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At the cellular level, vitamin B12 is involved in DNA synthesis and neuroprotection, acting as a cofactor for enzymes critical to these processes, such as methionine synthase and methylmalonyl-CoA mutase (72, 73)

GLP-1 receptor agonists like semaglutide and liraglutide intentionally slow gastric emptying as part of their therapeutic mechanism, but distinguishing this expected effect from true gastroparesis presents diagnostic challenges

The most clinically documented interaction is with cyclosporine, where berberine can significantly increase blood levels, potentially requiring dose adjustments and therapeutic drug monitoring

doi: 10.3390/cancers6031597 104 YuQRenLRenFLiF