Ashwagandha (Withania somnifera) is an evergreen shrub found in parts of India, Asia, and Africa. The herb is often used to treat conditions related to physical and emotional stress, including insomnia, anxiety, and arthritis.

Ashwagandha has the potential to interact with certain medications, including drugs that lower blood sugar, affect the immune system, and regulate thyroid hormones.

If you are interested in ashwagandha, it’s important to talk to your healthcare provider about potential interactions with any medications or supplements you take.

Ashwagandha may help lower blood sugar levels in your body. Therefore, taking ashwagandha with other medications that treat diabetes and lower blood sugar may lead to dangerously low blood sugar levels. Examples of blood sugar-lowering medications include:

• Insulin
• Glumetza (metformin)
• Glucotrol (glipizide)
• Ozempic or Wegovy (semaglutide)

Hypoglycemia (low blood sugar) occurs when blood sugar drops below 70 milligrams per deciliter (mg/dL). A normal fasting blood sugar (at least 8 hours without eating) is 70-99 mg/dL. Signs of hypoglycemia include feeling weak, increased heart rate, sweating, hunger, confusion, passing out, and seizures.

Low blood sugar is considered an emergency and can often be treated by drinking or eating foods to raise blood sugar. If you’re frequently experiencing episodes of hypoglycemia, talk with your healthcare provider about ways to prevent low blood sugar.

Ashwagandha may help lower blood pressure. Taking ashwagandha with medications that lower blood pressure may cause your blood pressure to drop too low.

Hypotension (low blood pressure) occurs when your blood pressure falls below 90/60 millimeters of mercury (mmHg). Normal blood pressure is between 90/60 and 120/80 mmHg.

Low blood pressure can reduce blood flow to important parts of the body, such as the heart or brain. Symptoms include confusion, fainting, lightheadedness, and weakness.

Examples of medications that lower blood pressure include:

• Norvasc (amlodipine)
• Tenormin (atenolol)
• Lasix (furosemide)
• Cozaar (losartan)

Supplements that may lower blood pressure include arginine, niacin, and omega-3 fatty acids.

If you are taking ashwagandha with any blood pressure-lowering medication, monitor your blood pressure closely. Let your healthcare provider know if you experience any episodes of low blood pressure.

Ashwagandha can cause sleepiness, drowsiness, and slow breathing. For this reason, it is best to avoid taking it with other medications that can cause sleepiness or drowsiness or affect breathing.

Sedatives are medications used to calm someone down, improve anxiety, or help someone sleep. Common examples of sedatives include:

• Benzodiazepines like Valium (diazepam) and Klonopin (clonazepam)
• Opioid medications like Roxicodone or Xtampza ER (oxycodone)
• Sleeping medications like Ambien (zolpidem)

Supplements that may be sedative include melatonin, kava, and L-tryptophan.

Taking ashwagandha with sedative medications may lead to a higher risk of drowsiness, breathing difficulties, and sleepiness.

Talk with your healthcare provider to determine the best way to take multiple medications that can cause sedation. They may recommend you only take these medications at night. Avoid driving or operating heavy machinery when taking medicines that can make you tired or drowsy.

Ashwagandha can affect the immune system’s activity. Several studies have found that the herb helps strengthen your immune system. This can cause issues for certain people, such as those with immune system disorders.

Immunosuppressants are medications that block the immune system from working as it normally would. They’re useful in treating certain health conditions, such as certain cancers and organ transplants. Examples of immunosuppressants include:

• Organ transplant medication like Prograf (tacrolimus)
• Corticosteroids like Rayos (prednisone)
• Some chemotherapies

Taking ashwagandha with immunosuppressants may affect how well the medication works. Let your healthcare provider know if you are taking ashwagandha with an immunosuppressant. They will help you determine whether it is safe to take them together.

Ashwagandha may be harmful to the liver (hepatotoxic). Several reports have linked ashwagandha to inflammation of the liver (hepatitis), yellowing of the skin and eyes (jaundice), liver failure, and the need for liver transplantation.

Taking ashwagandha with other hepatotoxic medications may increase your risk for liver damage. Examples of hepatotoxic medications include:

• Indocin (indomethacin)
• Dilantin (phenytoin)
• Rifadin (rifampin)

Hepatotoxic supplements include garcinia, green tea extract, black cohosh, and kava.

If taking ashwagandha with any other hepatotoxic medication or supplement, your provider will need to monitor your liver health closely.

Ashwagandha may increase the amount of thyroid hormone your body naturally produces. Some research suggests that ashwagandha increases the creation and release of thyroid hormones triiodothyronine (T3) and thyroxine (T4) into the blood.

Taking ashwagandha with other thyroid hormone drugs may lead to unnecessarily high levels of thyroid hormone in your body. Symptoms of high thyroid hormone levels include nervousness, trouble sleeping, diarrhea, fast and irregular heartbeat, and mood swings.

Thyroid hormone replacement medication is prescribed to increase certain thyroid hormone levels. Examples of thyroid hormone-related medications include:

• Armour Thyroid (desiccated thyroid)
• Synthroid, Tirosint, or Unithroid (levothyroxine)
• Cytomel (liothyronine)

Ashwagandha increases the chance of side effects from thyroid hormone medications, which include weight gain or loss, hair loss, joint pain, sweating, and nervousness.

If you take ashwagandha with thyroid hormone medication, watch for symptoms related to high hormone levels. Your healthcare provider will monitor your levels if you start taking ashwagandha.

If you’re taking an ashwagandha supplement, let your healthcare provider know. They will help you determine if the supplement is safe with other medications and supplements you may be taking. They can also examine how ashwagandha could affect your medical conditions.

See a healthcare provider if you experience signs or symptoms of low blood sugar, low blood pressure, drowsiness, liver injury, or high thyroid hormone levels while taking ashwagandha. If left untreated, these issues can lead to serious complications.

Ashwagandha (Withania somnifera) is an evergreen shrub grown in parts of India, Asia, and Africa. The herb is often used to treat conditions related to physical and emotional stress, including insomnia, anxiety, and arthritis.

Ashwagandha may interact with medications that lower blood pressure and blood sugar, sedatives, immunosuppressants, hepatotoxic drugs, and thyroid hormone medications.

If you are interested in taking ashwagandha, discuss any medications or supplements you may be taking with your healthcare provider. They can help you determine if it is safe to take these with ashwagandha.