Drug & supplement interaction

Ashwagandha + Ethinyl Estradiol, Ethynodiol Diacetate

Ethinyl Estradiol, Ethynodiol Diacetate brand names: Demulen 1/35, Zovia 1/35, Demulen Compack, Demulen 1/50, Zovia 1/50, and others.

Moderate Interaction
Medically reviewed by · Updated October 2026
The bottom line Moderate

Ethinyl Estradiol, Ethynodiol Diacetate falls into 3 drug categories that Ashwagandha can interact with; the most serious is rated moderate. Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Ashwagandha and Ethinyl Estradiol, Ethynodiol Diacetate

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Ashwagandha interacts with whole categories of medication. Ethinyl Estradiol, Ethynodiol Diacetate falls into 3 of those categories, so it can interact with Ashwagandha in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

HEPATOTOXIC DRUGS

1 of 3

Why this applies to Ethinyl Estradiol, Ethynodiol Diacetate

Ethinyl Estradiol, Ethynodiol Diacetate falls under HEPATOTOXIC DRUGS — the group Ashwagandha interacts with.

Theoretically, taking ashwagandha with hepatotoxic drugs might increase the risk of liver damage.
Ashwagandha has been linked to cases of acute hepatitis, liver failure, hepatic encephalopathy, autoimmune hepatitis, the need for liver transplantation, and death due to liver failure.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

The birth control pill you asked about contains ethinyl estradiol, an estrogen that your liver processes. On its own, estrogen-containing pills can occasionally stress the liver. Ashwagandha has its own rare but real connection to liver trouble, including reports of hepatitis and, in extreme cases, serious liver injury. The concern here isn't that one changes the blood level of the other. Instead, it's that two things that can each tax the liver might add up.

This is a theoretical caution based on how these work, not proven cases of them combined, so try not to panic. Still, watch for warning signs like yellowing skin or eyes, dark urine, belly pain, or unusual tiredness, and check with your pharmacist or doctor before adding ashwagandha.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Björnsson HK, Björnsson ES, Avula B, et al. Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020;40(4):825-829. PubMed
  2. Ireland PJ, Hardy T, Burt AD, Donnelly MC. Drug-induced hepatocellular injury due to herbal supplement ashwagandha. J R Coll Physicians Edinb. 2021;51(4):363-365. PubMed
  3. Suryawanshi G, Abdallah M, Thomson M, Desai N, Chauhan A, Lim N. Ashwagandha-Associated Acute Liver Failure Requiring Liver Transplantation. Am J Ther 2023;30(1):e80-e83. PubMed
  4. Pusec CM, Wolsky R, Llerena C, Sura P. A Case of Supplement-Induced Hepatitis. Cureus 2022;14(10):e30433. PubMed
  5. Lubarska M, Halasinski P, Hryhorowicz S, et al. Liver Dangers of Herbal Products: A Case Report of Ashwagandha-Induced Liver Injury. Int J Environ Res Public Health 2023;20(5):3921. PubMed
  6. Tóth M, Benedek AE, Longerich T, Seitz HK. Ashwagandha-induced acute liver injury: A case report. Clin Case Rep 2023;11(3):e7078.
  7. Bokan G, Glamocanin T, Mavija Z, et al. Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause. Pharmaceuticals (Basel) 2023;16(8):1129. PubMed
  8. Philips CA, Valsan A, Theruvath AH, et al. Ashwagandha-induced liver injury-A case series from India and literature review. Hepatol Commun 2023;7(10):e0270. PubMed
Minor

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

2 of 3

Ethinyl Estradiol, Ethynodiol Diacetate also falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES.

Theoretically, ashwagandha might decrease the levels and clinical effects of CYP1A2 substrates.
In vitro research shows that ashwagandha extract induces CYP1A2 enzymes.
Severity Minor Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist for your birth control pill (the ethinyl estradiol and ethynodiol diacetate combo). Lab studies hint that ashwagandha may speed up a liver enzyme called CYP1A2, which helps process certain medicines. In theory, faster clearing could lower the hormone levels in your pill a little. Since this isn't a prodrug, that would mean slightly weaker effect, not stronger.

Now, the honest part: this is only test-tube evidence and rated minor, so a real-world drop in protection is unlikely and unproven. Still, because a pill that's too weak can mean breakthrough bleeding or reduced contraception, it's worth a quick chat with your pharmacist or doctor before adding ashwagandha.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. PubMed
Minor

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

3 of 3

Ethinyl Estradiol, Ethynodiol Diacetate also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

Theoretically, ashwagandha might decrease the levels and clinical effects of CYP3A4 substrates.
In vitro research shows that ashwagandha extract induces CYP3A4 enzymes.
Severity Minor Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Your birth control pill (the Demulen/Zovia/Kelnor family) is partly cleared by a liver enzyme called CYP3A4. In lab and test-tube studies, ashwagandha appears to speed up that enzyme, which could in theory clear the estrogen and progestin a bit faster and slightly lower their levels. With a contraceptive, the worry is that anything that weakens it could make it a little less reliable, possibly with some breakthrough spotting.

I want to be honest about the strength of this, though: it comes only from laboratory data, not from real people taking both together, and it's rated as a minor, possible interaction. So this is a theoretical concern, not a proven one. Still, because pregnancy prevention matters so much, it's worth a quick chat with your pharmacist or doctor before adding ashwagandha.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Haron MH, Dale O, Martin K, et al. Evaluation of the Herb-Drug Interaction Potential of Commonly Used Botanicals on the US Market with Regard to PXR- and AhR-Mediated Influences on CYP3A4 and CYP1A2. J Diet Suppl 2022. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Ashwagandha Also Interacts With Other Medications

Ashwagandha has 917 moderate, 455 minor known drug interactions in our database — the Ethinyl Estradiol, Ethynodiol Diacetate one above is among them. If you take anything else, check it against the full list below.

Moderate 917 Minor 455 No known interaction 1,458 (incl. Ethinyl Estradiol, Ethynodiol Diacetate)
Taking anything else?

Check Another of Your Medications Against Ashwagandha

Covers the 2,830 medications we’ve checked against Ashwagandha. Pick one to open its full report.

From our Q&A

Questions About Ashwagandha or Ethinyl Estradiol, Ethynodiol Diacetate

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Ashwagandha or Ethinyl Estradiol, Ethynodiol Diacetate, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Ethinyl Estradiol, Ethynodiol Diacetate

This page covers Ashwagandha only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Ethinyl Estradiol, Ethynodiol Diacetate page lists 239 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Grapefruit (major), Siberian Cocklebur (major) and St. John's Wort (major).

By severity: 6 major · 195 moderate · 38 minor.

From our pharmacist’s overview on the Ethinyl Estradiol, Ethynodiol Diacetate page

“The stakes here are pregnancy prevention, so I read this list with genuine seriousness. Ethinyl estradiol with ethynodiol diacetate (Zovia, Demulen, Kelnor) is a combined birth control pill, and the interactions that concern me most are the ones that can quietly weaken it.”

Reviewed by 2 · Jul 18, 2026

Open the Ethinyl Estradiol, Ethynodiol Diacetate interaction page

One more smart check

Taking Ashwagandha as Part of a Dietary Supplement Product? Check It for Interactions

We hold 4,964 real supplement products containing Ashwagandha, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Ashwagandha. Your product may carry other ingredients that interact with Ethinyl Estradiol, Ethynodiol Diacetate too, on top of Ashwagandha — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Ashwagandha and Ethinyl Estradiol, Ethynodiol Diacetate Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Ashwagandha
Top 5%

#31 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Ethinyl Estradiol, Ethynodiol Diacetate
Top 10%

#228 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Ashwagandha

What is Ashwagandha?

Ashwagandha
  • Stress and anxiety
  • Sleep problems
  • Fatigue and low energy
  • Athletic performance
  • General well-being (adaptogen)

Ashwagandha is an Ayurvedic herb most often taken to help with stress, anxiety, and sleep, and some small studies suggest it may help, though the evidence is still limited. It is generally well tolerated for short-term use in healthy adults, but it should be avoided in pregnancy and used cautiously by people with thyroid or liver problems. Talk with your pharmacist or doctor before starting it.

Read the full Ashwagandha monograph & all interactions
Keep checking

Other Drugs & Ashwagandha

Browse every other medication we’ve checked against Ashwagandha — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
917Moderate
455Minor
1,457No known interaction
917 Moderate 455 Minor 1,457 No interaction
Moderate

917 interactions

Showing 60 of 917 moderate interactions — see all 917 on the Ashwagandha page.

Minor

455 interactions

Showing 60 of 455 minor interactions — see all 455 on the Ashwagandha page.

No interaction 1,457 drugs checked — show the list

We also checked Ashwagandha against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,457 medications checked with no known interaction — see the full Ashwagandha list.

See the full Ashwagandha interactions page
See every supplement checked against Ethinyl Estradiol, Ethynodiol Diacetate, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Ashwagandha monograph › Uses, safety, and every drug interaction in one place Ethinyl Estradiol, Ethynodiol Diacetate supplement interactions › Every supplement checked against Ethinyl Estradiol, Ethynodiol Diacetate, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Ashwagandha and Ethinyl Estradiol, Ethynodiol Diacetate Together: Common Questions

Can you take Ashwagandha with Ethinyl Estradiol, Ethynodiol Diacetate?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 3 interactions listed for Ashwagandha and Ethinyl Estradiol, Ethynodiol Diacetate?
Ethinyl Estradiol, Ethynodiol Diacetate belongs to more than one drug category, and Ashwagandha interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Ashwagandha and Ethinyl Estradiol, Ethynodiol Diacetate interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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