Ashwagandha Side Effects and Liver Injury Reports

Warning signs to act on first

In the case series we read, people who developed ashwagandha-linked liver injury had jaundice (yellowing of the skin and eyes) and symptoms such as nausea, lethargy, itching and abdominal discomfort, after a delay of 2 to 12 weeks of use. [1]

If you notice these signs while taking ashwagandha, contact a doctor or pharmacist promptly and tell them exactly which products you take. If you feel seriously unwell, call 911 (US). Do not stop or change a prescribed medicine on your own; ask the prescriber or pharmacist. The reports describe recovery after the supplement was stopped, usually over weeks to months. [2] Our liver safety guide lists more signs, and side effects and reporting explains how to report a reaction.

What the plant is

Ashwagandha is Withania somnifera (L.) Dunal, family Solanaceae (accepted name per GBIF); supplements use root, leaf or root-and-leaf extracts. [3][4] See root vs leaf.

Liver injury reports

NCCIH says that although it is rare, a number of cases link liver injury to ashwagandha supplements. [4] Our label: evidence of harm (case reports, uncommon).

The scoping review describes a reproducible clinical syndrome of unpredictable ("idiosyncratic"), frequently cholestatic injury. [2] In the case series, four of five patients were also using other supplements, and in one case rhodiola was a possible cause alongside ashwagandha. [1] Chemical analysis of available supplements confirmed ashwagandha and found no other toxic compounds. [1] Another review lists ashwagandha among major agents implicated in herbal and supplement liver injury. [5]

How common is it?

Proper evidence not found in the sources we read for a rate of liver injury among people who use ashwagandha. A 2026 review of trials in healthy adults (23 studies, 2,317 participants) reports no serious adverse events attributable to standardized root extracts, and biomarkers staying in normal ranges. [6] An 8-week trial of 80 healthy volunteers also found no untoward effects, with liver tests among its primary outcomes. [7] The same authors say recent case reports mainly involved non-standardized or multi-ingredient products. [6] Short trials of a few dozen or hundreds of people can miss a rare reaction, so both sets of findings can be true. NCCIH says there is not enough information on long-term safety. [4]

Regulators

A 2026 review mentions European risk assessments and a Danish ban. [8] We could not open the Danish authority's page, the Australian TGA pages, or the NIH LiverTox entry (a security check blocked it), so we do not describe their wording here. See Is ashwagandha safe, and is it banned? for the regional picture.

Common, milder effects

NCCIH lists drowsiness, stomach upset, diarrhea and vomiting. [4] The same review reports gastrointestinal discomfort, headache and transient drowsiness, infrequently and in both treatment and comparator groups. [6] A 2024 pooled review noted that four included studies reported mild to moderate adverse events. [9]

Who should be especially careful

• Existing liver disease: deaths in the scoping review were in people with pre-existing cirrhosis. [2] A 2026 review says ashwagandha poses significant risks to people with liver or kidney dysfunction. [10] See adaptogens and the liver or kidneys.
• Pregnancy and breastfeeding: NCCIH says avoid it in pregnancy and do not use it while breastfeeding. [4]
• Before surgery, autoimmune or thyroid conditions: NCCIH does not recommend it. [4] See the thyroid guide.
• People taking several medicines: NCCIH lists possible interactions with medicines for diabetes and high blood pressure, immunosuppressants, sedatives, anti-seizure and thyroid hormone medicines. [4] See medicine interactions.

Overdose

Proper evidence not found. We searched PubMed for ashwagandha overdose and toxicity and found only animal and unrelated studies. If someone has taken a large amount or a child has swallowed some, call Poison Help at 1-800-222-1222 (US); other countries are on Poison Help by country.