed Syrup |
omeprazole |
Prilosec, Prilosec OTC |
dextromethorphan |
AeroTuss, Buckley's Cough Suppressant , Buckley's DM, Buckley's Mixture, Cough DM, Cough Suppressant , Delsym, Delsym Children's, Delsym Children's Cough Relief, Delsym Cough, Dexalone, ElixSure Cough, ElixSure Cough DM, Giltuss DM, PediaCare Children's Long Acting Cough, PediaCare Infants' Long-Acting Cough, PediaCare Long-Acting Cough , Robafen Cough, Robitussin, Robitussin Children's Cough, Robitussin Cough, Robitussin CoughGels, Robitussin Lingering Cold Long-Acting Cough, Robitussin Pediatric Cough, Scot-Tussin CF, Silphen DM, Theraflu Long Acting Cough Strip, Triaminic Long Acting Cough , Triaminic Long Acting Cough Strip, Tylenol Children's Simply Cough, Vicks DayQuil Cough, Vicks DayQuil Nature Fusion, Vicks Formula 44, Vicks Nature Fusion Cough, Zicam Concentrated Cough, Zicam Cough Max, Zicam Cough Nite |
tacrolimus |
ASTAGRAF XL, ENVARSUS, HECORIA, Prograf, Protopic |
caffeine |
Cafcit, NoDoz, Stay Awake, Vivarin |
cyclosporine |
Cequa, Gengraf , Neoral, Restasis, Sandimmune, SangCya, Verkazia |
metformin |
Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet, RIOMET ER |
