Can You Take Ashwagandha And Orilissa Together?

In our latest question and answer, the pharmacist discusses if ashwagandha and Orilissa can be taken together.

Question

Can you take ashwagandha and Orilissa together? I suffer from depression, stress and anxiety but I am not currently on meds for those. I do take vitamin D as prescribed by my doctor. I take Orilissa for an ovary problem I'm having. I wanted to start taking the ashwagandha for my anxiety. Would the two counteract each other or the vitamin D?

Asked by ImmaMagiccat On Nov 09, 2022

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Nov 11, 2022
Last updated Nov 11, 2022

Key points

  • There are no reported interactions between ashwagandha and Orilissa but some studies suggest they may share interfering effects on certain hormones.
  • You should only take ashwagandha and Orilissa together under the supervision of your doctor so you can be appropriately monitored.

Answer

There, unfortunately, are no studies that have evaluated whether or not ashwagandha and Orilissa are safe to take together. I could not find any case reports of them interfering with one another and based on what we know about how they are metabolized and absorbed, it is unlikely they interfere in this way.

However, there is one possible interaction between ashwagandha and Orilissa that I discuss below, but that is more of a theoretical interaction based on very little information.

Why It's Difficult To Determine Drug/Herbal Interactions

I do want to mention that it can be difficult to determine whether or not an herbal interacts with a prescription drug, not just due to the lack studies, but also because herbals can have a wide range of little understood effects.

Ashwagandha, sometimes referred to an Indian Ginseng, is a great example of this. This herb has historically been used for a number of different indications/conditions, including:

  • Stress
  • Fatigue
  • Athletic Performance
  • Anxiety
  • Pain
  • Thyroid disease
  • Menopausal symptoms
  • Sexual dysfunction

If it is used for such a wide range of conditions, you would assume it likely has a variety of mechanisms via which it works. 

Additionally, unlike many prescription drugs, which often only have one active ingredient, herbs contain several active constituents. With ashwagandha, several active constituents of the shrub have been identified, including

  • Alkaloids (e.g., isopelletierine, anaferine)
  • Lactones (e.g., withanolides, withaferins)
  • Saponins
  • Terpenoids
  • Flavonoids
  • Tannins
  • Salvigenin
  • Withanolides 
  • Withaperuvin

All of these constituents could potentially have different effects on the body, which makes it challenging to determine potential drug interactions.

Potential Interaction Discussion

Having said all of the above, I did find a few studies that potentially indicate a theoretical interaction between Orilissa and ashwagandha.

Orilissa (elagolix) is a gonadotropin-releasing hormone (GnRH) receptor antagonist. it inhibits GnRH signaling, which in turn, suppresses luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This leads to decreased blood concentrations of the sex hormones estradiol and progesterone.

One study (in men) found that ashwagandha caused increases in luteinizing hormone (LH) and decreases in follicle-stimulating hormone (FSH). It stated:

Treatment of infertile men [with ashwagandha] recovered the seminal plasma levels of antioxidant enzymes and vitamins A, C, and E and corrected fructose. Moreover, treatment also significantly increased serum T and LH and reduced the levels of FSH and PRL [prolactin].
Fertil Steril . 2010 Aug;94(3):989-96.

Other studies have found conflicting results in that ashwagandha decreased LH levels (in women):

Ashwagandha intake demonstrated a statistically significant reduction in total MENQoL [The Menopause-Specific Quality of Life] scores (p < 0.0001) and was also associated with a statistically significant increase in serum estradiol (p < 0.0001) and a significant reduction in serum FSH (p < 0.0001) and serum LH (p < 0.05) compared with the placebo.
J Obstet Gynaecol Res . 2021 Dec;47(12):4414-4425.

Since Orilissa affects certain hormones and some studies suggest that ashwagandha can as well, we just don't know how they could potentially interfere with each other.

In all likelihood, there probably isn't a significant interaction between them, but you should check with your doctor first before combining them. If they are used together, be sure to monitor yourself for effect and any adverse reactions.

There are no known interactions between either and vitamin D.

Final Words

I hope this was helpful! Please contact us again anytime.

References

  • Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males, PubMed
  • Effect of an ashwagandha (Withania Somnifera) root extract on climacteric symptoms in women during perimenopause: A randomized, double-blind, placebo-controlled study, PubMed
  • Effects of Withania somnifera on Reproductive System: A Systematic Review of the Available Evidence, PubMed
  • A Randomized, Double-Blind, Placebo-Controlled, Crossover Study Examining the Hormonal and Vitality Effects of Ashwagandha ( Withania somnifera) in Aging, Overweight Males, PubMed
  • ORILISSA Prescribing Information, AccessFDA

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at Hello@HelloPharmacist.com! You can also connect with Dr. Brian Staiger on LinkedIn.

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