What Medications Interact with Ashwagandha Supplements? Here’s 5 Interactions to Consider
Key takeaways:
Ashwagandha (Withania somnifera) is an herbal supplement that people take to help with stress, anxiety, and sleep. You should avoid taking it with sedatives, such as benzodiazepines and sleep medications. The combination can raise the risk of excessive drowsiness.
Ashwagandha may lower your blood pressure and blood glucose (sugar) levels. Taking it with diabetes or high blood pressure medications can raise the risk of these levels dropping too low. Ashwagandha can also interfere with thyroid medications and immunosuppressants.
Talk to your prescriber before taking ashwagandha with mental health medications like Lexapro (escitalopram), Zoloft (sertraline), and Wellbutrin (bupropion). The combination hasn’t been studied enough, and there’s a risk your serotonin levels may go too high.
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Ashwagandha is an evergreen plant found in India, Africa, and the Middle East. It’s become a popular supplement in recent years due to its reported effects on stress, anxiety, and sleep.
It’s easy to think that ashwagandha is risk-free since it’s a natural substance that’s sold over the counter (OTC). But just like medications, herbal supplements have side effects and drug interactions to consider before taking them.
Here, we’ll review five ashwagandha interactions you should be aware of. Keep in mind, this isn’t a complete list of all possible interactions. It’s best to review your medication list with your prescriber or pharmacist before taking ashwagandha to make sure it’s a safe option for you.
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1. Sedatives and sleep medications
The plant name of ashwagandha, Withania somnifera, is Latin for “sleep inducer.” Since ashwagandha can make you sleepy, it’s not a good idea to mix it with other medications that have the same effect. This includes:
Sleep medications, such as zolpidem (Ambien) and zaleplon (Sonata)
Benzodiazepines, such as alprazolam (Xanax) and clonazepam (Klonopin)
Opioid pain medications, such as oxycodone (Roxicodone)
Barbiturate medications, such as phenobarbital
Combining these medications with ashwagandha can raise the risk of excessive drowsiness. It may also put you at risk for unwanted side effects or toxicity, which can be dangerous to your health.
2. Thyroid medications
Ashwagandha may increase the levels of thyroid hormones in your body. So if you’re taking medications to increase or decrease thyroid hormone levels, it could interfere with your treatment.
Common thyroid hormone and antithyroid medications include:
Levothyroxine (Synthroid, Levoxyl)
Desiccated thyroid (Armour Thyroid)
Liothyronine (Cytomel)
Methimazole
Propylthiouracil
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If you’re taking medication to lower your thyroid hormone levels, ashwagandha is probably not a safe supplement for you. If you’re taking a thyroid hormone medication, your prescriber may need to keep an eye on your levels if you start taking ashwagandha. In either case, talk to your endocrinologist first for guidance.
3. Insulin and other diabetes medications
Ashwagandha may lower your blood glucose (sugar) levels. If you’re taking medication to treat diabetes, ashwagandha could make your levels drop too low if they’re combined. Common diabetes medications include:
Metformin
Sulfonylureas, such as glipizide (Glucotrol XL)
Dipeptidyl peptidase-4 (DPP-4) inhibitors (also called gliptins), such as sitagliptin (Januvia)
Sodium-glucose cotransporter 2 (SGLT2) inhibitors, such as dapagliflozin (Farxiga)
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Some studies also show that ashwagandha may help manage diabetes symptoms. If your prescriber OKs taking it with your other medications, they’ll likely have you keep a closer eye on your blood glucose levels. But you shouldn’t take ashwagandha on your own without your prescriber’s approval.
4. Immunosuppressant medications
Ashwgandha can change the activity of your immune system. If you take medications to calm an overactive immune system (immunosuppressants), ashwagandha may make them more or less effective. This could interfere with your treatment or raise the risk of infection and other side effects.
Some immunosuppressants include:
Corticosteroids, such as prednisone
Organ transplant medications, such as azathioprine (Imuran) and tacrolimus (Prograf)
Some biologics and biosimilars, such as adalimumab (Humira) and adalimumab-adbm (Cyltezo)
Talk with your prescriber before taking ashwagandha if you take an immunosuppressant. They can help determine if it’s safe and what symptoms you should look out for if you take it.
5. Beta blockers and other medications that lower blood pressure
Ashwagandha can lower your blood pressure. If you’re taking medication to lower your blood pressure, combining it with ashwagandha raises the risk of low blood pressure (hypotension). This can make you feel dizzy or lightheaded. In some cases, you may even lose consciousness.
Common blood pressure medications include:
Angiotensin converting enzyme (ACE) inhibitors, such as ramipril (Altace)
Angiotensin II receptor blockers (ARBs), such as losartan (Cozaar)
Calcium channel blockers, such as amlodipine (Norvasc)
Beta blockers, such as atenolol (Tenormin)
Diuretics (“water pills”), such as furosemide (Lasix) and hydrochlorothiazide
Your prescriber may have you check your blood pressure more often if you’re taking ashwagandha with one of these medications. Depending on your medical history, they may suggest avoiding ashwagandha altogether.
Can you take ashwagandha with antidepressants like Lexapro, Zoloft, or Wellbutrin?
One study looked at combining ashwagandha and a selective serotonin reuptake inhibitor (SSRI). The combination was better at treating symptoms of anxiety than an SSRI alone, and no significant side effects were reported. But this was a very small study, so the results can’t be used as proof that the combination is safe.
Ashwagandha seems to increase serotonin levels in the body. So it’s possible that taking it with other medications that increase serotonin could raise the risk that serotonin levels will go too high. This could lead to serotonin syndrome, which can be life-threatening in some cases.
There aren’t any reports of an interaction between ashwagandha and antidepressant medications. But we don’t have enough evidence to know for sure if the combination is safe. It’s best to talk to your prescriber before taking ashwagandha with another medication for depression or anxiety.
The bottom line
Ashwagandha (Withania somnifera) is an herbal supplement that people take to help with stress, anxiety, and sleep. You shouldn’t combine ashwagandha with other medications that make you sleepy, such as benzodiazepines and sleep medications. The combination could raise the risk of excessive drowsiness and other dangerous side effects.
Ashwagandha may lower your blood pressure and blood glucose (sugar) levels. If you take it with blood pressure or diabetes medications, these levels could drop too low. Ashwagandha can also interfere with thyroid medications and immunosuppressants.
We don’t have enough evidence to know if it’s safe to take ashwagandha with other medications for depression or anxiety. There’s a risk that your serotonin levels could go too high if they’re combined, so it’s best to check with your prescriber first.
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References
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Durg, S., et al. (2020). Withania somnifera (Indian ginseng) in diabetes mellitus: A systematic review and meta-analysis of scientific evidence from experimental research to clinical application. Phytotherapy Research.
Fuladi, S., et al. (2021). Assessment of the efficacy of Withania somnifera root extract in patients with generalized anxiety disorder: A randomized double-blind placebo- controlled trial. Current Reviews in Clinical and Experimental Pharmacology.
Majeed, M., et al. (2024). 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. Journal of Integrative and Complementary Medicine.
MedlinePlus. (2024). Ashwagandha.
National Center for Complementary and Integrative Health. (n.d.). Know the science: How medications and supplements can interact.
National Center for Complementary and Integrative Health. (n.d.). Natural doesn’t necessary mean safer, or better.
National Center for Complementary and Integrative Health. (2023). Ashwagandha.
Simone, C. G., et al. (2023). Anxiolytics and sedative-hypnotics toxicity. StatPearls.
Wiciński, M., et al. (2023). Can ashwagandha benefit the endocrine system?—a review. International Journal of Molecular Sciences.
