Abstract Summary
Objective
To identify populations who should not take ashwagandha (Withania somnifera) by evaluating clinical safety data, regulatory guidance, and documented adverse effects, with emphasis on contraindications, high-risk health conditions, and drug interactions.
Context
Ashwagandha is widely promoted for stress reduction, sleep support, and hormonal balance. As its use has expanded globally, safety concerns have emerged regarding its suitability for certain individuals. Regulatory agencies and clinical researchers have highlighted specific groups for whom ashwagandha may pose health risks, particularly related to pregnancy, liver health, autoimmune activity, and medication interactions.
Methods Used
Approach
A narrative review of safety-focused literature was conducted, including clinical reviews, pharmacovigilance reports, public health advisories, and authoritative medical references. Particular attention was given to contraindications noted by government health agencies and adverse-event case reports published in peer-reviewed journals.
Data Collection
Data were drawn from analyses of reported side effects, documented cases of supplement-induced liver injury, endocrine and immune system effects, and known herb–drug interactions. Sources included clinical databases such as PubMed, as well as safety communications from national health institutes and regulatory bodies.
Researchers' Summary of Findings
Impact on Health
Evidence indicates that ashwagandha should be avoided during pregnancy and breastfeeding due to insufficient safety data. Children are also advised to avoid its use. Individuals with liver disease may be at increased risk, as case reports associate ashwagandha with rare but serious liver injury. People with autoimmune or thyroid disorders may experience symptom exacerbation due to its immune- and hormone-modulating effects. Caution is also warranted for those preparing for surgery or taking medications affecting blood sugar, blood pressure, immune function, or sedation. Individuals with hormone-sensitive prostate cancer may face additional risk due to potential testosterone elevation.
Health Implications
While ashwagandha is often described as generally well-tolerated in healthy adults, its safety profile is not universal. The growing number of regulatory warnings and adverse-event reports underscores the importance of individualized risk assessment. Symptoms such as jaundice, dark urine, persistent nausea, severe fatigue, or itching should prompt immediate discontinuation and medical evaluation. These findings reinforce that “natural” does not equate to “risk-free,” particularly for vulnerable populations.
Sustainability
Ashwagandha is a resilient plant that can be cultivated sustainably, but responsible use extends beyond agriculture. Product quality, accurate labeling, and appropriate consumer education are essential to minimize harm. From a public health perspective, sustainability includes ensuring that herbal supplements are used safely, conservatively, and only by individuals for whom the risk–benefit profile is favorable.
DOI
10.1002/ccr3.7078
