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Ashwagandha

Also known as Withania somnifera

Not medically reviewed

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Evidence source: NIH ODS evidence synthesis
Linked references: 8 identified
Human evidence: Human evidence identified
Randomized trials: Randomized trial identified
Reviews and meta-analyses: Systematic review or meta-analysis identified
Evidence recency: 2020–2024
Source-described consistency: Not characterized in these source blocks
MEDucated evidence rating: Not assigned

Reference counts describe frozen source associations; a larger count does not establish stronger evidence.

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Evidence types identified

Study type could not be determined6
Randomized controlled trial1
Systematic review1

Source-described limitations

No explicit limitation phrase was identified in these imported source blocks.

Classified references

Mandlik Ingawale DS, Namdeo AG. Pharmacological evaluation of Ashwagandha highlighting its healthcare claims, safety, and toxicity aspects. J Diet Suppl 2021;18:183-226 [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Panossian AG, Efferth T, Shikov AN, Pozharitskaya ON, Kuchta K, et al. Evolution of the adaptogenic concept from traditional use to medical systems: Pharmacology of stress- and aging-related diseases. Med Res Rev 2021;41:630-703. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Gerontakos SE, Casteleijn D, Shikov AN, Wardle J. A Critical Review to Identify the Domains Used to Measure the Effect and Outcome of Adaptogenic Herbal Medicines. Yale J Biol Med 2020;93:327-46. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Ministry of Ayush, Government of India. Safety of Ashwagandha, Withania somnifera. Report of the Expert Committee. 2024.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Langade D, Thakare V, Kanchi S, Kelgane S. Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study. J Ethnopharmacol 2021;264:113276. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Holvoet H, Long DM, Law A, McClure C, Choi J, et al. Withania somnifera Extracts Promote Resilience against Age-Related and Stress-Induced Behavioral Phenotypes in Drosophila melanogaster; a Possible Role of Other Compounds besides Withanolides. Nutrients 2022;14. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Speers AB, Cabey KA, Soumyanath A, Wright KM. Effects of Withania somnifera (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Curr Neuropharmacol 2021;19:1468-95. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine 2021;28:100434.
Systematic review · Population basis: human · Directness: not assessed

Read imported source wording

Withania somnifera (L.) Dunal is an evergreen shrub cultivated in tropical and subtropical areas of Asia, Africa, and Europe. It is commonly called by the Sanskrit name, ashwagandha, because the plant’s roots are said to smell like a wet horse (“ashwa” for horse and “gandha” for smell) [1]. Ashwagandha is also sometimes known as winter cherry or Indian ginseng, although it does not belong to the ginseng family. Ashwagandha root has been used in the traditional Ayurvedic and Unani medicine systems of India as an adaptogen, which is loosely defined as a compound or product that increases the ability of a person to resist, adapt, or become resilient in nonspecific ways to biological, physical, or chemical stressors [2,3]. The chemical composition of ashwagandha root and leaf differ [4]. Most commercial ashwagandha supplements contain extracts from the plant’s root, although some contain extracts from both the root and leaf.

The species name somnifera comes from the Latin word for sleep-inducing, signifying another purported property of this botanical [5]. In addition to sleep, ashwagandha is commonly promoted for stress and anxiety reduction.

Ashwagandha is rich in phytochemicals, including steroidal lactones (known as withanolides) and alkaloids. While withanolides are believed to be responsible for many of ashwagandha’s proposed effects, evidence from preclinical studies suggests that other, non-withanolide components may also be involved [6-8].

Where did MEDucated get this?

Ashwagandha: Is it helpful for stress, anxiety, or sleep? — Fact Sheet for Health Professionals

NIH Office of Dietary Supplements. Government health-professional reference material imported without MEDucated medical review.

Source section: Introduction
ODS revision: May 2, 2025
Retrieved: 2026-08-10T22:07:08.613Z
Source fingerprint: 58946efc438d695cbfed1c8833b5bd233647dc649d12f4d42522cd333c5853af
Cited reference numbers: 1, 2, 3, 4, 5, 6, 7, 8

Inspect the official NIH ODS source

Source attribution does not imply NIH or ODS endorsement of MEDucated.

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What evidence has studied

Imported NIH ODS source content is available for this topic. MEDucated has preserved the source wording and has not converted it into personalized guidance.

Source-backed preview

Structural characterization

Evidence profile

No overall rating assigned

Evidence source: NIH ODS evidence synthesis
Linked references: 14 identified
Human evidence: Human evidence identified
Randomized trials: Randomized trial identified
Reviews and meta-analyses: Systematic review or meta-analysis identified
Evidence recency: 2020–2024
Source-described consistency: Not characterized in these source blocks
MEDucated evidence rating: Not assigned

Reference counts describe frozen source associations; a larger count does not establish stronger evidence.

Inspect technical evidence details

Evidence types identified

Randomized controlled trial9
Systematic review1
Study type could not be determined2
Clinical guideline1
Meta-analysis1

Source-described limitations

ODS says additional research is needed
A daily dose of 300 to 600 mg ashwagandha root extract (standardized to 5% withanolides) is provisionally recommended for the treatment of generalized anxiety disorder by an international taskforce created by the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Treatments (CANMAT) [18]. The taskforce issued this recommendation in 2022, and they noted that more research is needed to support a stronger recommendation.
ODS describes a small study base
Evidence from a small number of studies suggests that taking ashwagandha extract may improve several aspects of sleep, including sleep quality, sleep efficiency, total sleep time, and sleep latency. These benefits tend to be more pronounced among people with insomnia.
ODS describes limited evidence
Research is limited, but the results from a few clinical trials suggest that ashwagandha extracts may help with sleep. For example, at one study center in India, 150 healthy men and women age 18 to 65 years with self-reported sleep problems characterized by insomnia and lack of restful sleep were randomized to take an ashwagandha root and leaf extract (Shoden) or placebo for 6 weeks [19]. The extract was standardized to contain 21 mg of withanolide glycosides per 60-mg capsule, and participants took two capsules each day. Both groups reported improvements in sleep quality as measured by a validated rating scale, but the improvements were greater in the ashwagandha group (72%) than in the placebo group (29%). In addition, participants who took ashwagandha extract showed improvements in sleep efficiency (time in bed spent in sleep), total sleep time, sleep latency (time taken to fall asleep), and awakening after sleep onset as assessed by actigraphy, which involves wearing a watch monitor on the wrist to measure body motion. They also reported improvements in quality of life.

Classified references

Langade D, Thakare V, Kanchi S, Kelgane S. Clinical evaluation of the pharmacological impact of ashwagandha root extract on sleep in healthy volunteers and insomnia patients: A double-blind, randomized, parallel-group, placebo-controlled study. J Ethnopharmacol 2021;264:113276. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine 2021;28:100434.
Systematic review · Population basis: human · Directness: not assessed
Remenapp A, Coyle K, Orange T, Lynch T, Hooper D, et al. Efficacy of Withania somnifera supplementation on adult's cognition and mood. J Ayurveda Integr Med 2022;13:100510. [PubMed abstract]
Study type could not be determined · Population basis: human · Directness: not assessed
Gopukumar K, Thanawala S, Somepalli V, Rao TSS, Thamatam VB, et al. Efficacy and Safety of Ashwagandha Root Extract on Cognitive Functions in Healthy, Stressed Adults: A Randomized, Double-Blind, Placebo-Controlled Study. Evid Based Complement Alternat Med 2021;2021:8254344. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Baker C, Kirby JB, O'Connor J, Lindsay KG, Hutchins A, et al. The Perceived Impact of Ashwagandha on Stress, Sleep Quality, Energy, and Mental Clarity for College Students: Qualitative Analysis of a Double-Blind Randomized Control Trial. J Med Food 2022;25:1095-101. [PubMed abstract]
Randomized controlled trial · Population basis: unknown · Directness: not assessed
ClinicalTrials.gov. The impact of ashwagandha on perceived stress, sleep and food cravings in college students 2022.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Fuladi S, Emami SA, Mohammadpour AH, Karimani A, Manteghi AA, et al. Assessment of the Efficacy of Withania somnifera Root Extract in Patients with Generalized Anxiety Disorder: A Randomized Double-blind Placebo- Controlled Trial. Curr Rev Clin Exp Pharmacol 2021;16:191-6. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Majeed M, Nagabhushanam K, Mundkur L. A standardized Ashwagandha root extract alleviates stress, anxiety, and improves quality of life in healthy adults by modulating stress hormones: Results from a randomized, double-blind, placebo-controlled study. Medicine (Baltimore) 2023;102:e35521. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Majeed M, Nagabhushanam K, Murali A, Vishwanathan DT, Mamidala RV, et al. A Standardized Withania somnifera (Linn.) Root Extract with Piperine Alleviates the Symptoms of Anxiety and Depression by Increasing Serotonin Levels: A Double-Blind, Randomized, Placebo-Controlled Study. J Integr Complement Med 2024;30:459-68. [PubMed abstract]
Randomized controlled trial · Population basis: unknown · Directness: not assessed
Pandit S, Srivastav AK, Sur TK, Chaudhuri S, Wang Y, et al. Effects of Withania somnifera Extract in Chronically Stressed Adults: A Randomized Controlled Trial. Nutrients 2024;16. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Smith SJ, Lopresti AL, Fairchild TJ. Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin®) in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial. J Psychopharmacol 2023;37:1091-104. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Sarris J, Ravindran A, Yatham LN, Marx W, Rucklidge JJ, et al. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. The World Journal of Biological Psychiatry 2022;23:424-55. [PubMed abstract]
Clinical guideline · Population basis: unknown · Directness: not assessed
Deshpande A, Irani N, Balkrishnan R, Benny IR. A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep Med 2020;72:28-36. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Cheah KL, Norhayati MN, Husniati Yaacob L, Abdul Rahman R. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLoS One 2021;16:e0257843. [PubMed abstract]
Meta-analysis · Population basis: unknown · Directness: not assessed

Read imported source wording

Research suggests that ashwagandha extracts may lower stress, anxiety, and cortisol levels. A taskforce created by the World Federation of Societies of Biological Psychiatry and the Canadian Network for Mood and Anxiety Treatments provisionally recommends specific daily doses of ashwagandha root extract for the treatment of generalized anxiety disorder, but they also note that they cannot provide a stronger recommendation without more data.

Results from several clinical trials suggest that ashwagandha extracts may help reduce stress and anxiety. A 2021 systematic review identified seven studies that investigated the use of ashwagandha to treat stress and anxiety [8]. A total of 491 adults, all from India, with either self-reported high stress and anxiety or a diagnosed anxiety disorder, were randomized to take ashwagandha or placebo for 6 to 8 weeks. Six of the studies used extracts made from ashwagandha root alone (three studies, KSM-66), root and leaf (two studies, Sensoril or Shoden), or unspecified parts (one study), while the seventh study used dried root powder made into granules. The ashwagandha dose varied from 240 to 1,250 mg/day of extract or 12,000 mg/day of whole root granules, which is equivalent to 6,000 mg of root powder. Overall, the studies found that ashwagandha significantly reduced stress and anxiety levels (subjectively measured by validated rating scales), reduced sleeplessness and fatigue, and reduced serum cortisol levels (a stress hormone) when compared with placebo. In several studies, the benefits appeared to be greater with doses of 500 to 600 mg/day than with lower doses.

Study doseSource intake rangeSource-described amount

Results from most of the studies published after this 2021 review also suggest that ashwagandha has a beneficial impact on perceived stress [9-17]. For example, one clinical trial conducted in Florida included 60 men and women (mean age 34 years) who reported experiencing stress. Participants took capsules that contained 225 mg/day or 400 mg/day of a proprietary ashwagandha root and leaf extract (NooGandha) or placebo for 30 days [9]. Compared with participants in the placebo group, those in both ashwagandha groups reported positive effects on stress, anxiety, depression, and food cravings as measured by validated rating scales. In addition, participants who took the 225-mg dose had lower saliva cortisol levels than those in the placebo group.

Study doseSource-described amount

At two health centers in India, 130 healthy men and women age 20 to 55 years with self-reported stress were randomized to take a sustained-released ashwagandha root extract (Prolanza) or placebo for 90 days [10]. The extract was standardized to contain 15 mg withanolides per 300-mg capsule, and participants took one capsule daily. Compared with those who received placebo, participants who took ashwagandha extract reported improvements in stress levels and sleep quality as measured by validated rating scales. They also had lower serum cortisol levels. In addition, participants reported improvements in psychological well-being, memory, and focus. Another study in India randomized 54 participants with mild to moderate stress and anxiety to receive either ashwagandha root extract (Shagandha) or placebo [14]. The participants in the ashwagandha group were given tablets that were standardized to contain 2.5% withanolides; each tablet included 500 mg of the root extract and 5 mg of piperine. At day 60, participants in the ashwagandha group had significantly lower scores for stress and anxiety on two validated rating scales than those in the placebo group. In addition, the quality of life scores increased significantly for people in the ashwagandha group between baseline and day 60, and the researchers noted improvements in multitasking and concentration among the participants in this group.

Study doseSource-described amount

At the University of Colorado, Colorado Springs, 60 students (age 18–50 years) were randomized to take an ashwagandha root extract (Gaia Herbs) or placebo for 30 days in a double-blind trial [11,12]. The extract contained 2.5 mg withanolides per 350-mg capsule, and participants took two capsules daily. The investigators gathered qualitative, subjective information from participants during daily check-ins and focus groups. Participants who took ashwagandha root extract reported increased well-being, including a sense of calm; improved energy levels; heightened mental clarity; and enhanced sleep quality. While the descriptions of stress were comparable in both groups, participants who took ashwagandha were more likely to describe their stress as manageable compared with those taking placebo.

Study doseSource-described amount

Another randomized clinical trial included 120 healthy men and women (mean age 54–55 years) who were overweight or mildly obese and experiencing low energy and fatigue [17]. Participants took an ashwagandha root extract (Witholytin, which contains 200 mg hydroalcoholic extract of ashwagandha root standardized to 1.5% withanolides) or placebo twice daily for 12 weeks. Compared with placebo, ashwagandha did not reduce perceived stress, but it did reduce fatigue.

Study doseSource-described amount

A daily dose of 300 to 600 mg ashwagandha root extract (standardized to 5% withanolides) is provisionally recommended for the treatment of generalized anxiety disorder by an international taskforce created by the World Federation of Societies of Biological Psychiatry (WFSBP) and the Canadian Network for Mood and Anxiety Treatments (CANMAT) [18]. The taskforce issued this recommendation in 2022, and they noted that more research is needed to support a stronger recommendation.

Source intake rangeSource-described amount

Evidence from a small number of studies suggests that taking ashwagandha extract may improve several aspects of sleep, including sleep quality, sleep efficiency, total sleep time, and sleep latency. These benefits tend to be more pronounced among people with insomnia.

Research is limited, but the results from a few clinical trials suggest that ashwagandha extracts may help with sleep. For example, at one study center in India, 150 healthy men and women age 18 to 65 years with self-reported sleep problems characterized by insomnia and lack of restful sleep were randomized to take an ashwagandha root and leaf extract (Shoden) or placebo for 6 weeks [19]. The extract was standardized to contain 21 mg of withanolide glycosides per 60-mg capsule, and participants took two capsules each day. Both groups reported improvements in sleep quality as measured by a validated rating scale, but the improvements were greater in the ashwagandha group (72%) than in the placebo group (29%). In addition, participants who took ashwagandha extract showed improvements in sleep efficiency (time in bed spent in sleep), total sleep time, sleep latency (time taken to fall asleep), and awakening after sleep onset as assessed by actigraphy, which involves wearing a watch monitor on the wrist to measure body motion. They also reported improvements in quality of life.

Source-described amount

In another trial conducted in India, 80 healthy men and women age 18 to 50 years, half of them with insomnia, were randomized to take an ashwagandha root extract (KSM-66) or placebo for 8 weeks [5]. The extract was standardized to a withanolide content of more than 5% per 300-mg capsule, and participants took two capsules each day. Participants with insomnia who took ashwagandha extract showed improvements in sleep quality, sleep onset latency, mental alertness on rising, and perceived anxiety symptoms compared with those taking placebo, as measured by actigraphy and validated rating scales. Participants without insomnia who took ashwagandha also reported that ashwagandha improved their sleep but not their perceived anxiety symptoms or their mental alertness on awakening.

A 2021 systematic review and meta-analysis included five studies (including the two described above) that investigated using ashwagandha to promote sleep [20]. All the studies were conducted in India. A total of 372 adults, either self-described as healthy or with insomnia, took ashwagandha or placebo for 6 to 12 weeks. The dose of the ashwagandha supplement used in these studies ranged from 250 to 600 mg/day as a root extract (KSM-66) or, in one study, 120 mg/day of a root and leaf extract (Shoden). Overall, the studies found that ashwagandha extract had a small but significant effect on improving sleep compared with placebo. The benefits were more prominent when the dose was 600 mg/day and when the treatment duration was at least 8 weeks. Benefits were also more prominent in participants with insomnia.

Study doseSource intake rangeSource-described amount

Where did MEDucated get this?

Ashwagandha: Is it helpful for stress, anxiety, or sleep? — Fact Sheet for Health Professionals

NIH Office of Dietary Supplements. Government health-professional reference material imported without MEDucated medical review.

Source section: Efficacy
ODS revision: May 2, 2025
Retrieved: 2026-08-10T22:07:08.613Z
Source fingerprint: 58946efc438d695cbfed1c8833b5bd233647dc649d12f4d42522cd333c5853af
Cited reference numbers: 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 5, 20

Inspect the official NIH ODS source

Source attribution does not imply NIH or ODS endorsement of MEDucated.

Potential benefits studied

Evidence sources studying this topic are not yet available in MEDucated.

Evidence unavailable

Known risks and safety considerations

Imported NIH ODS source content is available for this topic. MEDucated has preserved the source wording and has not converted it into personalized guidance.

Source-backed preview

Structural characterization

Evidence profile

No overall rating assigned

Evidence source: NIH ODS evidence synthesis
Linked references: 26 identified
Human evidence: Human evidence identified
Randomized trials: Randomized trial identified
Reviews and meta-analyses: Systematic review or meta-analysis identified
Evidence recency: 2000–2024
Source-described consistency: Not characterized in these source blocks
MEDucated evidence rating: Not assigned

Reference counts describe frozen source associations; a larger count does not establish stronger evidence.

Inspect technical evidence details

Evidence types identified

Systematic review2
Randomized controlled trial3
Study type could not be determined15
Case series2
Case report2
Controlled clinical trial1
Narrative review1

Source-described limitations

No explicit limitation phrase was identified in these imported source blocks.

Classified references

Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine 2021;28:100434.
Systematic review · Population basis: human · Directness: not assessed
Smith SJ, Lopresti AL, Fairchild TJ. Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin®) in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial. J Psychopharmacol 2023;37:1091-104. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Tandon N, Yadav SS. Safety and clinical effectiveness of Withania Somnifera (Linn.) Dunal root in human ailments. J Ethnopharmacol 2020;255:112768. [PubMed abstract]
Study type could not be determined · Population basis: human · Directness: not assessed
LiverTox. Ashwagandha. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2019. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Inagaki K, Mori N, Honda Y, Takaki S, Tsuji K, et al. A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha. Kanzo 2017;58:448-54.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Weber S, Gerbes AL. Ashwagandha-Induced Liver Injury: Self-Reports on Commercial Websites as Useful Adjunct Tools for Causality Assessment. Am J Gastroenterol 2021;116:2151-2. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Bjornsson HK, Bjornsson ES, Avula B, Khan IA, Jonasson JG, et al. Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int 2020;40:825-9. [PubMed abstract]
Case series · Population basis: unknown · Directness: not assessed
Lubarska M, Hałasiński P, Hryhorowicz S, Mahadea DS, Łykowska-Szuber L, et al. Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury. Int J Environ Res Public Health 2023;20. [PubMed abstract]
Case report · Population basis: unknown · Directness: not assessed
Ireland PJ, Hardy T, Burt AD, Donnelly MC. Drug-induced hepatocellular injury due to herbal supplement ashwagandha. J R Coll Physicians Edinb 2021;51:363-5. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Philips CA, Valsan A, Theruvath AH, Ravindran R, Oommen TT, et al. Ashwagandha-induced liver injury-A case series from India and literature review. Hepatol Commun 2023;7. [PubMed abstract]
Case series · Population basis: unknown · Directness: not assessed
Gannon JM, Forrest PE, Roy Chengappa KN. Subtle changes in thyroid indices during a placebo-controlled study of an extract of Withania somnifera in persons with bipolar disorder. J Ayurveda Integr Med 2014;5:241-5. [PubMed abstract]
Controlled clinical trial · Population basis: unknown · Directness: not assessed
Sharma AK, Basu I, Singh S. Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. J Altern Complement Med 2018;24:243-8. [PubMed abstract]
Randomized controlled trial · Population basis: human · Directness: not assessed
Chittiboyina AG, Khan IA. Current issues in phytomedicine research - Conundrum on the chemistry of ashwagandha and its biological effects. J Ethnopharmacol 2024;325:117871. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Curry KM, McNeil LE, Flores A, Fuks J. Thyrotoxicosis with Ashwagandha: A Case Report. SSRN 2019.
Case report · Population basis: unknown · Directness: not assessed
NatMed. Ashwagandha. 2023.
Study type could not be determined · Population basis: unknown · Directness: not assessed
American Herbal Products Association. American Herbal Products Association’s Botanical Safety Handbook, 2nd edition. Boca Raton, FL: CRC Press LLC; 2013.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Engels G, Brinckmann J. HerbalGram, The Journal of the American Botanical Council. Ashwagandha. 2013; Issue 99.
Study type could not be determined · Population basis: unknown · Directness: not assessed
National Center for Complementary and Integrative Health. Ashwagandha. 2023.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Mikulska P, Malinowska M, Ignacyk M, Szustowski P, Nowak J, et al. Ashwagandha (Withania somnifera)-Current Research on the Health-Promoting Activities: A Narrative Review. Pharmaceutics 2023;15. [PubMed abstract]
Narrative review · Population basis: unknown · Directness: not assessed
American Herbal Pharmacopoeia. Ashwagandha Root, Withania somnifera - Analytical, Quality Control, and Therapeutic Monograph. Santa Cruz, CA; 2000.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Philips CA, Theruvath AH. A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine. Medicine (Baltimore) 2024;103:e37903. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
McKeown M. Why did Denmark ban Ashwagandha? McGill University, Office for Science and Society, 2023.
Study type could not be determined · Population basis: unknown · Directness: not assessed
ANSES. AVIS de l’Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail relatif aux risques liés à l'utilisation des préparations de Withania somnifera (L.) Dunal dans les compléments alimentaires. 2024.
Study type could not be determined · Population basis: unknown · Directness: not assessed
American Herbal Pharmacopoeia. AHP Responds to Claims of Ashwagandha Abortifacient Effects. 2024.
Study type could not be determined · Population basis: unknown · Directness: not assessed
Smith SJ, Lopresti AL, Teo SYM, Fairchild TJ. Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review. Adv Nutr 2021;12:744-65. [PubMed abstract]
Systematic review · Population basis: human · Directness: not assessed
Lopresti AL, Drummond PD, Smith SJ. A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males. Am J Mens Health 2019;13:1557988319835985. [PubMed abstract]
Randomized controlled trial · Population basis: unknown · Directness: not assessed

Ashwagandha appears to be well tolerated for up to about 3 months of use, but its long-term safety is not known. Common side effects (e.g., loose stools, nausea, drowsiness) are usually mild. However, there are a few reports of more serious side effects, including adverse effects on liver function. Ashwagandha might also affect thyroid function and interact with some medications. Some experts advise against the use of ashwagandha by women who are pregnant and by men with hormone-sensitive prostate cancer.

In the studies described above and in many other clinical trials, ashwagandha has been well tolerated by participants for up to about 3 months of use. Common side effects are mild and include stomach upset, loose stools, nausea, and drowsiness [8,21]. Increased heart rate variability has also been reported [17]. Evidence on the safety of using ashwagandha over many months or years is lacking.

There are a few reports of more serious side effects associated with ashwagandha use, including adverse effects on liver function [22]. In a 2017 report of liver injury that was associated with ashwagandha use, a 20-year-old man in Japan developed liver dysfunction and hyperbilirubinemia after using ashwagandha (plant part and dose not specified) in combination with multiple antianxiety drugs [23]. Since then, the use of ashwagandha has been linked to acute liver injury in other individuals, some of whom had pre-existing liver disease [24-28]. These include five cases of people (three men and two women, age range 21–62 years) who reportedly took supplements that contained 450 to 1,350 mg ashwagandha (plant part not specified) daily over the course of 1 week to 4 months and experienced signs of liver injury, such as jaundice, pruritus, nausea, lethargy, abdominal discomfort, and hyperbilirubinemia [25]. In these cases and others, the conditions of the individuals improved over time after they stopped taking the supplement; some also received medical treatment [23,25-27]. However, the contents of the products that the individuals took were not independently verified in all cases, and some products were combination products that contained ashwagandha and other ingredients.

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Some research suggests that ashwagandha might affect thyroid function. In one study, three adult men who took 500 mg/day of a standardized ashwagandha root and leaf extract for 8 weeks had small increases in blood thyroxine (T4) levels [29]. A small clinical trial with 50 participants with subclinical hypothyroidism found that ashwagandha root extract, at a dose of 300 mg twice daily for 8 weeks, lowered serum thyroid-stimulating hormone (TSH) and increased triiodothyronine (T3) and T4 levels compared with placebo [30].

Study doseSource-described amount

Three case reports have also described thyrotoxicosis in women who were taking ashwagandha extract (age range 32–73 years) [31]. However, the doses of ashwagandha were not specified in two of these case reports, and the third case involved an unusually high dose (1,950 mg/day for more than 2 months) [32]. Discontinuing ashwagandha resolved the symptoms of thyrotoxicosis in all three cases. These findings suggest that ashwagandha might interact with thyroid hormone medications. Ashwagandha might also interact with other medications, including antidiabetes medications, antihypertensives, immunosuppressants, and sedatives [8,33].

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Some experts advise against the use of ashwagandha by women who are pregnant because some reports have suggested that it has the potential to cause spontaneous abortion [8,33-38]. A risk assessment released by the Technical University of Denmark in 2020 discussed both this potential abortifacient effect of ashwagandha and potential effects on thyroid and sex hormones; Denmark subsequently banned the use of ashwagandha in 2023 [39,40]. The French Agency for Food, Environmental, and Occupational Health and Safety (ANSES) issued a statement in 2024 that recommended against using ashwagandha in certain populations, including pregnant and breastfeeding women and people with endocrine disorders [41]. One of the sources for this information is a monograph on ashwagandha root published in 2000 by the American Herbal Pharmacopoeia (AHP) [38]; however, AHP has stated that their report has been misrepresented and that there is no evidence that ashwagandha root causes abortions [42]. Ashwagandha use might also increase testosterone levels [8,17,43,44], so according to experts, it might not be safe for men with hormone-sensitive prostate cancer [36,37].

Where did MEDucated get this?

Ashwagandha: Is it helpful for stress, anxiety, or sleep? — Fact Sheet for Health Professionals

NIH Office of Dietary Supplements. Government health-professional reference material imported without MEDucated medical review.

Source section: Safety
ODS revision: May 2, 2025
Retrieved: 2026-08-10T22:07:08.613Z
Source fingerprint: 58946efc438d695cbfed1c8833b5bd233647dc649d12f4d42522cd333c5853af
Cited reference numbers: 8, 17, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44

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Evidence source: NIH ODS evidence synthesis
Linked references: 5 identified
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Speers AB, Cabey KA, Soumyanath A, Wright KM. Effects of Withania somnifera (Ashwagandha) on Stress and the Stress- Related Neuropsychiatric Disorders Anxiety, Depression, and Insomnia. Curr Neuropharmacol 2021;19:1468-95. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine 2021;28:100434.
Systematic review · Population basis: human · Directness: not assessed
Cheah KL, Norhayati MN, Husniati Yaacob L, Abdul Rahman R. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLoS One 2021;16:e0257843. [PubMed abstract]
Meta-analysis · Population basis: unknown · Directness: not assessed
D'Cruz M, Andrade C. Potential clinical applications of Ashwagandha (Withania somnifera) in medicine and neuropsychiatry. Expert Rev Clin Pharmacol 2022;15:1067-80. [PubMed abstract]
Study type could not be determined · Population basis: unknown · Directness: not assessed
Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore) 2019;98:e17186. [PubMed abstract]
Randomized controlled trial · Population basis: unknown · Directness: not assessed

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Ashwagandha extracts may help reduce anxiety and stress and improve sleep. However, it is challenging to develop recommendations for using ashwagandha, because the studies that have evaluated it have used various preparations and doses. Ashwagandha appears to be well tolerated during short-term use, but the long-term safety of ashwagandha is not known. In addition, ashwagandha may not be safe for certain people.

Several randomized, placebo-controlled clinical trials, most of them fairly small in size and of short duration, have found that ashwagandha may reduce perceived stress and anxiety and improve the quality and duration of sleep [7,8,20,45]. Because studies have used various ashwagandha preparations (with different extraction and standardization processes) and doses, it is difficult to identify specific extracts or recommended amounts [7,46]. In addition, most studies have been conducted as part of a traditional medical system, so the potential effects of ashwagandha when used as a dietary supplement outside of that approach remain unclear.

Ashwagandha appears to be well tolerated for up to 3 months of use. However, the efficacy and safety of long-term ashwagandha use over months or years for stress, anxiety, or sleep is not known. In addition, ashwagandha may have potential adverse effects on the liver and thyroid and might not be safe for men with prostate cancer or women who are pregnant or breastfeeding.

Where did MEDucated get this?

Ashwagandha: Is it helpful for stress, anxiety, or sleep? — Fact Sheet for Health Professionals

NIH Office of Dietary Supplements. Government health-professional reference material imported without MEDucated medical review.

Source section: Implications for use
ODS revision: May 2, 2025
Retrieved: 2026-08-10T22:07:08.613Z
Source fingerprint: 58946efc438d695cbfed1c8833b5bd233647dc649d12f4d42522cd333c5853af
Cited reference numbers: 7, 8, 20, 45, 46

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Fixture ID: fixture:supplement:ashwagandha:ods-evidence-preview
Fixture revision: source-revision:nih-ods:ashwagandha-health-professional:2026-08-10.58946efc438d
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Ashwagandha: Is it helpful for stress, anxiety, or sleep? — Fact Sheet for Health Professionals

NIH Office of Dietary Supplements

Fixture ID: fixture:supplement:ashwagandha:ods-evidence-preview
Fixture revision: source-revision:nih-ods:ashwagandha-health-professional:2026-08-10.58946efc438d
Content classification: source backed demonstration
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Evidence classification: government reference
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