Is Ashwagandha (Withania somnifera) safe for use?

Safety of Ashwagandha (Withania somnifera)

Ashwagandha (Withania somnifera) root extract is generally safe for most adults when used appropriately, but should be discontinued at least two weeks before surgery due to its sedative properties.

General Safety Profile

• Randomized, placebo-controlled studies have demonstrated that Ashwagandha root extract is generally well-tolerated in healthy adults when taken at recommended dosages (typically 300-600 mg daily) for periods of 8-12 weeks 1, 2
• A comprehensive 8-week safety study found no statistically significant changes or abnormalities in hematological parameters, biochemical markers, or thyroid hormonal profiles in participants taking Ashwagandha 1
• Clinical trials in elderly populations (ages 65-80) have shown good tolerability with no significant adverse events at doses of 600 mg/day for 12 weeks 3

Perioperative Considerations

• Ashwagandha has sedative properties that can potentially interact with anesthesia medications, warranting caution in perioperative settings 4
• The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends holding Ashwagandha for 2 weeks before surgery due to its potential to enhance the sedative effects of anesthetics 4
• Ashwagandha may inhibit γ-aminobutyric acid metabolism, which could potentiate the effects of sedatives used during surgical procedures 4

Reported Adverse Effects

• Most common adverse effects (>5% incidence) reported in clinical trials are mild and transient, including:

  • Somnolence
  • Epigastric discomfort
  • Loose stools 2

• Less common adverse effects (<5% incidence) include:

  • Drowsiness
  • Giddiness
  • Vertigo
  • Decreased appetite
  • Nasal congestion 2, 5

• One case report noted increased appetite, libido, and hallucinogenic effects with vertigo at even low doses, suggesting individual sensitivity may vary 5

Special Populations

• Elderly: Clinical studies specifically in older adults (65-80 years) have shown Ashwagandha to be well-tolerated and effective for improving quality of life, sleep quality, and cognitive function 3
• Cognitive impairment: Studies in adults with mild cognitive impairment have demonstrated safety and efficacy at doses of 300 mg twice daily for 8 weeks 6

Potential Benefits

• Clinical trials have demonstrated potential benefits in several areas:
  • Improved memory and cognitive function 6
  • Enhanced quality of sleep 3
  • Increased muscle strength and activity 5
  • Reduced total and LDL cholesterol 5
  • Improved general well-being in elderly populations 3

Precautions and Contraindications

• Patients scheduled for surgery should discontinue Ashwagandha at least 2 weeks before the procedure 4
• Individuals taking sedative medications should exercise caution due to potential additive effects 4
• Unlike some other herbal supplements (such as St. John's wort), Ashwagandha has not been specifically identified as having significant drug interactions through the CYP450 pathway 2

Clinical Recommendation

• For general use, Ashwagandha appears safe for most adults at recommended dosages (300-600 mg daily) 1, 3
• Monitor for mild side effects, particularly somnolence and gastrointestinal symptoms 2
• Discontinue use at least 2 weeks before any scheduled surgical procedures 4
• Consider individual sensitivity, as some people may experience adverse effects even at lower doses 5