ashwagandha

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

REMS

Stress and anxiety relief.
Fatigue and low energy.
Memory and focus.
Support of adrenal function.
Immune system support.
Insomnia.
Mild depression.
Male fertility and testosterone support.
Inflammation and arthritis.
Exercise performance.
Mild hypothyroidism.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Allergy to plants in the Solanaceae family;
Hyperthyroidism.

Use Cautiously in:

Autoimmune disorders (may worsen conditions like lupus, rheumatoid arthritis, or multiple sclerosis);
Diabetes;
Hypotension;
Surgery (discontinue ≥2 wk before procedure);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

GI: diarrhea, vomiting, LIVER FAILURE

CV: hypotension

Endo: hypoglycemia

Neuro: drowsiness

Interactions ⬆ ⬇

Natural-Drug Products:

May ↑ risk of hypotension with antihypertensives.
May ↑ risk of hypoglycemia with antidiabetic drugs.
May have additive effects with CNS depressants.
May ↓ effectiveness of immunosuppressants.

Natural-Natural Products:

May ↑ risk of CNS depressions with valerian, kava-kava, chamomile, and melatonin.
May ↑ risk of bleeding with garlic, ginkgo, and turmeric.
May cause immunostimulant effect withechinacea.

Availability ⬆ ⬇

Capsule/tablet: ^OTC
Gummies: ^OTC
Liquid/tinctures: ^OTC
Powder: ^OTC
Tea: ^OTC

Route/Dosage ⬆ ⬇

Anxiety

PO (Adults ): Capsule/tablet: 300 mg twice daily for 10 wk.

Exercise performance/Menopause

PO (Adults ): Capsule/tablet: 300 mg twice daily for 8 wk.

Sleep quality

PO (Adults ): Capsule/tablet: 300 mg twice daily for 10–12 wk.

US Brand Names ⬆ ⬇

Ajagandha, Amangura, Amukkirag, Asgand, Ashvagandha, Asundha, Asvagandha, Aswaganda, Indian ginseng, Kanaje Hindi, Kuthmithi, Samm al ferakh, Winter cherry, Withania

Action ⬆ ⬇

Contains biologically active compounds such as withanolides, alkaloids, and saponins.
Enhances resistance to physical and mental stress by modulating cortisol levels and supporting hypothalamic-pituitary-adrenal axis balance.
May act on GABA receptors, producing calming effects on the CNS.
Scavenges free radicals and ↓ oxidative stress.
Enhances immune function by ↑ WBC counts and activity.

Therapeutic effects:

Reduced stress.
Improved sleep and mental clarity.
Enhanced strength, stamina, and physical performance.
Enhanced immunity and reduced inflammation.
Enhanced male reproductive health.
Improved symptoms of hypothyroidism.

Classifications ⬆ ⬇

Therapeutic Classification: antianxiety agents, sedative/hypnotics

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	Unknown	Unknown	Unknown

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of herb to patient.
Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
Advise patient that ashwagandha may be safe when taken in the short term (up to 3 mo).
Advise patient to notify health care provider if signs and symptoms of drowsiness, jaundice, dark urine, GI upset, rash, or signs/symptoms of hyperthyroidism (tremors, excessive sweating, palpitations) occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding before using this herb.

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Indications ⬇