Is Berberine Bad for Your Kidneys or Liver? The Trial Record

In the trials that measured them, up to three months at 600 to 1,500 mg a day, berberine did not worsen creatinine, urea or liver enzymes, and in ten trials of 811 people with fatty liver the liver enzymes fell.^{1, 2, 3} The cautions: no trial has included anyone with chronic kidney disease, it raises the blood levels of transplant medicines, and the French food-safety agency advises people with liver or heart conditions not to take it.¹⁸ Part of the Wellgard berberine guide; the gut effects are on berberine side effects.

Sources checked on 30 October 2026.

Is berberine bad for your kidneys?

No trial has recorded kidney harm, and none has included anyone with kidney disease, so the record speaks only for healthy kidneys. In 52 kidney-transplant recipients taking 0.2 g three times a day for three months with ciclosporin, against 52 who did not, there were "no significant effects on liver or renal functions"; in obese adults taking 500 mg three times a day for 12 weeks, kidney and liver tests "showed no detrimental side effects".^{1, 2} Neither reports an eGFR, the figure on a UK kidney blood test, and neither ran beyond three months; the renal team decides for anyone with kidney disease. The NHS chronic kidney disease page says "Check with a doctor or pharmacist if you plan to take any over-the-counter medicines", and names nutritional supplements; the NHS herbal medicines page says not to take herbal medicines if "you have kidney or liver problems".^{4, 5}

Is berberine bad for your liver?

The pooled trials recorded no rise in liver enzymes, and the human harm signal is small: no published case report, three regulator-recorded cases and one event in a 16-person trial. Across 37 diabetes trials of 3,048 people total adverse events were not increased; in 18 placebo-controlled lipid trials of 1,788 adults, the 16 reporting adverse events recorded no serious one; and across 12 trials in people with metabolic conditions ALT changed by −1.66 IU/L (95% CI −3.98 to 0.65) and AST by −0.87 IU/L, neither significant.^{6, 7, 8} The trial event: among 12 people with ulcerative colitis on 900 mg a day for three months with mesalazine, one grade 3 rise in transaminases; none of four on placebo.⁹ A PubMed search for a berberine liver-injury case report on 30 October 2026 returned no records; the three regulator-recorded cases (one in Canada, two in the US on a multi-ingredient product) had no link established, and the French food-safety agency's 2019 opinion advises people with liver conditions not to take berberine supplements.¹⁸

What did the fatty-liver trials find?

In people with non-alcoholic fatty liver disease (now called MASLD) the liver enzymes fell: across 10 randomised trials of 811 patients, ALT fell by a standardised effect of −0.72 (95% CI −1.01 to −0.44), AST by −0.79 and GGT by −0.62, with "only mild gastrointestinal adverse events reported".³ Those are standardised effect sizes, not U/L; the abstract gives neither units nor doses and durations. The finding concerns people who had fatty liver, and any place for berberine there is a liver clinic's question: the NHS says the condition "can usually be treated with healthy lifestyle changes".¹²

What about transplant medicines and the kidneys?

The transplant finding is the firmest berberine interaction measured in people, and it concerns the medicine, not the kidney. Trough ciclosporin levels ended 29% higher in the 52 recipients taking berberine than in the 52 taking ciclosporin alone; in six patients studied in detail, exposure rose 34.5% and half-life lengthened by 2.7 hours; liver and kidney tests did not change.¹ The mechanism is enzyme inhibition: in healthy men, two weeks of 300 mg three times a day reduced CYP3A4 activity (a probe medicine's exposure rose 40%) and CYP2D6 and CYP2C9 activity.¹³ That effect builds over days and does not switch off between doses, so spacing berberine from a medicine by a few hours does not remove the interaction.¹⁴ Tell the transplant team before any supplement; what medicines interact with berberine goes medicine by medicine.

Is berberine bad for your heart or blood pressure?

No oral berberine trial has recorded a heart-rhythm event; the caution rests on laboratory and historical intravenous findings, and on the French agency's advice. In obese adults taking 500 mg three times a day for 12 weeks, electrocardiographs showed no detrimental finding, and the pooled trials above reported no serious adverse event.^{2, 7} A 2017 toxicology review lists cardiotoxicity among berberine's dose- and route-dependent effects, and a 2026 interactions review lists QT prolongation, a heart-rhythm measure, and low blood pressure among the additive risks with medicines that have the same effects.^{11, 14} In the placebo-controlled pooling of metabolic-syndrome trials, blood pressure did not change significantly on berberine; it is not a blood-pressure treatment.¹⁵ With a heart-rhythm condition or on heart or blood-pressure medicines, ask your GP or pharmacist first; palpitations or fainting mean stop and see a GP, and 999 if someone collapses.

Does berberine make you pee more, or cause kidney stones?

No trial reports either: no study has measured a urinary effect, and no human study of berberine and kidney stones exists. A new urinary symptom is a GP conversation whatever you are taking; potassium is in the FAQ.

Before you take berberine: the cautions

Berberine displaces bilirubin from its carrier protein, which is why it is avoided in pregnancy, breastfeeding and infancy: in a jaundiced newborn the freed bilirubin can damage the brain; the French food-safety agency's 2019 opinion also advises children, adolescents and people with diabetes or liver or heart conditions not to take berberine supplements.^{10, 18} It interacts with medicines, as above, so a pharmacist checks any regular medicine.^{1, 13, 14} It adds its glucose-lowering to insulin and the sulfonylureas, so anyone on a diabetes medicine asks the diabetes team first (in the supervised diabetes trials hypoglycaemia was not increased: relative risk 0.48, not significant).⁶ How to take berberine covers the with-meals, divided-dose pattern the trials used; the gut effects are on berberine and gut health, pregnancy and breastfeeding on berberine for women.

What we don't know

Whether berberine is safe with chronic kidney disease: no randomised trial has included anyone with it, or on dialysis, and none reports eGFR.^{1, 2} Whether it is safe long term at the 900 to 2,400 mg a day most trials used: the longest ran about six months.^{6, 7} Whether oral berberine affects heart rhythm: no oral trial has recorded a rhythm event, and none was designed to look for one.^{2, 7}

Frequently asked questions

Is berberine safe for kidney disease?

Not studied: no randomised trial has included people with chronic kidney disease or on dialysis, so nobody can call it safe for reduced kidney function; the renal team decides, and the NHS asks people with kidney disease to check before any supplement.⁴

Is berberine good for fatty liver?

In 10 trials of 811 people with non-alcoholic fatty liver disease the liver enzymes, cholesterol and insulin resistance improved on berberine; it is a liver clinic's question, and the NHS route is lifestyle change first.^{3, 12}

Does berberine affect potassium?

No study has measured it. The potassium in berberine research is a potassium channel on cells, a laboratory mechanism, not the potassium level in your blood.^{6, 14} The NHS tells people with chronic kidney disease "it's important to avoid taking potassium supplements"; berberine is not one, and anyone told to watch potassium asks the renal team first.¹⁶

How long did the longest safety trial run?

Up to two years: 1,108 adults in China took 0.3 g of berberine twice a day or placebo after bowel-polyp removal; constipation was the commonest adverse event, 1% against under 0.5%, and no serious adverse event was reported.¹⁷

Sources

1. Wu X, et al. Effects of berberine on the blood concentration of cyclosporin A in renal transplanted recipients. European Journal of Clinical Pharmacology, 2005. Controlled trial, 52 against 52 transplant recipients, 3 months; funding not stated on PubMed. PubMed 16133554.
2. Hu Y, et al. Lipid-lowering effect of berberine in human subjects and rats. Phytomedicine, 2012. Pilot, obese adults, 500 mg three times a day for 12 weeks; funding not stated on PubMed. PubMed 22739410.
3. Nie Q, et al. The clinical efficacy and safety of berberine in the treatment of non-alcoholic fatty liver disease. Journal of Translational Medicine, 2024. Meta-analysis, 10 randomised trials, 811 people with fatty liver; no competing interests declared. PubMed 38429794.
4. NHS. Chronic kidney disease: living with. Page last reviewed 22 March 2023 (review was due 22 March 2026). Read 30 October 2026. nhs.uk/conditions/kidney-disease/living-with.
5. NHS. Herbal medicines and complementary therapies. Page last reviewed 1 May 2026. Read 30 October 2026. nhs.uk/conditions/herbal-medicines.
6. Xie W, et al. Glucose-lowering effect of berberine on type 2 diabetes. Frontiers in Pharmacology, 2022. Meta-analysis, 37 randomised trials, 3,048 adults; no commercial funding declared. PubMed 36467075.
7. Blais JE, Huang X, Zhao JV. Overall and sex-specific effect of berberine for the treatment of dyslipidemia in adults. Drugs, 2023. Meta-analysis, 18 placebo-controlled trials, 1,788 adults; funding not stated on PubMed. PubMed 36941490.
8. Asbaghi O, et al. The effect of berberine supplementation on obesity parameters, inflammation and liver function enzymes. Clinical Nutrition ESPEN, 2020. Meta-analysis, 12 randomised trials; no conflicts declared. PubMed 32690176.
9. Xu L, et al. A phase I trial of berberine in Chinese with ulcerative colitis. Cancer Prevention Research, 2020. Randomised phase I trial, 16 people, 900 mg a day for 3 months; funding not stated on PubMed. PubMed 31619442.
10. Chan E. Displacement of bilirubin from albumin by berberine. Biology of the Neonate, 1993. Laboratory and rat study. PubMed 8513024.
11. Rad SZK, Rameshrad M, Hosseinzadeh H. Toxicology effects of Berberis vulgaris (barberry) and its active constituent, berberine. Iranian Journal of Basic Medical Sciences, 2017. Narrative toxicology review. PubMed 28656087.
12. NHS. Non-alcoholic fatty liver disease (NAFLD). Page last reviewed 31 July 2025. Read 30 October 2026. nhs.uk/conditions/non-alcoholic-fatty-liver-disease.
13. Guo Y, et al. Repeated administration of berberine inhibits cytochromes P450 in humans. European Journal of Clinical Pharmacology, 2012. Crossover study, healthy men, 2 weeks; no conflict declared. PubMed 21870106.
14. Dumitru CN, et al. Berberine-drug interactions. Pharmaceuticals, 2026. Narrative review; no conflicts declared. PubMed 42653808.
15. Liu D, et al. Efficacy and safety of berberine on the components of metabolic syndrome. Frontiers in Pharmacology, 2025. Meta-analysis of placebo-controlled trials; no commercial funding declared. PubMed 40740996.
16. NHS. Chronic kidney disease: treatment. Page last reviewed 22 March 2023 (review was due 22 March 2026). Read 30 October 2026. nhs.uk/conditions/kidney-disease/treatment.
17. Chen YX, et al. Berberine versus placebo for the prevention of recurrence of colorectal adenoma. Lancet Gastroenterology & Hepatology, 2020. Randomised trial, 1,108 adults, up to 2 years; Chinese state research funding. PubMed 31926918.
18. ANSES. Opinion on the safety of berberine-containing plants in food supplements, saisine 2018-SA-0095. Agency opinion, in French, 1 August 2019. anses.fr.

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General information, not medical advice: with a kidney, liver or heart condition or any regular medicine, ask your specialist team, GP or pharmacist before berberine, and never change a prescribed medicine on the strength of a supplement.