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Check Before You Use an Adaptogen: Who Should Be Careful

Who should ask a clinician or pharmacist before using adaptogens: a situation-by-situation table of which plants health sources flag, and what to do. Not medical advice.

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.

Most people who try an adaptogen herb have no trouble. But some situations call for a quick check first: a medicine you take, a health condition, pregnancy, an operation coming up. This page is the guide behind the "Check before you use" filter on the Adaptogens hub. It lists the situations where a named health source flags a plant, and tells you who to ask. It does not tell anyone to start, stop or change a medicine. That is for your prescriber or pharmacist.

A flag is not a verdict. It means a source we read raised a concern, from a case report, a trial, a lab finding or a regulator's caution. We say which kind wherever the detail matters. A plant with no flag in a row is not proven safe. It may only mean we found nothing in the sources we read.

Read this first

  • Ask before you add. If you take any prescription medicine, ask a pharmacist before starting an adaptogen. Bring the product label.
  • "Natural" is not a safety category. NCCIH (the US National Center for Complementary and Integrative Health) says this in its plant pages, and several sources below describe real side effects. [1][2][3]
  • Tell every clinician. That includes the surgeon, dentist and anaesthetist before any procedure. Surgery and blood thinners are the most time-sensitive row below.
  • Never stop a prescribed medicine on your own because of something you read here.
  • Emergency line: see "Get urgent care first" right below.

Get urgent care first

Call 911 (US) or your local emergency number, or go to urgent care, for: trouble breathing, swelling of the face, lips or throat, hives with dizziness (possible severe allergy), fainting, chest pain or a very fast or irregular heartbeat, black or bloody stools, vomiting blood, or yellow skin or eyes (jaundice) with dark urine. NCCIH lists severe allergic reactions among the rarer reports with Asian ginseng, and irregular heartbeat and cardiac arrest with large or long-term licorice use. [2][3] If you think someone swallowed too much of a product, Poison Help in the US is 1-800-222-1222. See also the emergency quick reference and when to seek help.

What "adaptogen" does and does not mean

The word was coined by N. V. Lazarev in 1947 for a substance said to raise the body's general resistance to stress. In its 2008 reflection paper on the adaptogenic concept, the European Medicines Agency's herbal committee (HMPC) wrote that the term is not accepted in the pharmacological and clinical terminology commonly used in the EU, and that it is not appropriate for a marketing authorisation. [7] The committee also said the clinical data it reviewed had shortcomings such as unclear study design and very small numbers, and that none of the studies would be enough to prove efficacy of Eleutherococcus preparations in a clearly defined condition, though the data justified further research. [7] The paper focused on Eleutherococcus (eleuthero), and says similar thinking may apply to other herbs. [7]

What this means for safety: "adaptogen" is a marketing and traditional label, not a promise that a herb is gentle or non-toxic. The old Soviet-era description listed "almost non-toxic" as a trait, but that is a claim in the paper's history section, not a finding. [7] Judge each plant by its own safety record, as below.

The situations, the flags, and what to do

Sources are numbered and listed at the bottom. Rows marked "site page" rely on the library's own pages, which carry their own citations. Follow the links for detail instead of repeating it here.
SituationWhich adaptogens are flagged, by which sourceWhat to do
Stimulation, insomnia, jitters, heart racingAsian ginseng: NCCIH says insomnia is the most common side effect. [2] Rhodiola: NCCIH lists dizziness, headache and trouble sleeping. [5] Eleuthero: insomnia, irritability and fast heartbeat in the EMA summary on the eleuthero cautions page (site page).If you have a heart rhythm problem, anxiety, or already sleep badly, ask a clinician first. Notice timing: many people find these are worse late in the day.
Thyroid disease or thyroid medicineAshwagandha: NCCIH says it is not recommended with thyroid disorders and might interact with thyroid hormone medicines. [1] Reviews from 2026 split: one says risk for people with thyroid disorders [10]; another says thyroid hormones appear to rise in hypothyroid settings. [11]Ask the prescriber before use, and tell them if a thyroid blood test changes. Details: thyroid cautions and ashwagandha and the thyroid.
Autoimmune disease, or medicines that calm the immune system (including after a transplant)Astragalus: NCCIH says it may worsen autoimmune conditions and may interact with immunosuppressants. [4] Ashwagandha: NCCIH says it is not recommended with autoimmune disorders and might interact with immunosuppressants. [1] Reishi: Memorial Sloan Kettering (MSK) flags immunosuppressants and possible autoimmune skin flare, per the reishi claim check (site page). Echinacea-type "immune boosters": see the echinacea page (site page).Ask the specialist who manages your condition or transplant. Do not add an "immune" herb without them. See autoimmune conditions and immunosuppressants.
Pregnancy and breastfeedingAshwagandha: NCCIH says avoid in pregnancy and do not use while breastfeeding. [1] Asian ginseng: some studies suggest oral use may be unsafe in pregnancy, and little is known about breastfeeding. [2] Rhodiola and astragalus: little is known, and NCCIH notes animal research suggesting astragalus may be toxic to a fetus. [4][5] Licorice: very large amounts (about 250 grams of extract per week) are described as unsafe, and the EMA monograph does not recommend use in pregnancy. [3][8] Ginkgo: may be unsafe in pregnancy. [6] A 2026 review judged evidence of ashwagandha harm to pregnancy inconclusive, which is not the same as safe. [10]Ask the midwife, obstetrician or pharmacist first. Also ask if you are trying to conceive. See pregnancy and breastfeeding and children and teenagers.
Blood thinners and surgeryAsian ginseng: NCCIH says it may interfere with blood clotting. [2] Ginkgo (sometimes grouped with "brain tonics", not a classic adaptogen): NCCIH says it may raise bleeding risk, especially with warfarin. [6] Reishi: MSK flags bleeding risk (site page above). A 2025 review says ginseng, ginkgo and similar products can raise bleeding risk with antithrombotic therapy, and that evidence and product quality vary. [14] Ashwagandha: NCCIH says it is not recommended for people about to have surgery. [1]Tell your surgical team and the clinician who prescribes your blood thinner about every supplement, ideally weeks before a planned procedure. See adaptogens before surgery and ginseng cautions.
Blood pressure and heart medicinesLicorice: NCCIH says glycyrrhizin can cause serious effects in people with high blood pressure, and the EMA monograph says licorice root may counteract blood pressure medicines and is not recommended with hypertension, kidney, liver or heart disease or low potassium. [3][8] Eleuthero: a reference says it "may" raise blood pressure (site page). Rhodiola: NCCIH reports an interaction with losartan. [5] Ashwagandha: NCCIH says it may interact with blood pressure medicines. [1]Ask your clinician or pharmacist, and check labels of teas and blends for licorice. See blood pressure and sugar and licorice root.
Diabetes medicinesAsian ginseng: NCCIH says it may lower blood sugar and to check with a provider if you have diabetes. [2] Ashwagandha: NCCIH says it may interact with diabetes medicines. [1] A 2026 randomized trial of Korean red ginseng in 70 adults already taking diabetes medicines found no difference in fasting glucose, 2-hour glucose or HbA1c versus placebo and no low-sugar events; it was 12 weeks and small. [15]If you use insulin or tablets for blood sugar, ask first, and ask what to watch for. See adaptogens for blood sugar.
Liver disease, or a history of liver troubleAshwagandha: NCCIH says rare liver injury has been linked to it. [1] A 2026 review of preclinical work notes the clinical pattern is mostly reversible cholestasis (bile flow slowed), sometimes with jaundice and itching, and that the responsible compounds are not identified. [9] He shou wu (Polygonum multiflorum): a 2026 review describes liver toxicity and some severe cases. [13] A 2026 liver-injury review lists both ashwagandha and Polygonum multiflorum among supplements linked to injury: most people recover after stopping, but some progressed to liver failure, death or transplant. [12] Asian ginseng: NCCIH lists liver damage among less common reports. [2] Licorice: the EMA monograph advises against use in liver disorders. [8]Skip these if you have liver disease unless your clinician agrees. Know the warning signs, below. See liver and kidney cautions, ashwagandha liver reports and he shou wu.
Hormone-sensitive conditionsAshwagandha: NCCIH says it should be avoided with hormone-sensitive prostate cancer because it may raise testosterone. [1] A 2026 review reports possible testosterone rises in men and effects on estrogen and gonadotropins in women, and calls for larger trials. [11]If you have a hormone-sensitive cancer, or take hormone therapy, birth control or treatment for a hormone condition, ask your specialist first. See women's hormones and adaptogens for men.
Sedatives, sleep medicines, seizure medicines, alcoholAshwagandha: NCCIH lists drowsiness as a side effect and names sedatives and anti-seizure medicines as possible interactions. [1] Ginseng (general): LactMed says it can enhance the effect of sedating drugs, per the medicine interactions page (site page).Take extra care with driving or machines. Ask a pharmacist before pairing with sleep aids, anti-anxiety medicines or alcohol. See supplements, sedatives and alcohol.
Heavy metals and product quality (shilajit, imported or traditional products)A 2025 lab study measured the toxic metal thallium in natural shilajit, up to 0.226 micrograms per gram, and some supplements had more than the raw material. [16] NCCIH notes supplements are not approved by the FDA before sale, so makers are responsible for safety and labeling. [5] See the lead and mislabeling reports on the safety overview (site page).Choose products with independent testing that you can check. Be extra careful with unlabeled imports, and with children or pregnancy. See contamination and adulteration and shilajit.

How to ask, in two minutes

  1. Write down every product: name, form, strength on the label, how often. Photograph the label.
  2. List your medicines and conditions, including thyroid, blood pressure, sugar, liver and kidney problems.
  3. Ask the pharmacist: "Is there a known interaction between this product and each of my medicines? What should I watch for, and who should I call?"
  4. Mention any planned surgery, pregnancy or trying to conceive.
  5. If something feels wrong, stop and call. You can report side effects through MedWatch.

For the evidence behind each interaction and how strong it is, see documented versus theoretical interactions. The overall picture is on the safety overview.

Related pages

Frequently asked questions

Does "Check before you use" mean the plant is unsafe?

No. It means a source we read raised a concern for that situation. Many people use these plants without problems, and a few flags rest on case reports or lab work only. The point is to ask the right person before you start.

Who is the right person to ask?

For medicines, a pharmacist is often the quickest. For a condition, pregnancy or surgery, ask the clinician who looks after it. Bring the product label.

I already take an adaptogen and one row fits me. What now?

Do not panic and do not stop a prescribed medicine yourself. Call your prescriber or pharmacist, tell them the product and how long you have used it, and ask whether to continue. If you have jaundice, trouble breathing or fainting, seek urgent care.

Why is licorice on a list of adaptogens?

Sources and traditions group licorice with tonics, and it appears in many blends. Its safety flags are among the best documented here, mostly for blood pressure, potassium and heart rhythm. [3][8]

Why does the EMA say "adaptogen" is not accepted, when products use the word?

The 2008 EMA committee paper says the term is not accepted in the pharmacological and clinical terminology commonly used in the EU, and not appropriate for a marketing authorisation. [7] Products can still use the word in marketing. That is why this library judges each plant by its own evidence.

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.

Liver warning signs, in plain words
Stop the product and contact a clinician promptly if you notice yellow skin or eyes, dark urine, pale stools, itching all over, unusual tiredness with nausea, or pain in the upper right belly after starting a supplement. Take the product with you. Severe symptoms need urgent care. More in liver injury warning signs.
References

All read 2026-10-24. We could not open LiverTox or MedlinePlus pages this session (blocked or not found), so they are not cited.

  1. NCCIH. Ashwagandha. https://www.nccih.nih.gov/health/ashwagandha. Read 2026-10-24.
  2. NCCIH. Asian Ginseng. https://www.nccih.nih.gov/health/asian-ginseng. Read 2026-10-24.
  3. NCCIH. Licorice Root. https://www.nccih.nih.gov/health/licorice-root. Read 2026-10-24.
  4. NCCIH. Astragalus. https://www.nccih.nih.gov/health/astragalus. Read 2026-10-24.
  5. NCCIH. Rhodiola. https://www.nccih.nih.gov/health/rhodiola. Read 2026-10-24.
  6. NCCIH. Ginkgo. https://www.nccih.nih.gov/health/ginkgo. Read 2026-10-24.
  7. EMA, Committee on Herbal Medicinal Products. Reflection paper on the adaptogenic concept, EMEA/HMPC/102655/2007, adopted 8 May 2008. https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-adaptogenic-concept_en.pdf. Read 2026-10-24.
  8. EMA/HMPC. European Union herbal monograph on Glycyrrhiza glabra L., G. inflata Bat., G. uralensis Fisch., radix, Revision 1, EMA/HMPC/108399/2024 (sections 4.4 to 4.6, 4.9). https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-glycyrrhiza-glabra-l-glycyrrhiza-inflata-bat-glycyrrhiza-uralensis-fisch-radix-revision-1_en.pdf. Read 2026-10-24.
  9. Williamson EM, Brendler T. Ashwagandha: Is It Safe? Part 2: A Preclinical Evidence Review. Phytotherapy Research 2026. PMID 40968393 (abstract read via Europe PMC). Read 2026-10-24.
  10. Li L, et al. Evaluating the Safety of Ashwagandha as a Food Additive: A Focus on Reproductive, Thyroid, and Immune System Effects. Phytotherapy Research 2026. PMID 41454545 (abstract). Read 2026-10-24.
  11. Vollmer G, Brendler T. Evaluation of Potential Hormonal Activities of Ashwagandha (Withania somnifera). Phytotherapy Research 2026. PMID 41454558 (abstract). Read 2026-10-24.
  12. Bjornsson ES. Common Causes of Drug-Induced Liver Injury in 2025. Turkish Journal of Gastroenterology 2026. PMID 42504634 (abstract). Read 2026-10-24.
  13. Wang Y, et al. Hepatotoxic Compounds and Mechanisms of Polygonum Multiflorum: A Narrative Review of Recent Advances. International Journal of Molecular Sciences 2026. PMID 42278266 (abstract). Read 2026-10-24.
  14. Dobre MZ, et al. Navigating the Effects of Anti-Atherosclerotic Supplements and Acknowledging Associated Bleeding Risks. International Journal of Molecular Sciences 2025. PMID 41155474 (abstract). Read 2026-10-24.
  15. Nam JS, et al. Korean red ginseng as adjunctive therapy in type 2 diabetes. Journal of Ginseng Research 2026. PMID 42395024 (abstract of a 12-week randomized, placebo-controlled trial, 70 adults). Read 2026-10-24.
  16. Kamgar E, et al. Quantifying of thallium in Shilajit and its supplements to unveil the potential risk of consumption of this popular traditional medicine. BMC Chemistry 2025. PMID 39827344 (abstract). Read 2026-10-24.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.