Ashwagandha

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Ashwagandha

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Ashwagandha

Common Names

  • Ashwagandha
  • Indian ginseng
  • Winter cherry

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

What is it?

Ashwagandha is a popular herb used in traditional Indian medicine (Ayurveda) for stress relief and to improve general health. It can help you relax and reduce swelling.

Some lab studies show that it can slow the growth of cancer cells, but this effect has not been observed in humans.

What is it used for?

Ashwagandha is used:

  • To reduce anxiety (strong feelings of worry)
  • To reduce stress
  • To reduce fatigue (feeling more tired or weak than usual)
  • To reduce joint pain
  • To treat diabetes

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?

Side effects of using ashwagandha may include:

  • Nausea (feeling like you’re going to throw up)
  • Headache
  • Drowsiness
  • Stomach irritation
  • Diarrhea (loose or watery stool)
What else do I need to know?
  • Don’t use ashwagandha if you’re pregnant because it may cause abortion (end your pregnancy).
  • Talk with your doctor if you have hormone-sensitive prostate cancer because ashwagandha may increase testosterone levels. This can interfere with your treatments.
  • Ashwagandha may increase the drowsiness effects of some prescription medications so talk with your healthcare provider before taking it.
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For Healthcare Professionals

Scientific Name
Withania somnifera
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, and red blood cell count in children (2); as well as sexual performance (2) and male infertility (27) in adults. Findings also indicate that it may help relieve anxiety (23) (54) ; stress (52); and improve both non-restorative sleep in healthy adults (55) and sleep quality in patients with insomnia (51) (56). 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). 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 chondro-protective effects in patients with knee joint pain (41).

Ashwagandha demonstrated anticancer effects 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 therefore patients with hormone-sensitive prostate cancer should consult their physicians before taking it (48).

Purported Uses
  • Anxiety
  • Stress
  • Fatigue
  • Rheumatoid arthritis
  • Diabetes
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: Reported in a clinical study, but symptoms were managed by 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).
  • Kidney transplant rejection: In a 69-year-old patient following use of ashwagandha. The patient needed a graft nephrectomy and was continued on maintenance dialysis (57).
Herb-Drug Interactions
  • Anticonvulsants, barbiturates, and benzodiazepines: Preclinical studies suggest that ashwagandha has sedative and GABAnergic properties, and may have additive effects (30) (49). Clinical relevance has yet to be determined.
  • Cytochrome P450 2B6 substrates: Ashwagandha inhibited CYP2B6 in vitro, and may affect the intracellular concentration of drugs metabolized by this enzyme (58). Clinical relevance is yet to be determined.
  • Cytochrome P450 3A4 substrates: Ashwagandha was found to be a moderate inducer of CYP3A4 in vitro, and can affect the intracellular levels of drugs metabolized by this enzyme (58). Clinical relevance is not known.
Herb Lab Interactions
  • May cause false elevation in digoxin immunoassay (28).
  • May increase thyroxine levels (39).
Dosage (OneMSK Only)
References
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  5. Anwer T, Sharma M, Pillai KK, et al. Effect of Withania somnifera on insulin sensitivity in non-insulin-dependent diabetes mellitus rats. Basic Clin Pharmacol Toxicol. 2008;102(6):498-503.
  6. Jayaprakasam B, Zhang Y, Seeram NP, et al. Growth inhibition of human tumor cell lines by withanolides from Withania somnifera leaves. Life Sci. 2003;74(1):125-132.
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  27. Ahmad MK, Mahdi AA, Shukla KK, et al. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fertil Steril. 2010;94(3):989-96.
  28. Dasgupta A, Tso G, Wells A. Effect of Asian ginseng, Siberian ginseng, and Indian Ayurvedic medicine Ashwagandha on serum digoxin measurement by digoxin III, a new digoxin immunoassay. J Clin Lab Anal. 2008;22(4):295-301.
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  31. Biswal BM, Sulaiman SA, Ismail HC, Zakaria H, Musa KI. Effect of Withania somnifera (Ashwagandha) on the development of chemotherapy-induced fatigue and quality of life in breast cancer patients. Integr Cancer Ther. 2013;12(4):312-22.
  32. Toniolo M, Ceschi A, Meli M, Lohri A, Favre G. Haemolytic anaemia and abdominal pain—a cause not to be missed. Br J Clin Pharmacol. 2011;72(1):168-9.
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  35. Chengappa KN, Bowie CR, Schlicht PJ, Fleet D, Brar JS, Jindal R. Randomized placebo-controlled adjunctive study of an extract of Withania somnifera for cognitive dysfunction in bipolar disorder. J Clin Psychiatry. 2013;74:1076-1083.
  36. Maliyakkal N, Appadath Beeran A, Balaji SA, Udupa N, Ranganath Pai S, Rangarajan A. Effects of Withania somnifera and Tinospora cordifolia extracts on the side population phenotype of human epithelial cancer cells: Toward targeting multidrug resistance in cancer. Integr Cancer Ther. 2015;14:156-171.
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  39. Gannon JM, Forrest PE, Roy Chengappa KN. Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder. J Ayurveda Integr Med. 2014;5:241-245.
  40. Savai J, Varghese A, Pandita N, et al. Investigation of CYP3A4 and CYP2D6 interactions of Withania somnifera and Centella asiatica in human liver microsomes. Phytother Res. May 2015;29(5):785-790.
  41. Ramakanth GS, Uday Kumar C, Kishan PV, et al. A randomized, double blind placebo controlled study of efficacy and tolerability of Withaina somnifera extracts in knee joint pain. J Ayurveda Integr Med. Jul - Sep 2016;7(3):151-157.
  42. Kaushik MK, Kaul SC, Wadhwa R, Yanagisawa M, Urade Y. Triethylene glycol, an active component of Ashwagandha (Withania somnifera) leaves, is responsible for sleep induction. PLoS One. 2017 Feb 16;12(2):e0172508.
  43. Chengappa KNR, Brar JS, Gannon JM, et al. Adjunctive Use of a Standardized Extract of Withania somnifera (Ashwagandha) to Treat Symptom Exacerbation in Schizophrenia: A Randomized, Double-Blind, Placebo-Controlled Study. J Clin Psychiatry. Jul 10 2018;79(5).
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  50. Gannon JM, Brar J, Rai A, et al. Effects of a standardized extract of Withania somnifera (Ashwagandha) on depression and anxiety symptoms in persons with schizophrenia participating in a randomized, placebo-controlled clinical trial. Ann Clin Psychiatry. May 2019;31(2):123-129.
  51. Langade D, Kanchi S, Salve J, Debnath K, Ambegaokar D. Efficacy and Safety of Ashwagandha (Withania somnifera) Root Extract in Insomnia and Anxiety: A Double-blind, Randomized, Placebo-controlled Study. Cureus. 2019 Sep 28;11(9):e5797.
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  55. Deshpande A, Irani N, Balkrishnan R, Benny IR. A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep Med. 2020 Aug;72:28-36.
  56. Langade D, Thakare V, Kanchi S, Kelgane S. Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study. J Ethnopharmacol. 2021 Jan 10;264:113276.
  57. Sriperumbuduri S, Umar MS, Lajoie-Starkell G, Fairhead TR, Hiremath S. Ashwagandha and Kidney Transplant Rejection. Kidney Int Rep. 2020 Oct 3;5(12):2375-2378.
  58. Kumar S, Bouic PJ, Rosenkranz B. Investigation of CYP2B6, 3A4 and β-esterase interactions of Withania somnifera (L.) dunal in human liver microsomes and HepG2 cells. J Ethnopharmacol. 2021 Apr 24;270:113766.
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