Harmless herbs? A case report of acquired long QT syndrome and torsades de pointes in a patient taking herbal supplements
Open accessAbstract
Key Teaching Points•Herbal supplements are gaining popularity and are often perceived as harmless because of their “natural” character. However, the use of these supplements may be associated with considerable side effects.•Data concerning the effectiveness, toxicity, and potential for interactions of herbal supplements are limited.•Dosing recommendations should always be respected and possible interactions with other medication or supplements should be considered. •Herbal supplements are gaining popularity and are often perceived as harmless because of their “natural” character. However, the use of these supplements may be associated with considerable side effects.•Data concerning the effectiveness, toxicity, and potential for interactions of herbal supplements are limited.•Dosing recommendations should always be respected and possible interactions with other medication or supplements should be considered.
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Cases of torsades de pointes associated with berberine use have been reported.
“Cases of torsades de pointes associated with berberine use have been reported.”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [90]
The Case report describes one patient with torsades de pointes who was taking berberine as well as hemp oil. The Discussion attributes her prolonged QT interval to the concomitant supplements; this paper does not establish multiple cases or implicate berberine alone. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCausality for the torsades de pointes case cannot be assigned to berberine alone, because cannabidiol both prolongs repolarization and inhibits CYP3A4 and CYP2D6.
“Causality cannot be assigned to berberine alone, since cannabidiol both prolongs repolarization and inhibits CYP3A4 and CYP2D6, which makes this case an illustration of, rather than an exception to, the combined mechanism described below [90].”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [90]
The Discussion attributes the case to the combined intake of berberine supplements and hemp oil, rather than berberine alone. It also describes CBD’s potential to prolong repolarization and its in vitro inhibition of CYP3A4, but names CYP2C19—not CYP2D6—as the other main enzyme CBD inhibits. CYP2D6 appears in the Discussion as an enzyme for which berberine is a substrate. (LLM, conf=0.90)
Experimental — accuracy not yet measuredCase reports carry a different asymmetry: the torsades de pointes case involved concurrent cannabidiol at six times the recommended dose, which is typical of supplement case reports, where polypharmacy and product uncertainty usually prevent attribution to a single agent.
“Case reports carry a different asymmetry. The torsades de pointes case discussed in Section 2.2.3 involved concurrent cannabidiol at six times the recommended dose, which is typical of supplement case reports, where polypharmacy and product uncertainty usually prevent attribution to a single agent [90].”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [90]
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Experimental — accuracy not yet measuredIn a published case report, acquired long QT syndrome with torsades de pointes (QTc 667 ms) occurred in a woman taking 250 mg berberine together with a cannabidiol/cannabigerol hemp-oil preparation at six times the recommended dose; the QTc normalized within five days of stopping all supplements.
“In a published case report, acquired long QT syndrome with torsades de pointes (QTc 667 ms) occurred in a woman taking 250 mg berberine together with a cannabidiol/cannabigerol hemp-oil preparation at six times the recommended dose; the QTc normalized within five days of stopping all supplements.”
From Berberine-Drug Interactions: Mechanisms, Clinical Relevance and Risk Stratification-A Narrative Review (2026) · cites this paper as [90]
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References 11 · Cited by 10
- Authors
- Déléaval, M., Burri, H., & Bakelants, E.
- Affiliations
- University Hospital of Geneva (CH)
- Corresponding author
- Bakelants, Elise
- Venue
- HeartRhythm Case Reports
- Publisher
- Elsevier BV
- Published
- 2022-05
- Volume
- 8
- Issue
- 5
- Pages
- 309-312
- ISSN
- 2214-0271 (ISSN-L)
- PMC
- PMC9123311
- OpenAlex
- W4280651501
- Cited by
- 10
- References
- 11
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 1
- FWCI
- 1.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- HeartRhythm Case Reports (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Plant-based Medicinal Research
- Keywords
- acquired long QT syndrome, torsades de pointes, herbal supplements, supplement toxicity, drug interactions, herbal supplement safety, cardiac arrhythmias
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