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Emodin and aloe-emodin are isomers with inhibitory effects on CYP1B1 activity (Meng et al., 2022)
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This leads to increase in gastric volumes and putting the patients at increased risk of aspiration during sedation (107)
In infants, signs of a vitamin B12 deficiency include failure to thrive, problems with movement, delays in reaching the typical developmental milestones, and megaloblastic anemia
Clinical Recommendations If you have diabetes and are considering berberine: Never start berberine without discussing it with your GP or diabetes specialist nurse Increase blood glucose monitoring frequency if berberine is commenced Be vigilant for hypoglycaemia symptoms: sweating, tremor, hunger, confusion, or palpitations Your diabetes medication doses may require adjustment under clinical supervision Keep fast-acting glucose (e.g., glucose tablets, sugary drink) readily available and follow your local hypoglycaemia management plan NICE guidelines (NG28) for type 2 diabetes management do not include berberine as a recommended treatment option
Shift toward non-daily dosing and non-injectable routes: weekly injectables, oral tablets and pipeline transdermal/patch approaches are reducing treatment burden
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