Adaptogen Medicine Interactions: Documented vs Theoretical
Which adaptogen and medicine combinations are reported in people, which come only from lab or animal studies, and which are theoretical, with the source and strength for each.
Content last updated . This page has not been medically reviewed.
Safety first. Supplements can cause side effects and interact with medicines. Read mushroom safety and interactions before you use any mushroom product.
If you take a prescription medicine, the safe answer is to ask a pharmacist before adding any adaptogen. This page shows how strong the evidence is behind the interactions that NIH, Memorial Sloan Kettering (MSK), the European Medicines Agency (EMA) and LactMed describe. It does not tell anyone to stop or change a medicine: that is for the prescriber or pharmacist. If you take antidepressants and feel worse, or you are in crisis, call or text 988 (US) or 911 for an emergency.
How we label the evidence
These are this page's labels, not the sources':- Reported in people: a case report or human study described it.
- Agency statement: a health agency says an interaction is possible or reported, without giving its basis in the summary we read.
- Lab or animal only: found in cells, enzymes or animals; relevance to people not shown.
- Theoretical: predicted from how the plant is thought to act.
General background is in how interactions work and interactions by drug class.
What the sources report
| Medicine group | Adaptogen | What the source found | Label |
|---|---|---|---|
| Warfarin and blood thinners | American ginseng | MSK says it has been shown to antagonize warfarin's effects in humans [1]. | Reported in people |
| Warfarin and blood thinners | Ginseng (general) | LactMed says ginseng decreases the blood levels of some drugs, such as warfarin [2]. | Agency statement |
| Warfarin and blood thinners | Eleuthero | LactMed says it may increase bleeding [3]. | Agency statement |
| Warfarin and blood thinners | Astragalus | MSK: anticoagulant properties; clinical significance not known [4]. | Theoretical |
| Warfarin and blood thinners | Rhodiola | Modestly inhibits an enzyme (CYP2C9) that handles warfarin and phenytoin [5]. | Lab only |
| Diabetes medicines | Asian ginseng | In humans it may increase the blood-sugar-lowering effect of insulin and sulfonylureas [6]. | Reported in people |
| Diabetes medicines | Ashwagandha | NIH says it might interact with diabetes medicines [7]. | Agency statement |
| Blood pressure medicines | Rhodiola | Interactions with losartan have been reported [8]. | Reported in people |
| Blood pressure medicines | Licorice | EMA says it may counteract the action of prescribed antihypertensives [9]. | Agency statement |
| Blood pressure medicines | Astragalus | Extract can lower blood pressure and may add to blood pressure medicines; clinical relevance not known [4]. | Theoretical |
| Blood pressure medicines | Maca | Enhanced losartan's effect in hypertensive rats [10]. | Animal only |
| Antidepressants | Rhodiola | A tachyarrhythmia (fast, irregular heartbeat) case was reported with an antidepressant [5]. MSK also notes MAO inhibition activity that may raise serotonergic side effects; relevance not determined [5]. | Case report; mechanism theoretical |
| Sedatives, anti-seizure medicines | Ashwagandha | NIH names both groups [7]; MSK: preclinical sedative effects, relevance undetermined [11]. | Agency statement |
| Sedatives, anti-seizure medicines | Ginseng (general) | LactMed says ginseng enhances the effect of sedating drugs [2]. | Agency statement |
| Immunosuppressants | Astragalus | Herbal granules containing astragalus were associated with a nearly 50% drop in tacrolimus concentration in one patient [4]. | Reported in people |
| Immunosuppressants | Schisandra | Increased tacrolimus blood levels in liver transplant patients [12]. | Reported in people |
| Immunosuppressants | Ashwagandha | NIH says it might interact with immunosuppressants [7]; a kidney transplant rejection case occurred in a 69-year-old using it [11]. | Agency statement; case |
| Thyroid hormone medicines | Ashwagandha | NIH names them [7]. See thyroid cautions. | Agency statement |
| Corticosteroids, diuretics, heart (digoxin) medicines | Licorice | Interactions with corticosteroids have been reported [13]; EMA says not to use with diuretics, cardiac glycosides or corticosteroids [9]. | Reported; agency statement |
| Corticosteroids, diuretics, heart (digoxin) medicines | Eleuthero | A case report found raised digoxin levels [14]. | Case report |
| Imatinib | Asian ginseng | MSK says to talk with your provider if taking imatinib, and lists a liver toxicity case in a man on long-term imatinib who drank ginseng energy drinks [6]. | Case report |
Where sources differ
EMA's ginseng monograph says no interactions have been reported with other medicines [15], and its rhodiola monograph says no clinically relevant interactions have been observed. [16] MSK and NIH describe the reports above. The EMA texts summarize data assessed for licensed traditional herbal medicines, and "none reported" is not "none possible".Lab tests
Ashwagandha may falsely raise a digoxin lab assay [11], and maca may interfere with testosterone tests. [10] Tell the lab or clinician what you take.Enzymes and transporters
Several summaries mention liver enzymes (such as CYP3A4) and the P-glycoprotein transporter. These are mostly lab or animal findings with relevance not yet determined. [11][12] A licorice monograph does report modest reduction in exposure to some medicines cleared by CYP3A4 in clinical studies. [9]What to do
Bring the product label to a pharmacist and ask about each medicine. See also adaptogens for people taking many medicines and the safety overview. Proper evidence not found for combinations we did not list; we searched NCCIH, MSK, EMA and LactMed this session.Frequently asked questions
Is "natural" safer with my medicines?
No. NIH says some herbs and medicines interact in harmful ways. [8]
Which interactions are best documented?
Reported-in-people entries above, such as ginseng with warfarin or insulin and rhodiola with losartan. [1][6][8] Strength varies, and the summaries do not give study sizes.
Do adaptogens interact with antidepressants?
Rhodiola has a case report with an antidepressant and a possible MAO-related mechanism. [5] Ask the prescriber or pharmacist.
Can I take them together if I space the doses?
Proper evidence not found in the sources we read. A pharmacist can say whether timing matters for your medicines.
Does the supplement label list interactions?
Not reliably. Labels may not match contents. [17]