Ashwagandha (Withania Somnifera) in Ayurveda

Liver. A case series of five people from Iceland and the US Drug-Induced Liver Injury Network [25] described liver injury, usually with jaundice and itching, which normally improved over 1 to 5 months after stopping. [26] A scoping review of 13 publications (25 patients) described a repeatable pattern of liver injury, with most people recovering, one liver transplant and three deaths in people who already had cirrhosis. [27] [28] A series from India found 8 people with injury from single-ingredient products, where three with existing chronic liver disease died. [29] In that series, product analysis found only natural plant compounds, with no adulteration or contamination. [30] The reviewers advise people with advanced liver disease to avoid ashwagandha. [31] See liver injury from Ayurvedic herbs.

Pregnancy and breastfeeding. NCCIH says to avoid it in both. [2]

Thyroid and autoimmune conditions, surgery. NCCIH does not recommend it for people about to have surgery or with autoimmune or thyroid disorders. [32] A 2023 review reported that thyroid hormone levels rose and TSH fell in some studies, [33] and a 2026 safety review names pregnant women, people with thyroid disorders and people with liver or kidney dysfunction as groups at particular risk. [34]

Medicines. NCCIH lists possible interactions with medicines for diabetes and high blood pressure, immunosuppressants, sedatives, anti-seizure medicines and thyroid hormone medicines. [35] [36] Because it may raise testosterone, people with hormone-sensitive prostate cancer should avoid it. [37] Never stop a prescribed medicine because of an herb. See medicine and thyroid interactions.