What to Look for When Taking Ashwagandha (Withania somnifera)
When taking ashwagandha, monitor for potential side effects including mild gastrointestinal issues, drowsiness, and possible drug interactions, while watching for beneficial effects on stress, sleep quality, and anxiety levels.
Potential Side Effects to Monitor
Common Side Effects (>5% occurrence)
- Somnolence/drowsiness
- Epigastric pain or discomfort
- Loose stools 1
Less Common Side Effects
- Dizziness/giddiness
- Nasal congestion
- Decreased appetite
- Nausea
- Constipation
- Dry mouth
- Hyperactivity
- Nocturnal muscle cramps
- Blurred vision
- Hyperacidity
- Skin rash
- Weight gain 1
Monitoring for Drug Interactions
Ashwagandha may interact with certain medications due to its effects on drug metabolism enzymes:
High-risk interactions with:
- Warfarin (blood thinner)
- Buprenorphine
- Tacrolimus 2
Monitor closely if taking medications metabolized by cytochrome P450 enzymes (CYP3A4, CYP2D6, CYP1A2, CYP2B6, CYP2C8, CYP2C9, and CYP2C19) 2
Avoid combining with sedatives or CNS depressants as ashwagandha may enhance their effects 1
Special Considerations for Specific Populations
Perioperative Period
- If scheduled for surgery, inform your healthcare provider about ashwagandha use
- Consider tapering or stopping ashwagandha at least 7 days before surgery if taking:
300 mg/day of ashwagandha extract
- Using ashwagandha more than 2-3 times daily 2
Pre-existing Conditions
- Liver function: Monitor liver enzymes if taking high doses (>300 mg/day) of CBD-dominant cannabis products alongside ashwagandha 2
- Thyroid function: Watch for changes in thyroid function as ashwagandha may affect thyroid hormone levels 1
Positive Effects to Monitor
When taking ashwagandha, also look for these potential beneficial effects:
- Improvement in sleep quality and mental alertness upon waking 3
- Reduction in anxiety and stress levels 4
- Increased serotonin levels, which may improve mood 4
- General improvement in quality of life measures 3
Dosing and Administration Guidance
- Standard dosing in clinical studies ranges from 300-600 mg daily 5, 3
- Some formulations include piperine (5 mg) to enhance absorption 4
- Take consistently at the same time each day for optimal results
- Allow at least 8 weeks to evaluate full effects 5, 3
When to Seek Medical Attention
Contact a healthcare provider immediately if experiencing:
- Severe allergic reactions (rash, itching, swelling)
- Significant changes in mood or mental status
- Unusual heart rate or blood pressure changes
- Severe gastrointestinal distress
- Any concerning symptoms that persist or worsen
Quality Considerations
- Choose standardized extracts (often standardized to 2.5% withanolides)
- Purchase from reputable manufacturers with third-party testing
- Be aware that product quality can vary significantly between manufacturers 6
Regular monitoring of these effects and potential side effects will help ensure safe and effective use of ashwagandha as a supplement.