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Updated 18 February 2013

Goldenseal (Hydrastis canadensis L.)

Goldenseal is one of the five top-selling herbal products in the United States. However, there is little scientific evidence about its safety or effectiveness. Goldenseal can be found in dietary supplements, eardrops, feminine cleansing products, cold/flu remedies, allergy remedies, laxatives, and digestive aids.

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Note: Goldenseal is sometimes referred to as "Indian turmeric" or "curcuma," but should not be confused with turmeric (Curcuma longa Linn.).

BACKGROUND

Goldenseal is one of the five top-selling herbal products in the United States. However, there is little scientific evidence about its safety or effectiveness. Goldenseal can be found in dietary supplements, eardrops, feminine cleansing products, cold/flu remedies, allergy remedies, laxatives, and digestive aids.

Goldenseal is often found in combination with echinacea in treatments for upper respiratory infections and is suggested to enhance the effects of echinacea. However, the effects when these agents are combined are not scientifically proven.

Goldenseal has been used by some people due to the popular notion that detection of illegal drugs in urine may be hidden by use of the herb, although scientific information is limited in this area.

The popularity of goldenseal has led to a higher demand for the herb than growers can supply. This high demand has led to the substitution of other herbs such as Chinese goldthread (Coptis chinensis Fransch.) and Oregon grape (Mahonia aquifolium [Pursh] Nutt.), that do not contain exactly the same isoquinoline alkaloids and may not affect the body in the same way as goldenseal.

Studies of the effectiveness of goldenseal are limited to one of its main chemical ingredients, berberine salts (there are few published human studies of goldenseal itself). Due to the small amount of berberine actually present in most goldenseal preparations (0.5-6%), it is difficult to extend the research of berberine salts to the use of goldenseal. Therefore, there is not enough scientific evidence to support the use of goldenseal in humans for any medical condition.

EVIDENCE TABLE

Conditions

Uses
disclaimer: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Grade*

Chloroquine-resistant malaria

A small amount of research reports that berberine, a chemical found in goldenseal, may be beneficial in the treatment of chloroquine-resistant malaria when used in combination with pyrimethamine. Due to the very small amount of berberine found in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have these effects. More research is needed before a recommendation can be made.

C

Common cold / upper respiratory tract infection

Goldenseal has become a popular treatment for the common cold and upper respiratory tract infections, and is often added to echinacea in commercial herbal cold remedies. Animal and laboratory research suggests that the goldenseal component berberine has effects against bacteria and inflammation. However, due to the very small amount of berberine in most goldenseal preparations, it is unclear whether goldenseal contains enough berberine to have the same effects.

C

Heart failure

One study suggests that berberine in addition to a standard prescription drug regimen for chronic congestive heart failure (CHF) may improve quality of life and decrease ventricular premature complexes (VPCs) and mortality. Further research is needed to confirm these results.

C

High cholesterol

Berberine, a compound isolated from a Chinese herb, may lower cholesterol and triglycerides with a mechanism of action different from that of statin drugs.

C

Immune system stimulation

Goldenseal is sometimes suggested to be an immune system stimulant. However, there is little human or laboratory evidence in this area. More research is needed before a firm conclusion can be drawn.

C

Infectious diarrhea

Berberine has been used as a treatment for diarrhea caused by bacterial infections (including diarrhea from cholera). Due to the very small amount of berberine in most goldenseal products, it is unclear whether goldenseal contains enough berberine to have the same effects. Therefore, there is currently not enough scientific evidence to make a firm recommendation in this area.

C

Narcotic concealment (urine analysis)

It has been suggested that taking goldenseal can hide the presence of illegal drugs from urine tests. However, there is limited research to support this idea. One study from the National Institute on Drug Abuse, National Institutes of Health, looked at marijuana and cocaine use and suggested that goldenseal probably does not have this effect.

C

Trachoma (Chlamydia trachomatosis eye infection)

The goldenseal component berberine has effects against bacteria and inflammation. Several poorly designed human studies report benefits of berberine used in the eye to treat trachoma. Better research is needed before a strong recommendation can be made.

C

*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

TRADITION

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Abnormal heart rhythms, acne, AIDS, alcoholic liver disease, anal fissures, anesthetic, antibacterial, anticoagulant (blood "thinning"), antifungal, antihistamine, anti-inflammatory, astrocytoma (brain tumor), atherosclerosis ("hardening" of the arteries), anxiety, appetite stimulant, arthritis, asthma, athlete's foot, bile flow stimulant, blood circulation stimulant, boils, bronchitis, cancer, canker sores, cervicitis (inflammation of the cervix), chemotherapy adjuvant, chicken pox, chronic fatigue syndrome, colitis (intestinal inflammation), conjunctivitis, constipation, Crohn's disease, croup, cystic fibrosis, cystitis, dandruff, deafness, diabetes mellitus, diarrhea, diphtheria, diuretic (increasing urine flow), eczema, eyewash, fever, fistula problems, flatulence (gas), gallstones, gangrene, gastroenteritis, genital disorders, gingivitis, glioblastoma, headache, H. pylori infection, hemorrhage (bleeding), hemorrhoids, hepatitis, hernia, herpes, high blood pressure, high tyramine levels, hypoglycemia (low blood sugar levels), impetigo, inducing (causing) abortion, indigestion, infections, influenza, insulin potentiation, itching, jaundice, keratitis (inflammation of the cornea of the eye), leishmaniasis, liver disorders, lupus, menstruation problems, morning sickness, mouthwash, muscle pain, muscle spasm, night sweats, obesity, osteoporosis, otorrhea (fluid from the ear), pain, pneumonia, premenstrual syndrome, prostatitis, psoriasis, sciatica, seborrhea, sedative, sinusitis, stomach ulcers, stimulant, strep throat, syphilis, tetanus, thrombocytopenia (low blood platelets), tinnitis (ringing in the ears), tonsillitis, tooth disease, trichomoniasis (vaginal infection), tuberculosis, urinary tract disorders, uterus inflammation, uterus stimulant, vaginal irritation, varicose veins, yeast infection.

DOSING

disclaimer: The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

For general use, various types of goldenseal dosing have been used, each taken by mouth three times daily, including 0.5 to 1 gram tablets or capsules, 0.3 to 1 milliliter of liquid/fluid extract (1:1 in 60% ethanol), 0.5 to 1 gram as a decoction, or 2 to 4 milliliters as a tincture (1:10 in 60% ethanol).

For infectious diarrhea, 100 to 200 milligrams of berberine hydrochloride taken by mouth four times daily or a single dose of 400 milligrams taken by mouth has been studied. Berberine sulfate is often used as well, and the hydrochloride and sulfate forms are generally thought to be equivalent.

Children (younger than 18 years)

There is not enough scientific evidence to safely recommend the use of goldenseal in children.

SAFETY

disclaimer: The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Goldenseal should be avoided by people with known allergy/hypersensitivity to goldenseal or any of its constituents, including berberine and hydrastine.

Side Effects and Warnings

Goldenseal is rarely reported to cause nausea, vomiting, breathing failure, or a feeling of numbness in the arms or legs. Large doses of goldenseal may cause mucus membrane irritation and worsening or stomach ulcers. Goldenseal used on the skin may cause irritation or ulcers.

Goldenseal may cause low sodium levels in the blood.

Possible effects of berberine, a chemical found in small amounts in goldenseal, include headache, slow heart rate, nausea, vomiting, abdominal bloating, and low white blood cell count. It is not clear if the amount of berberine in goldenseal products is enough to cause these reactions. Toxic doses of berberine may cause seizures or irritation of the esophagus and stomach when taken by mouth. Berberine used intravenously (through the veins) may cause abnormal heart rhythms. Berberine may increase blood concentrations of bilirubin. Berberine theoretically may cause low blood pressure, although a different chemical in goldenseal, hydrastine, may actually cause increased blood pressure.

Goldenseal or berberine could increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Goldenseal or berberine may cause increased sun sensitivity, although this is not a commonly reported symptom.

Berberine may lower blood sugar. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

The popularity of goldenseal has led to the substitution of other alkaloid-containing herbs, including Chinese goldthread (Coptis chinensis) and Oregon grape, which do not contain the same active components and may increase the risk of serious toxicity or adverse events.

Pregnancy and Breastfeeding

Use of goldenseal or berberine is not recommended during pregnancy or breastfeeding. The chemical hydrastine (found in goldenseal) may induce labor when taken by mouth during pregnancy, and could have dangerous effects.

INTERACTIONS

disclaimer: Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Goldenseal or its component berberine could increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin©) or heparin, anti-platelet drugs such as clopidogrel (Plavix©), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin©, Advil©) or naproxen (Naprosyn©, Aleve©).

Goldenseal may interfere with the way the body processes certain drugs using the cytochrome P450 liver enzyme system. As a result, the levels of these drugs may be increased in the blood and this may cause increased effects or potentially serious adverse reactions. Chemicals in goldenseal may increase the effects of L-phenylephrine and decrease the effects of tetracycline, neostigmine, or yohimbine.

Berberine may reduce the gastrointestinal absorption of P-glycoprotein mediated substrates including chemotherapeutic agents such as daunomycin.

Berberine may lower blood sugar. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

Berberine may lower cholesterol and triglycerides levels, increasing the effects of some drugs like lovastatin (Mevacor©).

Interactions with beta-blockers or 1,3,-bisC2- chloroethyn-1-nitosurea (BCNU) may occur.

Interactions with Herbs and Dietary Supplements

Goldenseal or its component berberine could increase the risk of bleeding when taken with herbs or supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Goldenseal may interfere with the way the body processes certain herbs and supplements using a liver enzyme called cytochrome P450. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system, such as bloodroot, cat's claw, or chamomile. The goldenseal component berberine may reduce the effectiveness of yohimbine, which is found in small amounts in yohimbe bark extract.

Berberine may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Berberine may lower cholesterol and triglycerides levels increasing the effects of some herbs and supplements like red rice yeast and guggul.

ATTRIBUTION

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

  • Bhowmick SK, Hundley OT, Rettig KR. Severe hypernatremia and hyperosmolality exacerbated by an herbal preparation in a patient with diabetic ketoacidosis. Clin Pediatr (Phila) 2007 Nov;46(9):831-4. View abstract
  • Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo effects of goldenseal, kava kava, black cohosh, and valerian on human cytochrome P450 1A2, 2D6, 2E1, and 3A4/5 phenotypes. Clin Pharmacol Ther 2005;77(5):415-426. View abstract
  • Gurley BJ, Swain A, Hubbard MA, et al. Supplementation with goldenseal (Hydrastis canadensis), but not kava kava (Piper methysticum), inhibits human CYP3A activity in vivo. Clin Pharmacol Ther 2008 Jan;83(1):61-9. View abstract
  • Inbaraj JJ, Kukielczak BM, Bilski P, et al. Photochemistry and photocytotoxicity of alkaloids from Goldenseal (Hydrastis canadensis L.) 1. Berberine. Chem Res Toxicol 2001;14(11):1529-1534. View abstract
  • Khin MU, Myo K, Nyuat NW, et al. Clinical trial of berberine in acute watery diarrhoea. Br Med J (Clin Res Ed) 12-7-1985;291(6509):1601-1605. View abstract
  • Kong W, Wei J, Abidi P, et al. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Nat Med 2004;10(12):1344-1351. View abstract
  • Pan GY, Huang ZJ, Wang GJ, et al. The antihyperglycaemic activity of berberine arises from a decrease of glucose absorption. Planta Med 2003;69(7):632-636. View abstract
  • Pan JF, Yu C, Zhu DY, et al. Identification of three sulfate-conjugated metabolites of berberine chloride in healthy volunteers' urine after oral administration. Acta Pharmacol Sin 2002;23(1):77-82. View abstract
  • 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 1987;155(5):979-984. View abstract
  • Sheng WD, Jiddawi MS, Hong XQ, et al. Treatment of chloroquine-resistant malaria using pyrimethamine in combination with berberine, tetracycline or cotrimoxazole. East African Medical Journal 1997;74(5):283-284.
  • Wang DY, Yeh CC, Lee JH, et al. Berberine inhibited arylamine N-acetyltransferase activity and gene expression and DNA adduct formation in human malignant astrocytoma (G9T/VGH) and brain glioblastoma multiforms (GBM 8401) cells. Neurochem Res 2002;27(9):883-889. View abstract
  • Yao M, Ritchie HE, Brown-Woodman PD. A reproductive screening test of goldenseal. Birth Defects Res B Dev Reprod Toxicol 2005 Oct;74(5):399-404. View abstract
  • Yin J, Hu R, Chen M, et al. Effects of berberine on glucose metabolism in vitro. Metabolism 2002;51(11):1439-1443. View abstract
  • Yount G, Qian Y, Moore D, et al. Berberine sensitizes human glioma cells, but not normal glial cells, to ionizing radiation in vitro. J Exp Ther Oncol 2004;4(2):137-143. View abstract
  • Zeng XH, Zeng XJ, Li YY. Efficacy and safety of berberine for congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 7-15-2003;92(2):173-176. View abstract
disclaimer: Natural Standard Bottom Line Monograph, Copyright © 2011 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. disclaimer: While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy. disclaimer: The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

Copyright © 2011 Natural Standard (www.naturalstandard.com)



Copyright © 2011 Natural Standard (www.naturalstandard.com)
 
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