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Ashwagandha: Safety, Liver Reports and What to Know

Also known as Withania somnifera, Indian ginseng, winter cherry, KSM-66, ashwagandha root extract

Short answer

Ashwagandha (Withania somnifera) is an herb from Ayurvedic medicine; most supplements use root or root-and-leaf extracts [1][2]. It appears well tolerated for up to about 3 months, but long-term safety is unknown [1][2]. Rare cases of liver injury have been reported. Avoid it in pregnancy and breastfeeding, and ask first if you have thyroid or autoimmune conditions [1].

Last reviewed · 2 sources

What is Ashwagandha?

Ashwagandha is an evergreen shrub. Its root has long been used in Ayurvedic and Unani medicine, where it is called an adaptogen [2]. It contains plant compounds called withanolides, as well as alkaloids [2]. It is being studied for stress, sleep and anxiety, but most studies are small and short and used different preparations, and evidence on anxiety is unclear [1][2].

Forms of Ashwagandha you'll see on labels

  • Root extract

    Most commercial ashwagandha supplements contain extracts of the root [2].

  • Root-and-leaf extract

    Some products combine root and leaf. Root and leaf have different chemical makeups [2].

  • Standardized extracts

    Some extracts are standardized to a withanolide content. Studies used many different extracts and methods, so results for one cannot be applied to another [2].

  • Root powder

    Dried root powder, sometimes made into granules, was used in some studies [2].

How Ashwagandha appears on a label

Labels list the extract amount in milligrams (mg), the plant part (root, leaf or both) and sometimes the percent of withanolides [2]. NIH says it is hard to recommend amounts because studies used different preparations and doses; one review covered 240 to 1,250 mg/day of various extracts [2].

When to take Ashwagandha

NIH sources do not name a best time of day, and they do not say whether to take ashwagandha with or without food.

What to keep apart from Ashwagandha

  • Thyroid hormone medicines

    Ashwagandha might affect thyroid function and interact with thyroid medicines [1][2]. Ask your doctor or pharmacist.

  • Diabetes and blood pressure medicines

    Ashwagandha might interact with these medicines [1]. Ask your pharmacist.

  • Sedatives and anti-seizure medicines

    Possible interactions are reported [1]. Ashwagandha can also cause drowsiness [1]. Ask your pharmacist.

  • Immunosuppressants

    Ashwagandha might interact with medicines that lower the immune response [1]. Ask your doctor.

Who should ask a doctor or pharmacist first

Avoid ashwagandha during pregnancy and do not use it while breastfeeding [1]. It is not recommended for people about to have surgery or for people with autoimmune or thyroid disorders [1]. People with hormone-sensitive prostate cancer should avoid it because it may raise testosterone [1]. If you have liver disease, or take medicines for diabetes, blood pressure, thyroid, seizures, sleep or immune suppression, ask a doctor or pharmacist first [1][2].

Keep Ashwagandha in a routine that fits

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Ashwagandha: questions people ask

It may be safe for short-term use, up to about 3 months, but there is not enough information on long-term safety [1]. Side effects can include drowsiness, stomach upset, diarrhea and vomiting [1].

Rarely, yes. A number of liver injury cases have been linked to ashwagandha supplements [1]. In reported cases, people improved after stopping [2]. Reported signs included yellow skin or eyes, itching, nausea and tiredness [2].

No. NCCIH says to avoid ashwagandha during pregnancy and not to use it while breastfeeding [1].

It might. Small studies found changes in thyroid hormone levels, and there are case reports of thyrotoxicosis that resolved after stopping [2]. People with thyroid disorders are advised not to use it [1].

There is no official amount. NIH says studies used many different preparations and doses, which makes recommendations hard [2].

It appears to be well tolerated for up to about 3 months. Safety over many months or years is not known [1][2].

Denmark banned ashwagandha in 2023, and France's food safety agency advised against it for some groups, including pregnant and breastfeeding women [2].

Ask your pharmacist first. It might interact with medicines for diabetes, blood pressure, thyroid and seizures, as well as sedatives and immunosuppressants [1].

Sources

  1. Ashwagandha — NIH National Center for Complementary and Integrative Health (NCCIH)
  2. Ashwagandha: Fact Sheet for Health Professionals — NIH Office of Dietary Supplements

Educational information, not medical advice. The amounts above are official reference values, not a recommendation for you. Check with your doctor or pharmacist before starting or changing supplements, especially if you take medication, are pregnant or have a health condition. Supin sells a subscription, not supplements. Last reviewed .

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