- Indian ginseng
- Winter cherry
For Patients & Caregivers
What is it?
What is it used for?
Ashwagandha is used to:
- To treat cancer
- To treat diabetes
- To reduce fatigue (feeling more tired or weak than usual)
- To reduce joint pain
- To reduce stress
- To reduce anxiety (strong feelings of worry)
It’s generally safe to use ashwagandha in food and tea. However, talk with your healthcare providers before taking supplements or higher amounts of ashwagandha. Supplements are stronger than the herbs you would use in cooking.
Ashwagandha can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.
What are the side effects?
What else do I need to know?
- Don’t use ashwagandha if you’re pregnant because it may cause abortion (end your pregnancy).
- Don’t use ashwagandha if you have hormone-sensitive prostate cancer because it may increase testosterone levels. This may interfere with your treatments.
- Ashwagandha may increase the drowsiness effects of prescription medication so talk with your healthcare provider before taking it.
For Healthcare Professionals
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 (52); and improve sleep quality in patients with insomnia (51). 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).
- 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).
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)
- 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).