Adaptogen Safety & Interactions
Plain-language safety overview for adaptogen herbs: urgent warning signs, medicine interactions, pregnancy, children, surgery, liver and thyroid cautions, and quality, from named health sources.
Content last updated . This page has not been medically reviewed.
Get help first
Call 911 for fainting, a seizure, trouble breathing, a severe allergic reaction (reported rarely with Asian ginseng [1]) or a very irregular heartbeat. Licorice products have been linked to irregular heartbeat and cardiac arrest in large or long-term use. [2] For a possible overdose or poisoning in the US, Poison Help is 1-800-222-1222 (other countries: poison help by country). If you are thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline, US).Yellow skin or eyes (jaundice) with itching, nausea or belly discomfort after starting an ashwagandha product is the pattern described in published liver-injury case series. [3] Contact a clinician promptly and bring the product. See liver safety and supplements.
"Natural" does not mean risk-free
"Adaptogen" is a contested label rather than a safety category, so this library judges each plant on its own evidence (see what adaptogens are). Some of these plants are well tolerated in short studies. Others have documented side effects, medicine interactions or liver reports. Absence of a warning in a source is not proof of safety. This page is information, not personal medical advice: a pharmacist or clinician who knows your medicines decides what is right for you.The main concerns, ingredient by ingredient
Details and sources for each row are on Side Effects by Ingredient.| Ingredient | What the sources stress most | Source type |
|---|---|---|
| Ashwagandha (Withania somnifera) | Rare but documented liver injury; avoid in pregnancy; not recommended before surgery or with autoimmune or thyroid disorders | NIH NCCIH [4]; case series [3] |
| Asian ginseng (Panax ginseng) | Insomnia most common; blood sugar and clotting effects; pregnancy caution | NIH NCCIH [1] |
| Rhodiola (Rhodiola rosea) | Dizziness, headache, insomnia; a reported losartan interaction; depression caution | NIH NCCIH [5] |
| Licorice (Glycyrrhiza species) | Glycyrrhizin can affect heart rhythm and blood pressure | NIH NCCIH [2] |
| Astragalus (Astragalus mongholicus or A. membranaceus) | Avoid with autoimmune disease; may interact with immune-suppressing medicines | NIH NCCIH [6] |
| He shou wu (Polygonum multiflorum) | Numerous reports of acute liver injury, sometimes fatal | NIH LiverTox [7] |
| Guduchi (Tinospora cordifolia) | Reports of clinically apparent liver injury with long-term use | NIH LiverTox [8] |
Medicines
Some interactions are reported in people, some come only from lab or animal work, and some are theoretical. The guide on documented versus theoretical interactions separates them. Groups that sources name include diabetes and blood pressure medicines, immunosuppressants, sedatives, anti-seizure medicines and thyroid hormone medicines (ashwagandha) [4], and corticosteroids (licorice). [2] General background is in how interactions work. Do not change a prescribed medicine on your own: ask the prescriber or pharmacist.Pregnancy, breastfeeding and children
NIH says ashwagandha should be avoided in pregnancy and not used while breastfeeding. [4] For ginseng, rhodiola and eleuthero, the European herbal monographs say safety in pregnancy and lactation has not been established and use is not recommended. [9][10][11] See pregnancy and breastfeeding and children and teenagers.Surgery
NIH does not recommend ashwagandha for people about to have surgery. [4] Memorial Sloan Kettering advises stopping Asian ginseng at least 1 week before surgery. [12] Tell the surgical team about every supplement. More in adaptogens before surgery.Liver, thyroid and immune conditions
Liver reports are strongest for ashwagandha, He shou wu and guduchi, and weaker or absent for others: LiverTox says ginseng and astragalus have not been implicated in liver injury. [13][14] NIH does not recommend ashwagandha with thyroid or autoimmune disorders. [4] See thyroid cautions and autoimmune conditions and immunosuppressants.Quality and mislabeling
NIH warns that what is on a supplement label may not be what is in the product. [15] LactMed also notes that labeled and actual ingredients or amounts are often different. [16] See contamination and adulteration and quality testing and certifications. Lead was found in ashwagandha and mucuna pills in one reported case of hemolytic anemia. [17]Not a substitute for care
Tiredness, low mood, poor sleep or stress can have medical causes. See adrenal fatigue claims for why "adrenal fatigue" is not an established diagnosis, and when to seek medical help.In this section
- Medication Interactions
- Pregnancy & Breastfeeding
- Children & Teenagers
Dashed labels are guides in preparation. We link a page only when it has real, sourced content.
Frequently asked questions
Are adaptogens safe to take with medication?
Not automatically. Sources describe reported or possible interactions for several of them, including ashwagandha with diabetes, blood pressure, immunosuppressant, sedative and thyroid medicines. [4] Ask a pharmacist before combining.
Which adaptogen has the most serious liver reports?
Ashwagandha and He shou wu have the strongest published liver-injury reports in the sources we read. [18][7] NIH calls ashwagandha liver injury rare. [4]
Is there a safe amount?
We do not give amounts. Safety depends on the plant part, extract, product, your health and your medicines, so a clinician or pharmacist decides. Trial and monograph amounts are not advice.
Can I use adaptogens if I am pregnant or breastfeeding?
Sources advise avoiding ashwagandha, and say safety is not established for ginseng, rhodiola and eleuthero. [4][9][10][11]
Does a "tested" label mean a product is safe?
No. LactMed notes that independent verification of a product's quality does not certify its safety or effectiveness. [16]