Ashwagandha Before Surgery and With Autoimmune Disease
What NCCIH and Memorial Sloan Kettering say about ashwagandha before surgery and with autoimmune conditions or transplants, and what the sources do not explain.
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.
Safety first. The U.S. National Center for Complementary and Integrative Health (NCCIH) says ashwagandha "is not recommended for people who are about to have surgery, or for those who have autoimmune or thyroid disorders". [1] Tell every member of your surgical and anesthesia team about all supplements, including ashwagandha (Withania somnifera (L.) Dunal), well before a planned procedure. Never stop or change a prescribed medicine on your own; ask the prescriber or pharmacist.
What the sources say, and what they leave out
NCCIH gives the surgery and autoimmune advice as a single sentence and does not explain why. [1] We searched PubMed for ashwagandha with surgery, anesthesia and perioperative terms and read the NCCIH and Memorial Sloan Kettering pages. Proper evidence not found for a study of ashwagandha around surgery in people, or for a documented bleeding or anesthesia problem caused by it. What we can offer are the related cautions that the sources do name.Autoimmune conditions
NCCIH says ashwagandha is not recommended for people who have autoimmune disorders. [1] Memorial Sloan Kettering adds that it "may also trigger or exacerbate autoimmune diseases". [2] The page we read does not name which autoimmune diseases, which preparations, or how often. We read the reasoning only as caution. Memorial Sloan Kettering lists "immunomodulating" effects in the part of its summary that covers preclinical studies, so this is lab-level evidence and a reason for caution, not a measured effect in people. [2]What this means in practice:
- If you have an autoimmune condition, ask your specialist before you start ashwagandha.
- If you already take it and your condition seems to be flaring, tell your specialist what you take. Do not guess whether the two are linked.
- Thyroid autoimmune disease is covered in ashwagandha and the thyroid.
Transplants and immunosuppressant medicines
NCCIH lists "medicines that decrease the immune system response (immunosuppressants)" among possible interactions. [1] Memorial Sloan Kettering lists a kidney transplant rejection in a 69-year-old patient associated with use of ashwagandha. [2] A published report in Kidney International Reports (2020) bears the title "Ashwagandha and Kidney Transplant Rejection". [3] A report like this shows a possible link and does not measure how often it happens. People with a transplant should treat ashwagandha as something to discuss with the transplant team before any use. More detail is on the page about ashwagandha and medicines.Frequently asked questions
Should I take ashwagandha before surgery?
NCCIH says it is not recommended for people about to have surgery. [1] Ask the surgical and anesthesia teams; the sources we read give no stopping time.
Does ashwagandha affect anesthesia?
Proper evidence not found. We searched PubMed and read NCCIH and Memorial Sloan Kettering. Sedative effects with some medicines are suggested from preclinical work. [2]
Can people with autoimmune disease take ashwagandha?
NCCIH does not recommend it, and Memorial Sloan Kettering says it may trigger or worsen autoimmune disease. [1][2] Ask your specialist.
Does ashwagandha interfere with transplant medicines?
NCCIH names immunosuppressants as a possible interaction, and a kidney transplant rejection case has been reported. [1][2]
Do I need to tell my doctor about ashwagandha?
Yes. List every supplement, with the plant part and other ingredients on the label, at every visit.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Before surgery: the cautions that sources name
| Concern | What the source says | Strength of evidence |
|---|---|---|
| General advice | Not recommended for people about to have surgery. [1] | Agency advice; reason not stated |
| Drowsiness and sedation | Drowsiness is a listed effect. [1] Preclinical studies suggest sedative effects that "may have additive effects" with barbiturates, benzodiazepines and anticonvulsants; clinical relevance is undetermined. [2] | Lab only; named as possible |
| Thyroid hormone changes | Memorial Sloan Kettering lists "May increase thyroxine levels" as a laboratory interaction. [2] | Reported in people (case reports) |
| Liver tests | Liver injury is rare, but "a number of cases" link it to ashwagandha supplements. [1] | Reported in people |
| Blood tests | A possible "false elevation in digoxin immunoassay". [2] | Reported |
The surgical-safety page Supplements Before Surgery covers bleeding, anesthesia and blood pressure for supplements in general. It is the better place to learn what to ask the surgical team. The sources we read do not give a timing for stopping ashwagandha before surgery, so that is a question for the surgeon, the anesthesia team and the pharmacist. Bring the bottle, which shows whether it is root, leaf or a blend.
Related cautions
References
- National Center for Complementary and Integrative Health (NIH, U.S.). Ashwagandha: Usefulness and Safety. Last updated March 2023. Read 2026-10-23.
- Memorial Sloan Kettering Cancer Center. Ashwagandha: Purported Benefits, Side Effects & More. About Herbs, Botanicals and Other Products. Read 2026-10-23.
- Ashwagandha and Kidney Transplant Rejection. Kidney International Reports, 2020. Only the title and record were read; no abstract is listed. Read 2026-10-23.