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[7] [8] Particular caution is warranted with: Diabetes medications (metformin, sulphonylureas, insulin) — berberine may enhance glucose-lowering effects, increasing hypoglycaemia risk Immunosuppressants (ciclosporin, tacrolimus) — berberine may increase blood levels of these medications via CYP3A4 inhibition [8] Anticoagulants — theoretical interactions require caution Other medications metabolised by CYP enzymes — effects may be variable Individuals taking multiple medications should consult their GP or pharmacist before starting berberine
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