When to Stop & Seek Advice

Urgent first

Call 911 (US) for trouble breathing, swelling of the throat, lips or tongue, chest pain, fainting, or stroke signs. The FDA's list of serious supplement reactions includes "throat/lip/tongue swelling, or wheezing," "chest pain, shortness of breath, palpitations, or irregular heartbeat," and "slurred speech, one-sided weakness of face, arm, leg, or blurry/loss of vision." [1]

Thoughts of suicide or marked mood changes. The same FDA list includes "marked mood (irritability, anxiety), cognitive, or behavioral changes, thoughts of suicide." [1] In the US, call or text 988 (Suicide & Crisis Lifeline). Do not wait to see if it passes. NCCIH's rhodiola page also says that if you or someone in your family may have depression, consult a health care provider. [2]

Someone swallowed much more than intended, or a child got into a product. Call Poison Help at 1-800-222-1222 (US). See Poisoning: what to do first and Poison help by country.

The FDA notes adverse reactions "can even result in Emergency Room visits or hospitalization." [1]

What the sources say to do about the product

The FDA says that if you think a supplement caused a serious reaction, "immediately stop using the product and fill out a safety report through the Safety Reporting Portal." [1] NCCIH says: "If you have side effects, stop taking the supplement and contact your health care provider." [3] This is about the supplement. Never stop or change a prescribed medicine on your own; ask the prescriber or pharmacist first.

Common effects to write down and mention

NCCIH names these as possible side effects. They are less urgent than the list above, but tell a clinician or pharmacist if they persist or bother you:

• Ashwagandha (Withania somnifera): drowsiness, stomach upset, diarrhea and vomiting. [4]
• Rhodiola (Rhodiola rosea): dizziness, headache, insomnia, and dry mouth or excess saliva. [2]
• Asian ginseng (Panax ginseng): insomnia is the most common; also possible are stomach and skin reactions. [5][6]

Keep notes using Tracking benefits and side effects.

Situations to raise with a clinician before or soon after starting

• Pregnancy or breastfeeding. NCCIH says ashwagandha should be avoided in pregnancy and not used while breastfeeding. [4] The EMA ginseng summary says not to use it in pregnancy or breastfeeding "due to the lack of adequate data." [6] See Adaptogens in pregnancy and breastfeeding.
• Children and teens. The EMA summaries say ginseng root is not for people under 18 and arctic root only for adults over 18. [6][7]
• Surgery. NCCIH says ashwagandha is not recommended for people about to have surgery. [4] The FDA says a health professional "may ask you to stop taking dietary supplements two or three weeks before the procedure." [8] See Adaptogens before surgery.
• Medicines. NCCIH lists possible ashwagandha interactions with diabetes, high blood pressure, immunosuppressant, sedative, anticonvulsant and thyroid hormone medicines, and rhodiola interactions with losartan. [4][2] See Adaptogen medicine interactions.
• Autoimmune or thyroid conditions. NCCIH does not recommend ashwagandha for these. [4] It says Asian ginseng may worsen autoimmune disorders. [5]

Report it

You can report a supplement problem through the US Health and Human Services Safety Reporting Portal, which the FDA uses to evaluate the marketplace. [3][1] More at Side effects, allergic reactions and reporting.

What these sources do not tell us

We did not find a source that says how long after stopping a supplement symptoms usually resolve, or which adaptogen-specific symptoms are most predictive of serious harm: Proper evidence not found in the pages we read. A clinician can judge for your situation.