Contraindications to Ashwagandha (Withania somnifera)
Ashwagandha is contraindicated in pregnancy, during breastfeeding, in patients taking sedative medications, and in those with autoimmune conditions or scheduled for surgery.
Major Contraindications
Pregnancy and Breastfeeding
- Ashwagandha is contraindicated in women who are pregnant or actively trying to conceive 1
- Women of reproductive potential should use reliable contraception methods when taking ashwagandha
- Not recommended for use in women who are nursing 1
Medication Interactions
- Contraindicated with concurrent use of sedative medications due to potential additive effects 1
- Should not be used in combination with monoamine oxidase inhibitors (MAOIs) due to potential interactions 1
- May potentiate the effects of benzodiazepines and barbiturates, increasing sedation risk 1
Pre-existing Medical Conditions
- Should be avoided in patients with autoimmune diseases (such as rheumatoid arthritis, lupus, Hashimoto's thyroiditis)
- Contraindicated in patients with hyperthyroidism due to potential effects on thyroid function
- Use with caution in patients with diabetes as it may affect blood glucose levels 2
Perioperative Considerations
- Should be discontinued at least 2 weeks before scheduled surgery due to:
- Sedative properties that may interact with anesthesia 1
- Potential for increased bleeding risk
- Possible interference with blood pressure control during surgery
Side Effects and Adverse Reactions
Common Side Effects (>5% incidence)
- Somnolence/drowsiness
- Epigastric discomfort
- Loose stools 2
Less Common Side Effects
- Dizziness/vertigo
- Decreased appetite
- Nasal congestion
- Dry mouth
- Hyperactivity
- Hallucinogenic effects 2, 3
Special Populations
Patients with Cardiovascular Concerns
- May lower blood pressure, use with caution in patients with hypotension 4
- Monitor blood pressure in hypertensive patients as it may enhance effects of antihypertensive medications
Patients with Neurological or Psychiatric Conditions
- Use with caution in patients with existing neurological disorders due to potential sedative effects
- One case report noted hallucinogenic effects at even low doses 3
Safety Profile
Despite these contraindications, clinical studies have demonstrated that ashwagandha is generally well-tolerated in healthy adults at standard doses (300-600 mg daily) 5, 2. Multiple randomized controlled trials have shown no significant changes in hematological parameters, biochemical markers, or vital signs with short-term use 5.
Monitoring Recommendations
- For patients taking ashwagandha, monitor:
- Thyroid function in patients with thyroid disorders
- Blood pressure in patients with cardiovascular conditions
- Blood glucose in diabetic patients
- Signs of excessive sedation when combined with other medications
The safety profile of ashwagandha appears favorable in healthy adults for short-term use (8 weeks), but long-term safety data remains limited 2.