Eleuthero

• Buy only a product that names Eleutherococcus senticosus and the root: past mix-ups with Periploca (a heart-poison plant) and other species. An older case report describes a newborn with male-hormone (androgenising) effects after the mother took a product sold as 'pure Siberian ginseng'. The EMA assessment report says follow-up research found that product was adulterated with Periploca sepium, a plant that contains cardiac (heart-active) glycosides. The report also says a case of high digoxin in a man taking 'Siberian ginseng' may have been a mix-up with Periploca, because the product was never tested. These are old reports; no recent case of Periploca in a product was found in the sources read. In a 2018 DNA test of 25 UK Siberian ginseng supplements, all contained E. senticosus but 36% also contained another Eleutherococcus species. A 2023 review lists eleuthero root extract among botanicals at risk of adulteration. Case report ^{47 3 36 16 30}
• Heart medicine (digoxin): tell your doctor and the lab. One older man's digoxin blood level rose each time he took 'Siberian ginseng' and fell when he stopped, without signs of toxicity. The EMA report says this may be a lab-test artefact or a product mix-up. In the lab, some digoxin blood tests (FPIA and MEIA) read falsely high or low in the presence of some Siberian ginseng products; other tests showed no interference. A small trial of older people taking digoxin and Eleutherococcus extract found no change in digoxin level. In cells the extract may block a drug pump (P-glycoprotein), which could in theory raise digoxin levels. Evidence is low certainty, but anyone taking digoxin should tell their cardiologist and the lab before using it. Case report ^{30 7 8 9 42 6 47}
• Blood pressure and heart rhythm: sources disagree, so check with your doctor. Older guides said people with high blood pressure should avoid it. The EMA removed that warning in its 2014 review because the original study did not support it and later trials reported no rise in blood pressure. A 2012 review still lists Siberian ginseng among supplements associated with raised blood pressure, and the EMA monograph lists a fast heartbeat (tachycardia) as a possible effect, frequency not known. The trials we read in older adults showed no blood-pressure change. Authoritative guidance ^{47 48 35 6}
• Diabetes medicines: blood sugar may go up or down. In 12 healthy adults a dose of Siberian ginseng raised blood sugar after a sugar drink. In one exercise trial blood sugar was lower during cycling. LactMed says eleuthero may increase blood sugar, while the EMA report says medicines that lower blood sugar should be considered. No trial in people with diabetes was found. If you use insulin or diabetes pills, ask your doctor and check your blood sugar more often. Controlled trial ^{39 27 47}
• Blood thinners and bleeding. LactMed says eleuthero may increase bleeding. The EMA report says medicines that thin the blood should be considered, and cites a single multi-herb bleeding case in the brain (not attributed to eleuthero alone). A safety-centre chart review listed gut bleeding, nosebleed and vaginal bleeding in people who took Eleutherococcus with antidepressants. No controlled trial with warfarin or aspirin was found; a rat study of a Kan Jang mixture found no real warfarin effect (as reported by the EMA). Case report ^{27 40 47}
• Pregnancy, breastfeeding and children under 12: not recommended. The EU monograph says safety in pregnancy and breastfeeding has not been established and use is not recommended, and use under 12 is not recommended. LactMed says most sources recommend against use while breastfeeding because of missing safety data. Animal studies reported by the EMA found no birth defects, and old Russian reports on pregnant women are described as uncontrolled or poorly described. Authoritative guidance ^{48 27 47}
• Hormone-sensitive conditions: no good human data, so ask your doctor. In rat tissue the extract bound oestrogen and other hormone receptors in a lab test (as reported by the EMA), and in the chronic fatigue trial breast tenderness and uterine bleeding were more common on the extract (14% versus 4%, not a significant difference). LactMed also mentions breast tenderness. No study in breast, ovarian, uterine or prostate cancer, endometriosis or fibroids was found. The sensible position is to ask your doctor before use if you have a hormone-sensitive condition. Laboratory research ^{47 19 27}
• Sleep, mood and nerves. Insomnia, irritability and headache are listed in the EU monograph (frequency not known). The EMA report says insomnia can happen if it is taken too close to bedtime. If you have a mood disorder such as bipolar disorder, do not add any herb without your prescriber knowing. Authoritative guidance ^{48 47 44}

No LiverTox entry for eleuthero was found in a Bookshelf search (not fully proven; the LiverTox site itself could not be checked). The LactMed entry does not mention liver injury. The EMA report lists no laboratory findings and no serious events or deaths for oral root preparations. The only liver-related item found was in Swedish spontaneous reports for a mixed Echinacea, Eleutherococcus and Adhatoda product, which included raised liver enzymes (EMA report). No published human case of liver injury from eleuthero alone was found. ^{45 47 27}

How often. No frequency of human liver injury was found. Not finding reports is not proof that none exist.

Monitoring. No agency monitoring advice was found. Stop and seek care for yellow skin or eyes, dark urine, pale stools or severe itching.

This is a safety connection. It is not evidence that Eleuthero supports liver health.

Summary. Animal tests report very low acute toxicity for Eleutherococcus root extracts. No overdose case and no serious event or death from oral root preparations were found by the EMA. Clinical records in the 1960s to 1980s are old and uncontrolled.

Animal. The EMA report gives oral LD50 values in mice of about 30 g/kg for powdered root and about 14.5 g/kg for a 33% ethanol extract. It says toxic signs at very high doses (sedation, ataxia, tremor, vomiting) were thought to come more from the alcohol in the extract than from the plant. Rats given extracts at up to 400 mg/kg a day for 33 to 47 days showed no appreciable difference from controls.

Human doses studied. Trial doses ranged from short single doses to 8 weeks in healthy volunteers and patients; see the individual studies.

High dose or long term signals. The EMA report says side effects are more likely if normal doses are exceeded (herbal safety guide quoted) and that insomnia, irritability and palpitations were seen at higher doses in 1966 studies. The EU monograph limits the period of use (not for more than 2 months) and says to see a doctor if symptoms last longer than 2 weeks. Long-term safety beyond that was not found.

Overdose response. No case of overdose is reported (EU monograph).

Genotoxicity. Aqueous and ethanolic root extracts were negative in the Ames test (strains TA 100 and TA 98) and the mouse micronucleus test (EMA). The EMA notes adequate reproductive toxicity and carcinogenicity tests have not been done; it also notes one Ames strain was missing from the published test.

Toxic plant parts. No toxic part of E. senticosus was identified in the sources read. The root and rhizome are the traditional parts; leaf, stem and fruit products have separate and smaller safety records. The toxic-plant concern is a different plant: Periploca sepium, which the EMA report says contains cardiac (heart-active) glycosides.

The best-documented quality problems are mix-ups with other species. The historical Periploca mix-up involved a heart-active plant. In a modern DNA test, about one in three UK Siberian ginseng supplements contained another Eleutherococcus species as well. The European Pharmacopoeia sets a minimum content of eleutheroside B plus E for the root.

Periploca sepium found in a product sold as pure Siberian ginseng. The EMA report says a case of newborn male-hormone effects attributed to maternal use of 'pure Siberian ginseng' was traced to a product adulterated with Periploca sepium, and that the digoxin case may also have been a mix-up. Periploca sepium (GBIF key 5526185, family Apocynaceae) is a different plant from E. senticosus (family Araliaceae). The original 1996 letter could only be read as a title (no abstract). ^{47 3 50}

Another Eleutherococcus species in supplements. Of 25 Siberian ginseng supplements tested by DNA barcoding in the UK, all contained E. senticosus but 36% also contained another Eleutherococcus species. ³⁶

Eleuthero root listed as at risk of adulteration. A 2023 review of the American Botanical Council adulterants programme lists eleuthero root extract among botanical extracts at risk of adulteration. ¹⁶

Standard for the root. The EMA report states the European Pharmacopoeia requires dried root with at least 0.08% for the sum of eleutheroside B and eleutheroside E, and that products on the market do not always meet pharmacopoeial requirements. ⁴⁷

Not true ginseng. LactMed says eleuthero is not related to true ginseng (Panax) and has different constituents. The EMA report says the US Ginseng Labelling Act of 2002 restricted the name 'Siberian ginseng' (this is second-hand; the law was not read). ^{27 47}

• Chest pain, a very fast or irregular heartbeat with dizziness or fainting: call emergency services. Do not wait.
• Swelling of the face, lips or tongue, hives, or trouble breathing after taking it: call emergency services (allergic reaction).
• Black or bloody stools, vomiting blood, a nosebleed that will not stop, or heavy unexpected vaginal bleeding, especially if you take blood thinners or antidepressants: seek urgent care.
• If you take digoxin: nausea, vomiting, blurred or yellow-tinged vision, or a very slow pulse: seek urgent care (these are signs of too much digoxin, whatever the cause).
• Shakiness, sweating and confusion if you take diabetes medicines (possible low blood sugar): treat with sugar and seek care.
• Yellow skin or eyes, dark urine or pale stools: stop it and see a doctor.
• Severe headache with very high blood pressure readings: seek urgent care.
• A newborn or infant with unusual symptoms after the mother used a product sold as Siberian ginseng: tell the paediatrician about the product.

Stop the supplement and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.