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Note that metformin alone rarely causes hypoglycaemia, but the risk may be higher with sulphonylureas or insulin Medicines metabolised by CYP3A4 or CYP2D6 enzymes : Berberine may inhibit these enzymes, potentially affecting blood levels of many medicines P-glycoprotein substrates : Berberine may affect transport of certain medicines, including some immunosuppressants and cardiac drugs Berberine products should be avoided during pregnancy and breastfeeding due to insufficient safety data