Does Ashwagandha Interact With Prescription Drugs?

Answer

Hello and thanks for reaching out to us!

First and foremost, I want to point out this it can tricky to determine whether or not a dietary/herbal supplement will interact with prescription drugs due to a general lack of studies on the matter. This holds true for ashwagandha.

Although ashwagandha is one of the more well-studied herbals on the market, there have not been extensive drug-interaction studies with it. We can, however, make some educated guesses on drug interactions based on ashwagandha works, and the effects it is known to have.

Since you don't mention any drugs in your question, we'll list some of the potential interactions below.

What Is Ashwagandha?

Ashwagandha, also known as 'Indian Ginseng' is an evergreen shrub indigenous to India, the Middle East, and some parts of Africa. It is very widely utilized as a dietary supplement and used for a number of purported medical benefits, including:

• As an adaptogen, helping the body resist physiological and psychological stress
• Analgesic (i.e. pain-relieving) effects
• Antidiabetic effects
• Anti-inflammatory effects
• Memory effects
• Immunologic effects
• Blood pressure effects
• Thyroid enhancing effects

As ashwagandha is a botanical, it appears to have many different active components and a complex mechanism of action for how it works.

Ashwagandha contains several active constituents including:

• Alkaloids (isopelletierine, anaferine)
• Steroidal lactones (withanolides, withaferins)
• Saponins

The mechanism of how ashwagandha works, for all of its purported benefits, is not well understood.

Ashwagandha With Diabetes Drugs

Ashwagandha may lower blood sugar (i.e. blood glucose). Therefore, it could theoretically increase the risk of hypoglycemia (i.e. low blood sugar).

One study, published in Phytotherapy Research, reported that ashwagandha supplementation reduced blood sugar and A1c levels, although this was a relatively small study. More are needed for more definitive results.

There aren't any specific antidiabetic drugs ashwagandha is known to interact with. It is just a general precaution that ashwagandha may decrease blood sugar. Therefore, it should be used cautiously with drugs used to treat diabetes, including:

• Metformin
• Insulin
• GLP-1 Agonists (e.g. Byetta, Trulicity, Ozempic, Rybelsus, Bydureron, Victoza, Mounjaro)
• Sulfonylureas (e.g. glipizide, glyburide, glimepride)
• SGLT2 Inhibitors (e.g. Jardiance, Farxiga, Invokana)

Ashwagandha With Blood Pressure Drugs

Just like with potential interactions between ashwagandha and diabetes drugs, there may be a potential issue with drugs used to treat high blood pressure as studies show ashwagandha may have blood-pressure-lowering effects.

The concern would be blood pressure drops too low if combining high blood pressure medications and ashwagandha.

Now, most studies suggest that ashwagandha doesn't have significant blood pressure lowering effects, so the interaction here is thought to be relatively mild. Nevertheless, be sure to talk to your doctor before adding on ashwagandha to blood pressure medicine, such as:

• ACE-Inhibitors (e.g. lisinopril, captopril, benazepril, quinapril)
• ARBs (e.g. losartan, valsartan, telmisartan)
• Beta-Blockers (e.g. metoprolol, nebivolol, propranolol)
• Diuretics (e.g. hydrochlorothiazide, spironolactone, chlorthalidone)

Ashwagandha With Thyroid Drugs

Ashwagandha might increase the effects and adverse effects of thyroid hormone drugs. Taking it with drugs that increase levels of thyroid hormone (e.g. levothyroxine, desiccated thyroid) could potentially increase thyroid hormone levels too much, increasing the risk of side effects.

One study on the matter reported that ashwagandha increased triiodothyronine (T3) and thyroxine (T4) levels by 41.5% and 19.6%, respectively, and reduced serum TSH levels by 17.4% from baseline. This, like many studies looking into herbal products, was small, and more are needed to better understand how ashwagandha works and the effects it has.

Ashwagandha With Immunosuppressants

Studies are inconclusive, but ashwagandha may have immune-stimulating properties. If you take a drug meant to suppress your immune systems, such as methotrexate or mycophenolate, they may have conflicting effects.

Again, be sure to talk to your doctor about adding ashwagandha to immunosuppressant drugs.

Final Words

Overall, ashwagandha doesn't seem to have many reported significant drug interactions.

Most reported drug interactions are based on the potential additive effects when combined with certain drugs (e.g. drugs for diabetes and blood pressure).

As always, be sure to talk to your doctor about combining any over-the-counter dietary supplement with your prescribed drugs as they have your complete medical profile.

Thanks again for reaching out!