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Combining fluoxetine with serotonergic weight loss ingredients (5-HTP, St John's wort, sibutramine) can cause serotonin syndromea potentially life-threatening condition

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NICE recommendations for type 2 diabetes management (NG28) emphasise: Lifestyle modification as the foundation: structured education (such as DESMOND), dietary changes, weight management, and physical activity Metformin as the first-line pharmacological treatment in most cases A stepwise approach to medication intensification based on individualised HbA1c targets Regular monitoring and cardiovascular risk reduction Berberine does not feature in these guidelines because there is insufficient evidence from large-scale, long-term trials conducted in UK populations to demonstrate its safety, efficacy, and cost-effectiveness compared to licensed treatments