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Printed from https://bottledhope.co/supplements/ashwagandha/. Last reviewed 2026-09-26. Check the site for the latest version.

Ashwagandha

An evergreen shrub used in Ayurvedic medicine for thousands of years. Its supplements are promoted for stress and anxiety, sleep, and athletic performance.

Explained simply · Last reviewed

What it is

Ashwagandha is an evergreen shrub, Withania somnifera. NCCIH, the US agency that studies complementary medicine, says it has been used as a medicinal plant for thousands of years, especially in traditional Ayurvedic medicine. It says ashwagandha supplements are now often promoted for stress and anxiety, sleep, male infertility and athletic performance, and typically contain extracts of the root, the leaf, or both.

More about Ashwagandha

NCCIH, the US agency that studies complementary medicine, says it has been used as a medicinal plant for thousands of years, especially in traditional Ayurvedic medicine. It says ashwagandha supplements are now often promoted for stress and anxiety, sleep, male infertility and athletic performance, and typically contain extracts of the root, the leaf, or both.

LiverTox, the US government's liver-injury database, describes ashwagandha as an Ayurvedic herb derived from extracts of the roots of this low-growing shrub, which it says is native to India and Southeast Asia. It says the name is a Sanskrit word meaning "horse smell", and that the herb is sometimes called "Indian ginseng". It calls ashwagandha the most frequently used Ayurvedic medication, and says it has recently become a popular herbal product in Western countries.

LiverTox reports that the plant's extracts contain more than 100 different chemical constituents, including alkaloids, steroidal lactones, saponins, withanolides and withaferins. It states that the ingredient responsible for its purported activities and side effects is not known, but that the withanolides are suspected. It says root extracts are often supplied as capsules or tablets, and that the total amount taken varies widely.

Also known as: Withania somnifera, Indian ginseng, winter cherry, poison gooseberry

At a glance

Safety: known risks, 5 groups who should avoid it or take extra care and 6 documented interactions. See Safety ↓

Claims made about Ashwagandha, and how strong the evidence is for each:

Each rating follows our published rules and the sources cited for it. We don’t add our own medical judgment. How we rate

Safety

Read this before the ratings below.

Risks

  • LiverTox, the US government’s liver-injury database, reports cases of clinically apparent liver injury in people taking commercial products labeled as containing ashwagandha. It assigns ashwagandha a likelihood score of B — a likely cause of clinically apparent liver injury. It reports that the injury typically appeared 2 to 12 weeks after starting it, usually with a cholestatic or mixed pattern, jaundice, and itching.
  • LiverTox describes most such cases as mild-to-moderate and self-limited, with jaundice often protracted but ultimately resolving. It also reports rare instances of fatal liver injury or need for emergency liver transplantation, particularly in people with pre-existing liver disease and cirrhosis, and describes fatal cases due to acute liver failure or acute-on-chronic liver failure.
  • LiverTox notes the cases were first reported in 2017 and that an increasing number have been reported since. It states that clinically apparent liver injury attributable to ashwagandha occurs although rarely.
  • Because commercial preparations are often mixtures of herbs and nutritional products and can be mislabelled or contain unknown herbs and medications, LiverTox states it is not always clear whether reported cases were caused by ashwagandha, one of its components, or a contaminant. It notes that in several reported cases the product was tested and found to contain ashwagandha without other contaminants.
  • NCCIH, the US agency that studies complementary medicine, states that ashwagandha may be safe when taken in the short term, up to 3 months, and that there is not enough information to reach conclusions about its long-term safety.
  • NCCIH reports that in some individuals ashwagandha preparations may cause drowsiness, stomach upset, diarrhea, and vomiting. LiverTox separately notes that large doses can cause gastrointestinal upset, diarrhea, nausea and vomiting.
  • Denmark: the Danish food authority (Fødevarestyrelsen) states on its consumer page on ashwagandha, as accessed on 23 September 2026, that the plant is illegal to sell as food in Denmark. It gives a risk assessment by the Technical University of Denmark (DTU) as the reason, stating that according to that assessment the plant has negative effects on sex hormones and reproduction in both men and women and can affect the metabolism, the immune system and the central nervous system. The authority’s page does not say when the prohibition took effect.
  • The Danish food authority has also warned consumers about specific products. In a press release dated 16 January 2025 it warned against three food supplements and described the plant ingredients in them, ashwagandha among them, as both illegal and harmful to health, stating that ashwagandha can have harmful effects on the immune system and on thyroid function. In a press release dated 11 March 2026 it warned against three supplements sold on a German web shop, citing among their ingredients ashwagandha, which it states can harm the immune system and the thyroid gland; it added that it is not possible to set an acceptable daily intake for ashwagandha.
  • The DTU risk assessment of the root that the Danish food authority publishes, prepared for it and dated 15 May 2020, concluded that the studies it reviewed point to various types of harmful effects from extracts of the root and of other parts of the plant, including effects on the thyroid and sex hormones, and that on the available data no intake limit can be set below which the root or its extracts would be without risk of harmful effects.
  • A 2024 editorial, ‘Danish ban on Ashwagandha: Truth, evidence, ethics, and regulations’ (J Ayurveda Integr Med 15(4):101028; PMID 38969606), contests the DTU assessment. It argues the assessment has technical, scientific and ethical pitfalls, including that it draws on studies of plant parts other than the root, and calls on the Danish authority to reconsider. The editorial reports no funding; three of its authors disclose that they research ashwagandha, and one an honorary association with the World Ashwagandha Council, which the disclosure describes as “a non-profit academic platform for research and propagation of Ashwagandha”.
  • Netherlands: the Dutch National Institute for Public Health and the Environment (RIVM), in a risk assessment for the Dutch health ministry published on 5 March 2024, states that studies in humans have usually focused on the herb’s positive effects and found no harmful effects in people taking ashwagandha supplements, but that physicians have reported intoxications with harmful effects on the liver and on thyroid hormone and cortisol levels. It states that the herb can cause harmful effects in people who are sensitive to it and that it is unknown who they are, and as a precaution it advises consumers not to use herbal preparations containing it, especially during pregnancy.
  • The Dutch food and consumer product safety authority (NVWA) repeats the RIVM advice on its consumer page on supplement risks, as accessed on 23 September 2026.

Who should avoid it or take extra care

  • People with cirrhosis or advanced chronic liver disease: LiverTox states that ashwagandha use should be avoided in these patients, and reports that the rare fatal and transplant cases occurred particularly in people with pre-existing liver disease and cirrhosis.
  • Pregnancy and breastfeeding: NCCIH states ashwagandha should be avoided during pregnancy and should not be used while breastfeeding.
  • People with autoimmune or thyroid disorders, and people about to have surgery: NCCIH states ashwagandha is not recommended for these groups.
  • People with thyroid, liver or heart conditions or hyperandrogenism, pregnant women, and people taking sedatives or other treatments that depress the central nervous system: France’s food safety agency (ANSES), in an opinion dated 19 April 2024 (reference 2021-SA-0077), recommends that these groups abstain from food supplements containing ashwagandha, citing suspected adverse effects on the thyroid, liver, heart, central nervous system, fertility and fetal development. Because of a lack of data, it also recommends as a precaution that breastfeeding women and children up to the age of 18 not take them. It states that the insufficient quality of the available data made it impossible to define a level of consumption without risk.
  • Anyone taking the medications listed below on a regular basis should talk to their doctor or pharmacist before taking ashwagandha.

Documented interactions

  • Thyroid hormone medications: NCCIH states there is evidence ashwagandha might interact with thyroid hormone medications. It separately states that ashwagandha is not recommended for people with thyroid disorders. Source [1]
  • Diabetes medications: NCCIH lists medications for diabetes among those ashwagandha might interact with. Source [1]
  • Blood pressure medications: NCCIH lists medications for high blood pressure among those ashwagandha might interact with. Source [1]
  • Immunosuppressants: NCCIH lists medicines that decrease the immune system response among those ashwagandha might interact with. Source [1]
  • Sedatives: NCCIH lists sedatives among the medications ashwagandha might interact with. It separately reports drowsiness as a possible side effect. Source [1]
  • Anticonvulsants: NCCIH lists anti-seizure medications among those ashwagandha might interact with. Source [1]

Safety sources: Source [1]Source [2]Source [3]Source [4]Source [5]Source [6]Source [7]Source [8]Source [9]Source [10]

What the evidence says

Each claim is rated on its own evidence. Ratings follow the scale on our methodology page.

  • Reduces stress Evidence rating: Limited

    People take it hoping it will help them feel less stressed.

    NCCIH, the US agency that studies complementary medicine, says some ashwagandha preparations may be effective for stress, but many ashwagandha trials were small and used varied preparations.

    NCCIH states that research shows some ashwagandha preparations may be effective for stress. It adds that many of the clinical trials of ashwagandha have had small sample sizes and have used a variety of ashwagandha preparations. It gives no rating of how sure it is (certainty).

    This page cites no systematic review for this claim that it could read in full. The rating rests on the NCCIH statement, which says only that some preparations may be effective.

    Sources: Source [1]

  • Reduces anxiety Evidence rating: Insufficient

    People take it hoping it will ease their anxiety.

    NCCIH, the US agency that studies complementary medicine, says the evidence on the effects of ashwagandha on anxiety is unclear.

    NCCIH, the same US agency that states some ashwagandha preparations may be effective for stress, states that evidence is unclear about its effects on anxiety. This page reads unclear evidence as not showing whether ashwagandha helps anxiety or not, rather than as evidence of no effect.

    The insufficient rating reflects the NCCIH verdict that the evidence is unclear; it is not a finding by this page about how much research exists. This page cites no systematic review for this claim that it could read in full.

    Sources: Source [1]

  • Improves sleep quality Evidence rating: Limited

    People who sleep poorly take it hoping it will help them sleep better.

    A 2021 review of five trials found a small improvement in overall sleep over placebo, rated moderate certainty; the Sleep Quality Scale and sleep efficiency were rated low certainty.

    A 2021 meta-analysis pooled five randomized trials of ashwagandha extract against placebo. It reported a small but significant improvement in overall sleep. The reviewers describe the effects as more prominent in adults diagnosed with insomnia and at longer treatment durations.

    The reviewers rated certainty separately for each outcome, rather than giving one figure. Their GRADE summary table rates six outcomes and one subgroup. Four outcomes were rated moderate: overall sleep, time taken to fall asleep (sleep onset latency), total sleep time, and time awake after falling asleep (wake time after sleep onset). Two were rated low: the Sleep Quality Scale measure and sleep efficiency. Those two were downgraded for heterogeneity and small sample size. The subgroup, sleep in trials lasting 8 weeks or longer, was rated moderate.

    Two further outcomes were reported in the results text without a certainty rating. The reviewers found no significant difference from placebo on total time in bed. They found none on the Pittsburgh Sleep Quality Index either. That comparison rested on two trials and 131 participants, with an I-squared of 90%, meaning the two trials disagreed substantially. This page reads that as too little consistent evidence to show an effect, not as evidence of no effect.

    The reviewers note that data on serious adverse effects are limited, and that more safety data would be needed to judge long-term use. They also record that one of the five pooled trials declared it was partially sponsored by the manufacturer of the extract it tested. Because the lowest certainty the GRADE table reports among the six outcomes it rates is low, this page rates the claim on that.

    Sources: Source [1]Source [2]

How and when to take it

What the cited sources say about taking it. Ask your doctor or pharmacist what applies to you.

  • Stop and seek medical advice if you develop jaundice, dark urine, or itching

    LiverTox, the US government’s liver-injury database, reports that liver injury typically appeared 2 to 12 weeks after starting ashwagandha, usually with jaundice and pruritus. It states that in most instances the injury subsides within 1 to 4 months of stopping the herbal product, and that rechallenge with the same product should be avoided. Source [1]

  • Tell your doctor or pharmacist before starting it if you take regular medication

    NCCIH, the US agency that studies complementary medicine, states there is evidence ashwagandha might interact with several medication classes, listed in the interactions below. Source [1]

Which form the evidence used

Supplements are sold in several forms. This is what the sources on this page say about them — which form the research used, and any comparison those sources themselves made. Where they made none, this page does not rank the forms.

  • Standardized root extract (for example KSM-66), What the sources supportDetails

    Four of the five trials in the 2021 sleep meta-analysis, covering 250 participants, used KSM-66, an extract of the plant root. Source [1]

  • Root-and-leaf extract (for example Shoden), What the sources supportDetails

    One trial in the 2021 sleep meta-analysis, covering 150 participants, used Shoden, an extract of both the root and the leaves. The reviewers record that this was the one trial of the five that declared it was partially sponsored by the manufacturer. No source cited here compared root extract against root-and-leaf extract, so this page cannot say whether either works better or is safer than the other. Source [1]

  • Whole-root powder and multi-ingredient blends, Details

    The trials in the 2021 sleep meta-analysis tested capsule extracts, not raw powders or blends. Its authors note that brands vary in extract preparation and dosage and call for standardization. Source [1]

  • All commercial preparations, whichever form, Details

    The points here apply to every ashwagandha product, not to any one form or brand. LiverTox, the US government’s liver-injury database, reports that the liver-injury cases involved commercial products labeled as containing ashwagandha. It states it is not always clear whether those cases were caused by ashwagandha, one of its components, or a contaminant. That is because commercial herbal preparations are often mixtures of herbs and nutritional products, and can be mislabelled and contain unknown herbs and medications. It adds that in several reported cases the product was tested and found to contain ashwagandha without other contaminants. Source [1]

  • Standardized root-only extracts, any brand, What the sources supportDetails

    A 2026 review of the safety of standardized root-only extracts in healthy adults, across brands, is listed in the sources below; it does not compare one form or brand against another. Its authors disclose that two of them were employed by two companies, and that two have received honoraria for consulting and speaking for supplement companies, including some that distribute the supplement the review investigated. They state those activities were independent of the review, and that the authors have no direct financial or business interests related specifically to the product the review investigated. Source [1]

Also documented elsewhere on this site

Other supplements we cover that document an interaction with the same thing. This is a pointer to what those pages say, not a statement about taking them together — we have no source reviewing these in combination.

Sources

  1. Ashwagandha: Usefulness and Safety
    National Center for Complementary and Integrative Health, NIH, 2023 · Health authority summary · Primary source
  2. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis
    PLOS ONE, 2021 · Meta-analysis · Primary source · Certainty: low
  3. Ashwagandha
    LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, National Institute of Diabetes and Digestive and Kidney Diseases, 2024 · Health authority summary · Primary source
  4. Back to the Roots: Safety and Tolerability of Standardised Ashwagandha (Withania somnifera) Root Extract in Healthy Adults-A Systematic Review of Biomarkers and Adverse Events
    Pharmaceuticals (Basel), 2026 · Systematic review · Supporting source · Certainty: low
    Some of its authors disclose ties to industry.
  5. Ashwagandha i kosttilskud og drikkevarer
    Fødevarestyrelsen (Danish Veterinary and Food Administration), 2026 · Health authority summary · Primary source
  6. Fødevarestyrelsen advarer mod kosttilskud der kan skade organer og nervesystem
    Fødevarestyrelsen (Danish Veterinary and Food Administration), 2025 · Health authority summary · Primary source
  7. Advarsel mod kosttilskud fra tysk hjemmeside
    Styrelsen for Fødevarer, Landbrug og Fiskeri (Fødevarestyrelsen), 2026 · Health authority summary · Primary source
  8. Risikovurdering af roden fra Withania somnifera
    DTU Fødevareinstituttet (National Food Institute, Technical University of Denmark), for Fødevarestyrelsen, 2020 · Health authority summary · Primary source
  9. Risk assessment of herbal preparations containing Withania somnifera (Ashwagandha)
    National Institute for Public Health and the Environment (RIVM), Netherlands, 2024 · Health authority summary · Primary source
  10. Risico's gebruik voedingssupplementen
    Nederlandse Voedsel- en Warenautoriteit (NVWA), 2026 · Health authority summary · Primary source
  11. Avis de l'Anses relatif aux risques liés à l'utilisation des préparations de Withania somnifera (L.) Dunal dans les compléments alimentaires (Saisine n° 2021-SA-0077)
    Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), 2024 · Health authority summary · Primary source

Page history

Show all 5 changes to this page
  • — Rewritten to the content style guideline; ratings and sources unchanged.
  • — Source audit. Two stress-and-anxiety meta-analyses (2022, Phytotherapy Research; 2024, EXPLORE) were removed because their full texts could not be read, and every figure taken from them went with them. The combined stress-and-anxiety claim was split in two, because the one remaining source, a US health authority, treats the outcomes differently: stress stays limited, now on that authority statement rather than a graded review; anxiety is rated insufficient, because the authority states the evidence on anxiety is unclear. The root-extract safety review is now read in full; its disclosure is reported more completely.
  • — Safety section extended with national regulatory positions, each cited from the regulator’s own publication: the Danish food authority’s consumer page stating ashwagandha is illegal to sell as food in Denmark, its 2025 and 2026 product warnings, and the 2020 DTU risk assessment it gives as the reason, noted as contested in a 2024 editorial; the Dutch RIVM 2024 advice, as repeated by the NVWA; and the French ANSES 2024 opinion. No rating changed.
  • — Published. Both claims and the safety section were verified against the live record by the site's source review; the LiverTox likelihood score was confirmed word-for-word against NIH own-source files. National regulatory advisories remain absent and are logged as an open gap in docs/08-open-decisions.md.
  • — First drafted. Stress and anxiety rated limited, sleep quality rated limited — both on low GRADE certainty reported by the cited meta-analyses. Safety section leads on the LiverTox likelihood score B for clinically apparent liver injury.