Contraindications for Ashwagandha (Withania somnifera)
Ashwagandha is contraindicated in pregnancy or women who may become pregnant without reliable contraception, in patients with hyperthyroidism, and should not be used concurrently with monoamine oxidase inhibitors (MAOIs).
Absolute Contraindications
Pregnancy and breastfeeding: Ashwagandha may have abortifacient properties and could potentially affect fetal development 1. Women who are pregnant or planning to become pregnant should avoid using ashwagandha.
Hyperthyroidism: Ashwagandha has been shown to increase thyroid hormone levels (T3 and T4) and may worsen hyperthyroidism 2. It can cause an increase in thyroxine (T4) levels, which could exacerbate existing thyroid conditions.
Concurrent use with MAOIs: Similar to other herbal supplements with psychoactive properties, ashwagandha should not be used with monoamine oxidase inhibitors due to potential risk of serotonin syndrome 3.
Relative Contraindications
Autoimmune diseases: Due to its immunomodulatory effects, ashwagandha may potentially worsen symptoms in patients with autoimmune conditions such as rheumatoid arthritis, lupus, or multiple sclerosis 1.
Diabetes: Ashwagandha may lower blood glucose levels, potentially interacting with diabetes medications and causing hypoglycemia 1.
Surgery: Discontinue ashwagandha at least 2 weeks before scheduled surgery as it may interfere with anesthesia and blood pressure control during surgical procedures 1.
Hormone-sensitive conditions: Since ashwagandha may have estrogen-like effects, it should be avoided in hormone-sensitive conditions like breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids 2.
Drug Interactions
Sedatives: Ashwagandha may increase the effects of sedative medications (benzodiazepines, barbiturates) 1.
Thyroid medications: May interfere with thyroid replacement therapies due to its effects on thyroid hormone levels 2.
Immunosuppressants: Could potentially counteract the effects of immunosuppressive drugs 1.
Blood pressure medications: May enhance the effects of medications used to treat hypertension, potentially causing hypotension 1.
Blood glucose-lowering medications: May potentiate the effects of anti-diabetic drugs 1.
Special Population Considerations
Children: Safety not well established; generally not recommended for use in children without medical supervision 1.
Elderly: May require lower doses due to potential increased sensitivity to side effects 1.
Liver disease: Use with caution as ashwagandha is metabolized by the liver and may affect liver function 4.
Monitoring Recommendations
For patients taking ashwagandha who do not have contraindications:
- Monitor thyroid function, particularly in patients with subclinical hypothyroidism or those on thyroid medications 2.
- Monitor blood glucose levels in diabetic patients 1.
- Monitor for potential adverse effects including mild drowsiness, gastrointestinal discomfort, and allergic reactions 5.
Common Adverse Effects
The most commonly reported adverse effects (>5% of users) include 1:
- Somnolence
- Epigastric discomfort
- Loose stools
Less common adverse effects include giddiness, drowsiness, vertigo, nasal congestion, decreased appetite, and hyperactivity 1.
Always recommend patients consult with their healthcare provider before starting ashwagandha, especially if they have existing health conditions or are taking other medications.