Autoimmune Conditions & Immunosuppressant Medicines
What NIH, Memorial Sloan Kettering and published reviews say about ashwagandha, astragalus, ginseng and other adaptogens in autoimmune disease and with immunosuppressant or transplant medicines.
Content last updated . This page has not been medically reviewed.
Safety first. Natural products can cause side effects and interact with medicines. Read who should be careful, by situation before you use anything on this page.
Can adaptogens be a problem for autoimmune conditions or immunosuppressant medicines? For several of them, health sources say yes, possibly. Autoimmune diseases are conditions in which the immune system attacks the body's own tissue (for example lupus or rheumatoid arthritis). Immunosuppressants are medicines that dampen the immune system, used for autoimmune disease and after organ transplants. Astragalus extracts, for example, are sold as supplements to improve immune function, [1] which is the opposite of what these medicines are meant to do. This page covers what is documented. It is not advice to stop any medicine: talk to the prescriber or pharmacist first.
What the sources say
| Ingredient | Autoimmune disease | Immunosuppressant or transplant medicines | Source |
|---|---|---|---|
| Ashwagandha, Withania somnifera | NIH: not recommended with autoimmune disorders [2]. MSK: may trigger or exacerbate autoimmune diseases [3]. | NIH: might interact with immunosuppressants [2]. MSK lists a kidney transplant rejection in a 69-year-old patient associated with its use [3]. | NCCIH 2023; MSK |
| Astragalus (Astragalus mongholicus / A. membranaceus) | NIH: might worsen symptoms; people with autoimmune diseases should avoid it [4]. | NIH: may interact with medicines that suppress the immune system [4]. MSK: herbal granules containing astragalus were associated with a nearly 50% reduction in tacrolimus concentration in one patient [1]. | NCCIH 2025; MSK |
| Asian ginseng, Panax ginseng | NIH: may worsen autoimmune disorders [5]. | Not described in the sources we read. | NCCIH 2025 |
| Schisandra, Schisandra chinensis | Not described in the sources we read. | MSK: increased blood levels of tacrolimus in liver transplant patients [6]. | MSK |
| Licorice, Glycyrrhiza species | Not described in the sources we read. | MSK: greatly reduced the oral bioavailability of cyclosporine; clinical relevance not known [7]. NIH: interactions with corticosteroids have been reported [8]. | MSK; NCCIH 2025 |
| Guduchi, Tinospora cordifolia | A multicenter study from India found acute hepatitis with autoimmune features that can unmask silent autoimmune hepatitis [9]. | Not described in the sources we read. | Hepatology Communications 2022 |
Note the direction of effect differs: astragalus was associated with lower tacrolimus levels in one case, while schisandra raised them in transplant patients. Both can matter, because immunosuppressant levels are monitored closely. These are individual reports, not rates.
Broader research: "immunostimulatory" herbs
A 2025 systematic scoping review of herbal supplements and autoimmune skin diseases found 227 herbal supplements with immunostimulatory properties and picked 15 with the most robust evidence. [10] Those included ashwagandha, astragalus, ginseng, liquorice and tinospora, among others. [10] The review counted evidence from human, animal-model and cell studies together and was written to help clinicians counsel patients, so it shows a theoretical reason for caution, not a measured rate of flares. [10] An earlier dermatology review said case reports suggest immunostimulatory herbs were associated with onset or flares of diseases with an exaggerated immune response. [11] The herbs that abstract names (such as spirulina, chlorella, echinacea and alfalfa) are not mainly adaptogens, so we do not extend it to them. [11]Evidence label: theoretical or case-report level, with some agency statements (NIH) that advise avoidance.
What this means in practice
- If you have an autoimmune disease or take immunosuppressants, ask your specialist before any adaptogen, including blends and "immune" teas.
- If you have had a transplant, tell the transplant team about every supplement, since drug levels are monitored.
- Do not use an adaptogen as a replacement for prescribed treatment.
- "Immune support" labels are marketing claims: see adaptogens and "immune support" claims checked.
See also ashwagandha before surgery and with autoimmune disease, immunodeficiency, autoimmune conditions and immunosuppression, existing health conditions and the medicine interactions guide.
Frequently asked questions
Is ashwagandha safe with autoimmune disease?
NIH says it is not recommended for people with autoimmune disorders, and MSK says it may trigger or exacerbate them. [2][3]
Do adaptogens stimulate the immune system?
Some sources describe immune-stimulating effects in lab and some human studies, but that is not shown to be a benefit, and it is a concern in autoimmune disease. [10]
Can I take astragalus with tacrolimus?
Ask the transplant team. MSK reports a large drop in tacrolimus concentration in one patient using a product containing astragalus. [1]
Which adaptogens are not a concern for autoimmune disease?
We cannot say. For most, the sources we read are silent, and silence is not proof of safety.
What if I notice a flare after starting a supplement?
Tell your clinician and bring the product. For an emergency call 911.