Common Names
- Ashwagandha
- Indian ginseng
- Winter cherry
For Patients & Caregivers
How It Works
A few preliminary studies suggest ashwagandha may help reduce stress, anxiety, and fatigue, but larger studies are needed.
Ashwagandha, also known as Indian ginseng, is a popular Ayurvedic herb and considered a tonic with multiple properties. In the lab, ashwagandha has been shown to have anti-inflammatory effects and relax the central nervous system in animals. Other experiments suggest it can enhance immune cells and impair or kill cancer cells, but more studies are needed to determine whether these effects can occur in humans. Clinical trials suggest ashwagandha may help reduce anxiety, stress, and fatigue, but larger studies are needed.
Ashwagandha may affect certain lab tests that measure thyroid functioning and digoxin levels.
Hemolytic anemia and abdominal pain were reported following ingestion of contaminated ashwagandha/mucuna pills.
Purported Uses
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To reduce stress and anxiety
A few studies suggest ashwagandha may be helpful for anxiety and stress. -
To treat diabetes
Lab studies suggest that ashwagandha may improve type 2 diabetes. Human studies are needed. -
To reduce fatigue
Results from a small study in patients with cancer-related fatigue suggest benefit. Additional studies are needed to confirm this. -
To reduce pain
A clinical trial suggests that a standardized extract may help patients with knee joint pain. Mild side effects like nausea and stomach irritation were observed in a few patients. -
To treat rheumatoid arthritis
A clinical trial showed that a compound of herbs and minerals containing ashwagandha reduced rheumatoid arthritis pain. Because the formula contained multiple herbs and minerals, whether ashwagandha played a role in observed benefits is unclear. -
As a sedative
In animal studies, ashwagandha has a tranquilizing effect.
Patient Warnings
Do Not Take If
- You have hormone-sensitive prostate cancer: Ashwagandha may increase testosterone levels.
- You are taking benzodiazepines, anticonvulsants, or barbiturates: Ashwagandha may have additive effects. Clinical relevance is not known.
- You are pregnant: Ashwagandha may induce abortion at higher doses, so pregnant women should not use it.
Side Effects
Commonly reported effects include mild to moderate, short duration drowsiness, upper GI discomfort, and loose stools
Less common effects reported include giddiness, drowsiness, hallucinogenic, vertigo, nasal congestion (rhinitis), cough, cold, decreased appetite, nausea, constipation, dry mouth, hyperactivity, nocturnal cramps, blurring of vision, hyperacidity, skin rash and weight gain
Case reports
- Nausea, headache, and stomach irritation: Occurred in one study and managed with standard therapies.
- Overactive thyroid: In a 32-year-old woman following ingestion of ashwagandha capsules for chronic fatigue. Symptoms resolved after discontinuing ashwagandha.
- Burning, itching, and discoloration of skin/mucous membrane: In a 28-year-old man after taking ashwagandha for decreased libido. Symptoms improved with conventional treatment.
- Irregular heartbeat, dizziness: 2 cases were possibly associated with the use of herbomineral preparations that contained ashwagandha.
- Elevation of liver enzymes, skin rash, fatigue, fever, edema, and diarrhea: In patients with advanced stage high-grade osteosarcoma, following use of Withaferin-A.
For Healthcare Professionals
Clinical Summary
A popular Ayurvedic herb, ashwagandha is often used in formulations prescribed for stress, strain, fatigue, pain, skin diseases, diabetes, gastrointestinal disease, rheumatoid arthritis, and epilepsy (1). It is also employed as a general tonic to improve energy levels, health, and longevity (2), and topically as an analgesic (3). Active constituents include alkaloids, steroidal lactones, saponins, and withanolides.
In vitro studies suggest that ashwagandha has neuroprotective (26) (37) and anti-inflammatory properties which may protect against cartilage damage in osteoarthritis (4). In addition, improvements in hyperglycemia, hyperinsulinemia, and insulin sensitivity were observed in a murine model of type 2 diabetes (5). Other studies indicate cytotoxic, immunomodulating (8), chemopreventive (1), and radiosensitizing effects (10), and enhancement in chromosomal stability (11).
Small clinical studies suggest that ashwagandha may promote growth, hemoglobin level, red blood cell count in children (2); and sexual performance (2) and male infertility (27) in adults. Findings also indicate that it may help relieve anxiety (23); stress (51); and improve sleep quality in patients with insomnia (52). In patients with schizophrenia, adjunctive treatment with ashwagandha improved symptoms and stress (43) (50), and affected markers of metabolic syndrome (34). Ashwagandha was also reported to have beneficial effects on cognitive function in patients with bipolar disorder (35), and is currently being evaluated to assess its effects on non-restorative sleep (44). Preliminary data suggest that it may help to improve balance in patients with progressive degenerative cerebral ataxias (24). An herbo-mineral formula containing ashwagandha was shown to benefit osteoarthritis (13); and a standardized extract produced analgesic, anti-inflammatory, and chondroprotective effects in patients with knee joint pain (41).
Ashwagandha demonstrated anticancer effects as well against several cancer cell lines (6) (7), but was ineffective against drug-resistant cancer stem cells (36). It prevented chemotherapy-induced neutropenia in a murine model (12); and the compound Withaferin A enhanced oxaliplatin effects in human pancreatic cancer cells (38). In a small study of breast cancer patients, ashwagandha alleviated chemotherapy-induced fatigue and improved quality of life (31). Larger trials are needed to confirm these observations.
Ashwagandha may increase testosterone levels, and should be avoided in patients with hormone-sensitive prostate cancer (48).
Mechanism of Action
Alkaloids, steroidal lactones, saponins, and withanolides are considered the biologically active components of ashwagandha. Anti-arthritic effects are attributed to cyclooxygenase (COX) inhibition.
In animal studies, anti-inflammatory activity by ashwagandha was comparable to hydrocortisone (15). Brain antioxidant effects and CNS tranquilizing effects may be due to influences on GABA receptor function (2) (17). Withanolides in the roots and leaves are considered similar to steroids in their biological activities (41). Triethylene glycol, a compound isolated from the leaves, was identified as an active sleep-inducing component in a murine model, and may potentially be used to relieve insomnia (42).
Microarray analysis revealed that ashwagandha represses proinflammatory gene expression, including IL-6, IL-1β, IL-8, Hsp70, and STAT-2, and induces p38/MAPK expression in a prostate cancer cell line (16). Ashwagandha may inhibit tumor growth (1) (21) and increased cytotoxic T lymphocyte production (8). In vitro studies show that root extracts have cytotoxic properties against lung, colon, CNS, and breast cancer cell lines (6). Withaferin A induced reactive oxygen species (ROS) generation and disruption of mitochondrial function in a human leukemia cell line, thereby inducing apoptosis (18). In estrogen receptor-positive (ER+) and negative (ER-) breast cancer cells, withaferin A induced apoptosis and decreased tumor size (19). Apoptosis of cancer cells by withanone is mediated through p53 (7). Withianone also exerts anticancer activity by binding to the TPX2-Aurora A Complex (29). Other studies show ashwagandha cytotoxicity is related to its structure. It enhances ATPase and inhibits succinate dehydrogenase activities, impairing oxidative phosphorylation.
In animal studies, ashwagandha enhanced radiation therapy effects (20) by reducing tumor GSH levels (10), and reversed paclitaxel-induced neutropenia in mice (12). No significant interactions have been reported between ashwagandha and either CYP3A4 or CYP2D6 enzymes in human liver microsomes (40).
Warnings
Hemolytic anemia and abdominal pain were reported following ingestion of ashwagandha/mucuna pills containing high amounts of lead (32). Symptoms resolved following standard treatment.
Contraindications
- Ashwagandha may increase testosterone levels, and should therefore be avoided in patients with hormone-sensitive prostate cancer (48).
- Patients who take benzodiazepines, anticonvulsants, or barbiturates should likely avoid ashwagandha because this botanical may have both sedative and GABAnergic effects (49).
- Pregnant women should avoid ashwagandha as it may induce abortion at higher doses (49).
Adverse Reactions
Commonly reported effects: Mild to moderate and transient drowsiness, upper GI discomfort, loose stools (43) (53)
Less common effects reported: Giddiness, drowsiness, hallucinogenic, vertigo, nasal congestion (rhinitis), cough, cold, decreased appetite, nausea, constipation, dry mouth, hyperactivity, nocturnal cramps, blurring of vision, hyperacidity, skin rash and weight gain (53)
Case reports
- Nausea, headache, and gastritis: Occurred in one study and managed with standard therapies (41)
- Thyrotoxicosis: In a 32-year-old woman following ingestion of ashwagandha capsules for chronic fatigue. Symptoms resolved after discontinuing ashwagandha (25).
- Burning, itching, and discoloration of skin/mucous membrane: In a 28-year-old man after taking ashwagandha for decreased libido. Symptoms abated with conventional treatment (33).
- Ventricular tachycardia: 2 cases were possibly associated with the use of herbomineral preparations that contained ashwagandha (45).
- Elevation of liver enzymes, skin rash, fatigue, fever, edema, and diarrhea: In patients with advanced stage high-grade osteosarcoma, following administration of Withaferin-A (47).