From the Guidelines
Ashwagandha use is not entirely safe due to potential interactions with medications and anesthesia, and its sedative properties. When considering the use of ashwagandha, it is crucial to weigh the potential benefits against the risks, particularly in the context of surgery or medication use. According to a critical review published in the American Journal of Kidney Diseases 1, certain dietary supplements, including ashwagandha, have sedative properties that can alter the safety profile of prescribed medications, especially those used in anesthesia. This is because many medications used in anesthesia are metabolized by the cytochrome P-450 (CYP450) pathway, and pharmacokinetic contributions of dietary supplements like ashwagandha may either attenuate or enhance the sedative properties of certain anesthetics.
Key considerations for ashwagandha use include:
- Potential for bleeding complications when combined with other agents, particularly in the context of elective surgery
- Risk of myositis or rhabdomyolysis, although this is more commonly associated with other supplements like red yeast rice and its active component lovastatin
- Interaction with medications, including sedatives, thyroid medications, immunosuppressants, and blood pressure drugs
- Effects on blood sugar and blood pressure levels, necessitating close monitoring in individuals with diabetes or hypotension
Given these considerations, it is recommended to exercise caution with ashwagandha use, especially in individuals with underlying health conditions or those taking medications. Consulting with a healthcare provider before starting ashwagandha supplementation is essential to ensure it is appropriate for the individual's specific situation and to minimize potential risks. The potential benefits of ashwagandha in modulating stress hormones and neurotransmitters must be carefully balanced against these risks, particularly in the context of real-life clinical medicine where caution is paramount.
From the Research
Safety of Ashwagandha Use
- The safety of Ashwagandha (Withania somnifera) use has been evaluated in several studies, including a randomized, double-blind, placebo-controlled study published in 2021 2, which found that Ashwagandha root extract was safe and well-tolerated in healthy adults.
- Another study published in 2021 3 also found that Ashwagandha root extract was safe and effective in reducing stress and improving cognitive function in healthy, stressed adults.
- A study published in 2019 4 found that Ashwagandha root extract was safe and effective in improving sleep quality and reducing anxiety in patients with insomnia.
- A review published in 2023 5 found that Ashwagandha has a positive effect on the functioning of the endocrine system, including improving the secretory function of the thyroid gland, normalizing adrenal activity, and multidirectional improvement on functioning of the reproductive system.
- An exploratory study published in 2012 6 found that Ashwagandha was tolerated well and appeared safe in healthy volunteers, with significant reduction in total- and LDL- cholesterol and increase of strength in muscle activity.
Potential Side Effects
- One study 6 reported that one volunteer showed increased appetite, libido, and hallucinogenic effects with vertigo at the lowest dose and was withdrawn from the study.
- However, other studies 2, 3, 4 did not report any significant adverse events or side effects.
Dosage and Safety
- The studies used different dosages of Ashwagandha root extract, ranging from 300 mg to 1250 mg per day.
- The safety and efficacy of Ashwagandha use may depend on the dosage and individual factors, and further studies are needed to fully understand its effects.