Indian ginseng

Ashwagandha/Drug Interactions:

  • AmphetaminesAmphetamines: In preliminary research, the effects of ashwagandholine alkaloids from ashwagandha on the central nervous system have been evaluated (34). In theory, ashwagandha may increase the effects of amphetamines.
  • AnalgesicsAnalgesics: Repeated administration of ashwagandha may attenuate the development of tolerance to narcotics, according to limited animal data (44).
  • AndrogensAndrogens: Ashwagandha may possess androgenic (testosterone-like) properties, according to rat evidence of increased testicular weight and spermatogenesis (8).
  • AntiarrhythmicsAntiarrhythmics: In animal research, ashwagandha showed mild positive inotropic and chronotropic effects (33). According to a review, active components of ashwagandha may interfere with digoxin measurements, particularly polyclonal antibody-based immunoassays (59).
  • AnticholinergicsAnticholinergics: According to laboratory research, ashwagandha has been associated with cholinesterase inhibition (37; 7).
  • Anticoagulants and antiplatelets Anticoagulants and antiplatelets : In animal research, ashwagandha was shown to significantly increase coagulation time (3) and increase platelet count (5).
  • Antidiabetic agentsAntidiabetic agents: According to limited human and animal research, ashwagandha may have hypoglycemic effects (38; 60).
  • AntihypertensivesAntihypertensives: According to animal research, ashwagandha may lower systolic and diastolic blood pressure (32).
  • Anti-inflammatoriesAnti-inflammatories: Anti-inflammatory effects have been reported in mice and rats (34; 35; 61).
  • AntilipemicsAntilipemics: In a case series, ashwagandha significantly decreased serum total cholesterol levels, triglycerides, low-density lipoprotein (LDL), and very-low-density lipoproteins (VLDL) (38). In humans, serum cholesterol decreased in a statistically significant manner after ashwagandha use (31).
  • AntineoplasticsAntineoplastics: Alcoholic extracts of ashwagandha dried roots, as well as the ashwagandha constituent withaferin A, have been suggested to possess antitumor or radiosensitizing properties, according to in vitro (62; 63; 64; 65; 66; 67) and animal research (68; 53; 66; 69; 65; 70). Antiangiogenic properties have been reported in laboratory research (71). Ashwagandha has been shown to increase paclitaxel's effectiveness in mice with lung cancer (14).
  • AntiparkinsoniansAntiparkinsonians: In animals with drug-induced parkinsonism, significant improvement in behavior and antioxidant status and a significant reduction in the level of lipid peroxidation were seen with ashwagandha treatment (72; 73). In a case study, in patients who received a multiherb preparation, including powdered milk and ashwagandha (as well as powdered Mucuna pruriens and Hyoscyamus reticulatus seeds), following a cleansing procedure, improvements in symptoms were observed, but these were likely due to the presence of L-dopa found in the preparation, which is an established drug used in the treatment of Parkinson's disease (74).
  • Cardiovascular agentsCardiovascular agents: In animal research, ashwagandha decreased blood pressure (32), possessed myocardial depressant effects in rabbits, and showed mild positive inotropic and chronotropic effects in frogs (33). Smooth muscle relaxant properties have been found (34; 35). Bradycardia has been reported in rats (36). Ashwagandha has been associated with anticholinesterase activity, which theoretically may lead to decreases in blood pressure (37). According to a review, active components of ashwagandha may interfere with digoxin measurements, particularly polyclonal antibody-based immunoassays (59).
  • Cholinesterase inhibitorsCholinesterase inhibitors: In laboratory research, ashwagandha has been associated with cholinesterase inhibition (37; 7).
  • Chronotropic agentsChronotropic agents: In animal research, ashwagandha has shown mild positive inotropic and chronotropic effects (33).
  • CNS depressantsCNS depressants: In preliminary research, the effects of alkaloids from ashwagandha on the central nervous system (34; 36) and smooth muscle (35) have been evaluated; it may cause sedation and possible life-threatening respiratory depression. According to in vitro and animal research, ashwagandha may have GABA-mimetic activity (40) and may interact with sedatives, hypnotics, or other central nervous system depressants (17), or increase the effects of barbiturates and ethanol.
  • Cyclophosphamide Cyclophosphamide : In animals, ashwagandha extract may reduce cyclophosphamide-induced immunosuppression and leukopenia (26; 58; 5) and urotoxicity (19; 20).
  • DigoxinDigoxin: Active components of ashwagandha may interfere with digoxin measurements, particularly polyclonal antibody-based immunoassays (59).
  • DiureticsDiuretics: In a case series, significant increases in urine volume and sodium levels compared to baseline were noted with use of ashwagandha (38).
  • Fertility agentsFertility agents: In humans, W. somnifera decreased oxidative stress. Testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin levels, indicators of semen quality, improved in infertile subjects following treatment (75).
  • Gastrointestinal agentsGastrointestinal agents: In animal research, ashwagandha caused diarrhea at the highest doses screened (53). Nausea and abdominal pain have also been reported: in a study of 42 patients: two had nausea and three complained of abdominal pain (39).
  • Haloperidol (Haldol?)Haloperidol (Haldol?): Ashwagandha may improve haloperidol-attenuated tardive dyskinesia, according to preliminary animal data (25).
  • Hormonal agentsHormonal agents: Ashwagandha may possess androgenic (testosterone-like) properties, according to rat evidence of increased testicular weight and spermatogenesis (8).
  • ImmunosuppressantsImmunosuppressants: According to limited animal data, ashwagandha extract may reduce cyclophosphamide-induced immunosuppression or leukopenia (26; 58; 5) and may have immunomodulatory effects, such as enhancement of total white blood cell (WBC) count, bone marrow cellularity, antibody titre, plaque-forming cells, and macrophage phagocytic activity (20).
  • Impotence agentsImpotence agents: In humans, testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin levels, indicators of semen quality, improved in infertile subjects following ashwagandha treatment (75).
  • InotropesInotropes: In animal research, ashwagandha has shown mild positive inotropic and chronotropic effects (33).
  • Iron saltsIron salts: Ashwagandha is reportedly rich in iron (76).
  • NarcoticsNarcotics: Repeated administration of ashwagandha may attenuate the development of tolerance to narcotics, according to limited animal data (44).
  • Neurologic agentsNeurologic agents: In humans, animals, and a functional assay, ashwagandha has caused neurologic effects, including sedation and possible life-threatening respiratory depression (34; 35; 40), GABA-like activity (41) enhancement of diazepam effects (40), formation of dendrites in human neuroblastoma cells (42; 43), increased barbiturate and ethanol effects (36), both antidepressant (17) and central nervous system depressant activity (4), interactions with sedatives such as barbiturates, ethanol, and urethane (34; 35; 36), morphine tolerance inhibition (44), decreased glutamic acid and 5-hydroxytryptophan levels (41), enhanced stress response (45; 46; 47; 48; 49), and improved memory function (50).
  • Paclitaxel (Taxol?)Paclitaxel (Taxol?): Ashwagandha has been shown to increase paclitaxel's effectiveness in mice with lung cancer (14).
  • Radioprotective drugsRadioprotective drugs: Alcoholic extracts of ashwagandha dried roots, as well as the ashwagandha constituent withaferin A, have been suggested to possess antitumor or radiosensitizing properties, according to in vitro (62; 63; 64; 65; 66; 67) and animal research (68; 53; 66; 69; 65; 70).
  • Renal agentsRenal agents: In a rat study, the development of kidney lesions was reported (57).
  • Respiratory agentsRespiratory agents: According to animal and in vitro research, ashwagandha may cause severe or life-threatening respiratory depression (34; 35; 40).
  • SedativesSedatives: In preliminary research, the effects of alkaloids from ashwagandha on the central nervous system (34; 36) and smooth muscle (35) have been evaluated; it may cause sedation and possible life-threatening respiratory depression. According to in vitro and animal research, ashwagandha may have GABA-mimetic activity (40) and may interact with sedatives, hypnotics, or other central nervous system depressants (17), or increase the effects of barbiturates and ethanol.
  • SteroidsSteroids: Ashwagandha may possess androgenic (testosterone-like) properties, according to animal evidence of increased testicular weight and spermatogenesis (8).
  • StimulantsStimulants: In preliminary research, the effects of ashwagandholine alkaloids from ashwagandha on the central nervous system have been evaluated (34). In theory, ashwagandha may increase the effects of amphetamines.
  • Thyroid agentsThyroid agents: Ashwagandha may cause hyperthyroidism, according to mouse data suggesting thyroid stimulation and increased T4 serum levels, and therefore may interact with drugs for hyperthyroidism or hypothyroidism (51; 52).

    • Ashwagandha/Herb/Supplement Interactions:

  • 5-Hydroxytryptophan (5-HTP)5-Hydroxytryptophan (5-HTP): Reduced 5-HTP levels were associated with 12 weeks of ashwagandha therapy in patients with anxiety (41).
  • AnalgesicsAnalgesics: Repeated administration of ashwagandha may attenuate the development of tolerance to narcotics, according to limited animal data (44).
  • AntiandrogensAntiandrogens: Ashwagandha may possess androgenic (testosterone-like) properties, according to rat evidence of increased testicular weight and spermatogenesis (8).
  • AntiarrhythmicsAntiarrhythmics: Active components of ashwagandha may interfere with digoxin measurements, particularly polyclonal antibody-based immunoassays (59).
  • Anticholinergic herbsAnticholinergic herbs: According to laboratory research, ashwagandha has been associated with cholinesterase inhibition (37; 7). Theoretically, anticholinergics may antagonize the effects of ashwagandha.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In animal research, ashwagandha was shown to significantly increase coagulation time (3) and increase platelet count (5).
  • Anti-inflammatoriesAnti-inflammatories: Anti-inflammatory effects have been reported in mice and rats (34; 35; 61).
  • AntilipemicsAntilipemics: In a case series, ashwagandha significantly decreased serum total cholesterol levels, triglycerides, low-density lipoprotein (LDL), and very-low-density lipoproteins (VLDL) (38). In humans, serum cholesterol decreased in a statistically significant manner after ashwagandha use (31).
  • AntineoplasticsAntineoplastics: Alcoholic extracts of ashwagandha dried roots, as well as the ashwagandha constituent withaferin A, have been suggested to possess antitumor or radiosensitizing properties, according to in vitro (62; 63; 64; 65; 66; 67) and animal research (68; 53; 66; 69; 65; 70). Antiangiogenic properties have been reported in laboratory research (71). Ashwagandha has been shown to increase paclitaxel's effectiveness in mice with lung cancer (14).
  • AntioxidantsAntioxidants: Ashwagandha has been reported to possess antioxidant properties (12; 4), including prevention of lipid peroxidation in animal studies (77; 78; 79).
  • AntiparkisoniansAntiparkisonians: In animals with drug-induced parkinsonism, significant improvement in behavior and antioxidant status and a significant reduction in the level of lipid peroxidation were seen with ashwagandha treatment (72; 73). In a case study, in patients who received a multiherb preparation, including powdered milk and ashwagandha (as well as powdered Mucuna pruriens and Hyoscyamus reticulatus seeds), following a cleansing procedure, improvements in symptoms were observed, but these were likely due to the presence of L-dopa found in the preparation, which is an established drug used in the treatment of Parkinson's disease (74).
  • AphrodisiacsAphrodisiacs: In humans, testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin levels, indicators of semen quality, improved in infertile subjects following ashwagandha treatment (75).
  • Arginine/L-arginineArginine/L-arginine: Ashwagandha contains arginine and may therefore add to the total dose and effects when taken concomitantly with arginine supplements.
  • Cardiovascular agentsCardiovascular agents: In animal experiments, ashwagandha decreased blood pressure (32), possessed myocardial depressant effects in rabbits, showed mild positive inotropic and chronotropic effects in frogs (33). Smooth muscle relaxant properties have been found (34; 35). Bradycardia has been reported in rats (36). Ashwagandha has been associated with anticholinesterase activity, which theoretically may lead to decreases in blood pressure (37).
  • Chronotropic herbsChronotropic herbs: In animal research, ashwagandha has shown mild positive inotropic and chronotropic effects (33).
  • DiureticsDiuretics: In a case series, significant increases in urine volume and sodium levels compared to baseline were noted with use of ashwagandha (38).
  • Fertility agentsFertility agents: In humans, W. somnifera decreased oxidative stress. Testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin levels, indicators of semen quality, improved in infertile subjects following treatment (75).
  • Gastrointestinal agentsGastrointestinal agents: In animal research, ashwagandha caused diarrhea at the highest doses screened (53). Nausea and abdominal pain have also been reported: in a study of 42 patients: two had nausea and three complained of abdominal pain (39).
  • Hormonal agentsHormonal agents: In humans, W. somnifera decreased oxidative stress. Testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin levels, indicators of semen quality, improved in infertile subjects following treatment (75). Ashwagandha may possess androgenic (testosterone-like) properties, according to rat evidence of increased testicular weight and spermatogenesis (8).
  • HypoglycemicsHypoglycemics: According to limited human and animal research, ashwagandha may have hypoglycemic effects (38; 12; 60).
  • HypotensivesHypotensives: According to animal research, ashwagandha may lower systolic and diastolic blood pressure (32).
  • ImmunosuppressantsImmunosuppressants: According to limited animal data, ashwagandha extract may reduce cyclophosphamide-induced immunosuppression or leukopenia (26; 58; 5) and may have immunomodulatory effects, such as enhancement of total WBC count, bone marrow cellularity, antibody titre, plaque-forming cells, and macrophage phagocytic activity (20).
  • Inotropic herbsInotropic herbs: In animal research, ashwagandha showed mild positive inotropic and chronotropic effects (33).
  • IronIron: Ashwagandha is reportedly rich in iron (76).
  • Neurologic agentsNeurologic agents: In humans, animals, and a functional assay, ashwagandha has caused neurologic effects, including sedation and possible life-threatening respiratory depression (34; 35; 40), GABA-like activity (41) enhancement of diazepam effects (40), formation of dendrites in human neuroblastoma cells (42; 43), increased barbiturate and ethanol effects (36), both antidepressant (17) and central nervous system depressant activity (4), interactions with sedatives such as barbiturates, ethanol and urethane (34; 35; 36), morphine tolerance inhibition (44), decreased glutamic acid and 5-hydroxytryptophan levels (41), enhanced stress response (45; 46; 47; 48; 49), and improved memory function (50).
  • OrnithineOrnithine: According to secondary sources, ashwagandha reportedly contains ornithine.
  • PotassiumPotassium: In humans, ashwagandha decreased serum potassium (38).
  • Radioprotective agentsRadioprotective agents: Alcoholic extracts of ashwagandha dried roots, as well as the ashwagandha constituent withaferin A, have been suggested to possess antitumor or radiosensitizing properties, according to in vitro (62; 63; 64; 65; 66; 67) and animal research (68; 53; 66; 69; 65; 70).
  • Renal agentsRenal agents: In a rat study, the development of kidney lesions was reported (57).
  • Respiratory agentsRespiratory agents: According to animal and in vitro research, ashwagandha may cause severe or life-threatening respiratory depression (34; 35; 40)
  • Saw palmetto (Serenoa repens)Saw palmetto (Serenoa repens): Ashwagandha may possess androgenic (testosterone-like) properties, according to rat evidence of increased testicular weight and spermatogenesis (8). Saw palmetto possesses 5-alpha reductase properties similar to finasteride (Proscar?) and may antagonize the potential androgenic effects of ashwagandha.
  • SedativesSedatives: In preliminary research, the effects of alkaloids from ashwagandha on the central nervous system (34; 36) and smooth muscle (35) have been evaluated; it may cause sedation and possible life-threatening respiratory depression. According to in vitro and animal research, ashwagandha may have GABA-mimetic activity (40) and may interact with sedatives, hypnotics, or other central nervous system depressants (17), or increase the effects of barbiturates and ethanol.
  • SteroidsSteroids: Ashwagandha may possess androgenic (testosterone-like) properties, according to animal evidence of increased testicular weight and spermatogenesis (8).
  • StimulantsStimulants: In preliminary research, the effects of ashwagandholine alkaloids from ashwagandha on the central nervous system have been evaluated (34). In theory, ashwagandha may increase the effects of amphetamines.
  • Thyroid agentsThyroid agents: In animal research, ashwagandha has been reported to stimulate thyroid function, including increased serum T4 concentrations (51; 52). A case report in a 32 year-old woman reported the development of thyrotoxicosis while taking capsules that contained ashwagandha herbal extract (80).

    • Ashwagandha/Food Interactions:

  • Iron containing foodsIron containing foods: Ashwagandha is reportedly rich in iron (76).

    • Ashwagandha/Lab Interactions:

  • 5-Hydroxytryptophan (5-HTP)5-Hydroxytryptophan (5-HTP): Reduced 5-HTP levels were associated with 12 weeks of ashwagandha therapy in patients with anxiety (41).
  • Blood glucoseBlood glucose: Ashwagandha may lower blood sugar levels, according to limited human research (in patients with type 2 diabetes), although the mechanism is unknown (38; 12; 60).
  • Blood lipidsBlood lipids: In a case series, ashwagandha significantly decreased serum total cholesterol levels, triglycerides, low-density lipoprotein (LDL), and very-low-density lipoproteins (VLDL) (38). In humans, serum cholesterol decreased in a statistically significant manner after ashwagandha use (31).
  • Blood pressureBlood pressure: In animal research, ashwagandha decreased blood pressure in dogs (32). Ashwagandha has been associated with anticholinesterase activity, which theoretically may lead to decreases in blood pressure (37).
  • Coagulation panelCoagulation panel: In animal research, ashwagandha was shown to significantly increase coagulation time (3) and increase platelet count (5).
  • Digoxin levelDigoxin level: Active components of ashwagandha may interfere with digoxin measurements, particularly polyclonal antibody-based immunoassays (59).
  • ElectrolytesElectrolytes: Ashwagandha has been reported to possess diuretic properties, according to a case series in individuals treated with powdered ashwagandha root for 12 days, after which significant increases in urine volume and sodium were reported (38). In rat research, the development of kidney lesions was reported (57).
  • Follicle-stimulating hormone (FSH)Follicle-stimulating hormone (FSH): Ashwagandha may possess androgenic (testosterone-like) properties, based on rat evidence of increased testicular weight and spermatogenesis, as well as decreased serum FSH and testosterone levels (8).
  • Hemoglobin/hematocritHemoglobin/hematocrit: Ashwagandha may stimulate red and white blood cell production, and increase platelet count (5). In humans, hemoglobin increased in a statistically significant manner (31).
  • Iron levelsIron levels: Ashwagandha is reportedly rich in iron (76).
  • Lipid profileLipid profile: In a human case study, treatment with ashwagandha caused significant decreases in serum total cholesterol levels, triglycerides, low-density lipoprotein (LDL), and very=low-density lipoproteins (VLDL) (38).
  • Platelet countPlatelet count: In animal research, ashwagandha was shown to significantly increase coagulation time (3) and increase platelet count (5).
  • Red blood cell countRed blood cell count: In humans, RBC counts increased in a statistically significant manner after ashwagandha use (31). According to animal research, ashwagandha may stimulate red blood cell production (5).
  • Respiratory rateRespiratory rate: In animal experiments, ashwagandha induced bradycardia in rats (36). Smooth muscle relaxant properties have been found (34; 35).
  • Serum potassiumSerum potassium: In humans, ashwagandha decreased serum sodium and potassium while urine sodium and volume increased (38).
  • Serum sodiumSerum sodium: In humans, ashwagandha decreased serum sodium and potassium while urine sodium and volume increased (38).
  • Semen parametersSemen parameters: In humans, testosterone, luteinizing hormone, follicle-stimulating hormone and prolactin levels, indicators of semen quality, improved in infertile subjects following ashwagandha treatment (75).
  • Testosterone levelTestosterone level: Ashwagandha may possess androgenic (testosterone-like) properties, based on rat evidence of increased testicular weight and spermatogenesis, as well as decreased serum FSH and testosterone levels (8).
  • Thyroid panelThyroid panel: Ashwagandha may increase serum T4 concentrations, according to mouse data (51; 52).
  • Urinary sodiumUrinary sodium: In humans, ashwagandha decreased serum sodium and potassium while urine sodium and volume increased (38).
  • Urine volumeUrine volume: In humans, ashwagandha decreased serum sodium and potassium while urine sodium and volume increased (38).
  • White blood cell countWhite blood cell count: According to animal research, ashwagandha may stimulate red and white blood cell production, and increase platelet count (5).