Ashwagandha (Withania somnifera) is an adaptogenic herb, used for centuries to help the body manage stress and anxiety. While its popularity for promoting relaxation and overall well-being has grown, its biological activity means it carries the risk of interacting with certain medications and other substances. Combining ashwagandha with the wrong items can lead to dangerous side effects or render your other treatments ineffective. This guide details the most important combinations to avoid.
Medications with Significant Interactions
The most critical warnings for ashwagandha involve its interaction with a range of prescription medications. The herb can either enhance, diminish, or otherwise interfere with the intended effects of these drugs. Anyone on prescription medication must consult a healthcare provider before starting ashwagandha.
Blood Sugar-Lowering Medications
Ashwagandha has demonstrated the ability to lower blood glucose levels. When combined with prescription diabetes drugs like insulin, metformin (Glumetza), or glipizide (Glucotrol), this effect can be amplified, potentially causing hypoglycemia (dangerously low blood sugar). Signs of hypoglycemia include weakness, sweating, increased heart rate, and confusion, and can become a medical emergency. Close monitoring of blood sugar is necessary for anyone mixing these substances under a doctor's supervision.
Blood Pressure-Lowering Medications
Similarly, ashwagandha may lower blood pressure. Individuals taking antihypertensive drugs such as beta-blockers (atenolol), ACE inhibitors (ramipril), or diuretics (furosemide) should be cautious. Taking both together could cause a hypotensive event, leading to dizziness, lightheadedness, or fainting. Blood pressure must be monitored to ensure it does not drop to unsafe levels.
Sedatives and CNS Depressants
Because ashwagandha can induce a calming effect, combining it with sedatives, including benzodiazepines (alprazolam, clonazepam), sleep aids (zolpidem), and opioid pain medication, can lead to excessive drowsiness, sleepiness, or respiratory issues. The combination of these central nervous system (CNS) depressants can be particularly risky and should be avoided, especially before driving or operating heavy machinery.
Immunosuppressant Medications
Ashwagandha may enhance the activity of the immune system. This could be a problem for people with autoimmune diseases or those taking immunosuppressant drugs, which are designed to dampen the immune response. Examples of such drugs include corticosteroids (prednisone) and organ transplant medications (tacrolimus). Combining them may reduce the effectiveness of the medication and could worsen the underlying condition.
Thyroid Hormone Medications
Some research indicates ashwagandha can increase thyroid hormone levels. This is problematic for individuals with thyroid disorders, especially those taking thyroid hormone replacement therapy (levothyroxine). The combination could push hormone levels too high, causing symptoms of hyperthyroidism like nervousness, a fast heartbeat, and mood swings.
Hepatotoxic Medications
In rare cases, ashwagandha has been linked to liver damage. Combining it with other medications known to be hard on the liver, such as certain pain relievers (indomethacin) or anti-inflammatories, can increase the risk of liver injury.
Herbal and Dietary Interactions
Ashwagandha can also interact with other herbs and dietary substances. While some combinations, like ashwagandha with caffeine, are sometimes used to balance effects, caution is still necessary and professional advice is recommended.
Sedative Herbs and Supplements
Just as with prescription sedatives, combining ashwagandha with other herbs known for their calming effects, such as valerian or St. John's Wort, could result in excessive drowsiness and heightened sedative effects. Stacking adaptogens can be complex and should be approached with caution to avoid unexpected side effects.
Alcohol
Consuming alcohol while taking ashwagandha can intensify the sedative effects of both substances. This combination can lead to excessive drowsiness and impaired cognitive function. It is safest to avoid alcohol entirely when using ashwagandha.
What to Avoid Mixing with Ashwagandha
| Substance/Group | Reason for Caution | Potential Outcome of Mixing |
|---|---|---|
| Blood Pressure Medication | Ashwagandha may lower blood pressure. | Blood pressure drops too low (hypotension). |
| Diabetes Medication | Ashwagandha can lower blood sugar. | Blood sugar drops too low (hypoglycemia). |
| Sedatives/Sleep Aids | Both can cause drowsiness and sedation. | Excessive drowsiness, impaired breathing, slowed CNS function. |
| Thyroid Hormones | Ashwagandha may increase thyroid levels. | Elevated thyroid hormone levels (hyperthyroidism). |
| Immunosuppressants | Ashwagandha may stimulate the immune system. | Reduced effectiveness of immunosuppressant drugs. |
| Hepatotoxic Drugs | Rare risk of liver injury with ashwagandha. | Increased risk of liver damage. |
| Other Calming Herbs | Additive sedative effects. | Excessive relaxation or drowsiness. |
| Alcohol | Enhanced sedative effects. | Impaired cognitive function, increased drowsiness. |
Who Should Avoid Ashwagandha?
Beyond specific interactions, certain populations should avoid ashwagandha altogether due to safety concerns:
- Pregnant or Breastfeeding Women: Ashwagandha is not recommended during pregnancy as it might cause miscarriages in higher doses. There is insufficient information regarding its safety during breastfeeding.
- Autoimmune Diseases: As ashwagandha can stimulate the immune system, individuals with autoimmune disorders like multiple sclerosis (MS), lupus (SLE), or rheumatoid arthritis (RA) should avoid it, as it could exacerbate symptoms.
- Liver Conditions: Individuals with liver disease should avoid ashwagandha, as rare cases of liver injury have been reported.
- Impending Surgery: Ashwagandha may slow down the central nervous system. It is recommended to stop taking the supplement at least two weeks before a scheduled surgery to prevent interference with anesthesia.
- Hormone-Sensitive Cancers: Ashwagandha may increase testosterone levels, so people with hormone-sensitive prostate cancer should avoid its use.
The Importance of Professional Guidance
Given the complexity of potential interactions and individual health conditions, consulting a healthcare professional is non-negotiable before taking ashwagandha, especially if you have pre-existing health issues or are on any medications. A doctor can help determine if it is safe for you and can monitor for any adverse effects.
Conclusion
While ashwagandha offers a host of potential benefits for stress and overall wellness, it is not a universally safe supplement. Understanding what you should not mix with ashwagandha is essential for preventing dangerous interactions and protecting your health. Always prioritize a discussion with a healthcare provider before introducing this powerful herb into your routine to ensure it aligns with your medical history and current medications. Self-treating without professional oversight can lead to serious complications and unintended consequences.
