Am curious about goldenseal and other berberine-containing plants and the
reputation for avoidance during lactation - have heard this yet fail to find
much evidence in descriptions/recommendations by knowledgable authors.  This
plant was not reviewed by Commission E.

The rather conservative authors of the Botanical Safety Handbook recommend it
not be used in pregnancy due to documented oxytocic and uterostimulant
properties of the plant's isoquinoline-type alkaloids (notably berberine,
hydrastine).  Like these authors, Brinker ( Herb Contraindications and Drug
Interactions) does not contraindicate for lactation, only for pregnancy.
Ody's herbal book does not mention lactation, only avoidance in pregnancy.

Newall et al.( Herbal Medicines for HCPs) states that berberine and berberine-
containing plants are considered non-toxic ( reference given) but potentially
toxic ( see below for more contradicting info) - they contraindicate for
pregnancy and suggest avoidance during lactation due to lack of information
(they suggest the same with most of the herbs in the book, including blessed
thistle and fenugreek).  Considerable work has been done on goldenseal's
pharmacology - it has anti-infective effects against bacteria (long list),
fungi, and protozoa.

The Bot Safety Handbood states that pure berberine is considered moderately
toxic with an LD 50 of 27.5 mg/kg in humans ( wonder how this was obtained??).
Goldenseal rhizome is reported to contain 0.5-6% berberine by weight, with a
typical tincture dose of 2-4 mls.  Total alkaloid content 2.5-6%.  Most
authors suggest very limited time for internal use.  Can irritate mucous
membranes, elevateblood pressure.  Decreases heparin anticoagulation.
Overdoses can induce GI upset, nervousness and depression. Very high overdoses
can cause a large range of serious/fatal cardiac, GI, CNS effects.

Another plant containing isoquinoline alkaloids (notably sanguinarine) is
bloodroot or Sanguinaria.  It is used as an effective bacterial inhibitor in a
widely available (US) commercial mouthwash and toothpaste.

Berberine-containing plants are used extensively to treat infections (esp.
antimalarial, antibacterial, dysentery ) in India, China/Asia as well as N.
America.  Perhaps at the global scale, the risks and benefits of use should be
considered differently than for populations able to afford easy access to
alternatives.

Sheila Humphrey
BSc  RN  IBCLC
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