✓ No active regulatory warningsFDA MedWatch, EMA EudraVigilance, WHO VigiBase, WADA Prohibited List · 2026-05-29
📰Read the full Goldenseal evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ Patient on codeine/tramadol using goldenseal — CYP2D6 inhibition blocks active metabolite [1]
⚠ Patient on CYP3A4 drugs — goldenseal interaction (grapefruit-equivalent) [1]
⚠ Patient buying goldenseal to pass drug test — myth; won't work [1]
⚠ Wild-harvested goldenseal — CITES endangered; choose cultivated or Oregon grape [1]
⚠ Pregnant patient — berberine is uterotonic; contraindicated [1]
ℹ️ Not obtained from food. Not applicable — this is not obtained from food in meaningful amounts; supplementation is the practical route.
🔬 Lab interpreter
Recommended test
Drug levels if on CYP2D6/3A4 medications
Drug levels if on CYP2D6/3A4 medications
Reference range / target
Therapeutic ranges
Therapeutic ranges
Pharmacokinetically verified CYP inhibition [1].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Goldenseal contains berberine (0.5–6%) but at lower levels than dedicated berberine supplements. Its two most important clinical facts: (1) verified CYP2D6 + CYP3A4 inhibition — a real drug interaction affecting codeine, tramadol, statins, and many other drugs; (2) the drug test masking myth is definitively FALSE. CITES-endangered — Oregon grape is the sustainable alternative [1].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
AVOID. Berberine causes uterine contractions. Traditional emmenagogue [1].
👦 Pediatric: See guidance
Not recommended for children. Berberine safety in children not established [1].
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: TID with meals [1].
💊 With food: With food to reduce GI irritation (very bitter) [1].
🚫 Avoid: During pregnancy. With CYP2D6/CYP3A4 drugs. Wild-harvested (CITES) [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['Goldenseal root extract', 'common', '250–500 mg TID. Standardized to berberine or total alkaloid content [1].'] | Standard | Check label | |
| ['Goldenseal + Echinacea combination', 'popular', 'Most common OTC cold/flu combination with goldenseal [1].'] | Standard | Check label | |
| ['Goldenseal tincture', 'traditional', '1–2 mL TID. Strong bitter taste [1].'] | Standard | Check label | |
| ['Oregon grape root (Mahonia)', 'sustainable alternative', 'Contains berberine. Not endangered. More sustainable than goldenseal [1].'] | Standard | Check label |
3 Common questions
Can goldenseal help me pass a drug test? ▼
NO. This is one of the most persistent myths in herbal medicine. Pharmacokinetic studies have definitively shown that goldenseal does NOT alter detection of THC, opiates, amphetamines, or other substances on standard immunoassay tests. The myth originated from a 1900 novel by John Uri Lloyd and has no scientific basis [1].
Is goldenseal a natural antibiotic? ▼
Berberine has genuine antimicrobial activity in vitro. However, oral berberine absorption is poor (~5%), and the berberine content in goldenseal is lower than dedicated berberine supplements. Topical goldenseal (eye wash, wound wash) has more pharmacological rationale than oral use for infections [1].
Why not just take berberine instead? ▼
If the goal is berberine's metabolic effects (glucose, lipids), dedicated berberine supplements (97% berberine, 500 mg BID) are more effective and cheaper than goldenseal (0.5–6% berberine). Goldenseal's niche is traditional cold formulas (with echinacea) and the additional hydrastine alkaloid [1].
Is goldenseal endangered? ▼
Yes. Hydrastis canadensis is CITES Appendix II due to overharvesting from wild Appalachian populations. Choose cultivated goldenseal or, better yet, Oregon grape (Mahonia aquifolium) — a more sustainable berberine source with similar alkaloid profile [1].
4 Clinical evidence
Strong
CYP inhibition: goldenseal (berberine + hydrastine) significantly inhibits CYP2D6 and CYP3A4 in pharmacokinetic studies — a clinically verified drug interaction [1]. HIGH
Moderate
Antimicrobial: berberine from goldenseal has broad-spectrum activity against bacteria, fungi, and protozoa in vitro (MRSA, E. coli, Candida, Giardia). Topical goldenseal used for wound/eye infections traditionally [1]. Upper respiratory infections: 1 small RCT of goldenseal+echinacea showed reduced cold duration, but goldenseal alone was not studied [1]. MODERATE
Insufficient
Drug test masking: pharmacokinetic studies confirm goldenseal does NOT mask THC, opiates, or other drugs on standard immunoassay tests. This myth originated from a 1900 John Uri Lloyd novel [1]. Immune stimulation: sometimes marketed as 'natural antibiotic,' but goldenseal's berberine is poorly absorbed orally and systemic antimicrobial effects at supplement doses are questionable [1]. Diabetes: berberine from goldenseal is too low-dose for the glucose-lowering effects seen with dedicated berberine (500 mg BID) [1]. LOW
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Pregnancy — berberine can cross the placenta and cause kernicterus in the newborn
✕ Neonates/infants
Relative
⚠ Berberine potently inhibits CYP3A4/CYP2D6 and P-glycoprotein — many drug interactions (important)
⚠ Concurrent ciclosporin and other narrow-window drugs
⚠ 'Masking' use to beat drug tests is ineffective
🚩 Red flags
● Patient on codeine + goldenseal — CYP2D6 inhibition; pain medication won't work [1]
● Pregnant patient using goldenseal [1]
● Patient buying wild goldenseal [1]
6 Interactions
Drug interactions
Codeine / Tramadol (CYP2D6 prodrugs) Major
Mechanism: Goldenseal inhibits CYP2D6, blocking conversion to active metabolites [1].
Effect: Codeine: no analgesic effect (can't form morphine). Tramadol: reduced efficacy [1].
Action: Avoid combination [1].
CYP3A4 substrates (statins, immunosuppressants) Moderate
Mechanism: CYP3A4 inhibition from berberine + hydrastine [1].
Effect: Increased drug levels [1].
Action: Monitor; same cautions as grapefruit [1].
Supplement synergies
Echinacea · Standard doses of each × 5–10 days
Traditional cold/flu combination. Complementary immune mechanisms [1].
Traditional cold/flu combination. Complementary immune mechanisms [1].
7 Regulatory
United States: CITES Appendix II. Available as dietary supplement. No FDA-approved claims [1].
CITES: International trade regulated due to overharvesting [1].
8 US supplement products
147
on-market products containing Goldenseal (NIH DSLD)
Brands carrying Goldenseal (81)
Click a brand to see its Goldenseal products.
9 Frequently paired with
10 Cite this page
Vancouver: Pkhakadze G. Goldenseal — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Sep 01]. Available from: https://supplement.ge/ingredients/goldenseal/
APA 7th: Pkhakadze, G. (2026). Goldenseal — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/goldenseal/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: March 2027
References: 4 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Goldenseal — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/goldenseal/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG