Ashwagandha
Natural Standard evidence-based flashcard. Copyright © 2008 (www.naturalstandard.com). Commercial distribution prohibited. This flashcard is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions. 		Image
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Summary:
Ashwagandha (Withania somnifera) is a small, grayish, erect evergreen shrub that grows to about 4-5 feet tall, with small greenish flowers and fruits that become orange-red when ripe. Ashwagandha is widely cultivated in India and the Middle East for its medicinal properties, and is also found in parts of Africa. Ashwagandha has been used in Ayurvedic medicine in India for many centuries. It has usually used as an "adaptogenic" herb, meaning that it is used with the intention to help the body resist physical and emotional stress. Indian herbalists practicing Ayurvedic medicine in the 19th century are thought to have brought Ashwagandha to America.

Uses
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Grade*
Diabetes (type 2) C
Diuretic C
High cholesterol C
Longevity/anti-aging C
Osteoarthritis C
Parkinson's disease C
*Key to grades: A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).

Safety:
Avoid if allergic or hypersensitive to ashwagandha products or any of their ingredients. Dermatitis (allergic skin rash) was reported in three of 42 patients in one ashwagandha trial. There are few reports of adverse effects associated with ashwagandha, but there are few human trials using ashwagandha, and most do not report the doses or standardization/preparation used. Avoid with peptic ulcer disease. Ashwagandha may have cause abortions based on anecdotal reports. Avoid if pregnant or breastfeeding.

Possible side effects:
Sedation, possible life-threatening respiratory depression, decrease blood pressure, abnormal heart rhythms, diarrhea, nausea, abdominal pain, irritation of mucous and serous membranes, kidney lesions, lower blood sugar levels, (in patients with type 2 diabetes), stimulate thyroid function and increase T4 levels, decreased serum FSH and testosterone levels, increase platelet count, immunomodulatory effects, anti-inflammatory effects.

Possible interactions:
Amphetamines, barbiturates, ethanol, blood-thinners like warfarin (like Coumadin®), diabetic drugs, blood pressure lowering drugs, cholinesterase inhibiting drugs like donepezil (like Aricept®), rivastigmine (like Exelon®), galantamine (like Reminyl®), tacrine (like Cognex®), neostigmine (like Prostigmin®), edrophonium chloride (like Tensilon®) and pyridostigmine bromide, paclitaxel, sedatives, hypnotics, central nervous system depressants, drugs for thyroid disease/disorders, 5-HTP, arginine, ornithine, finasteride (like Proscar®), and other herbs or supplements with similar effects.
Repeated administration of ashwagandha may cause a tolerance to narcotics.

Dosing:
Tablets may be standardized to 4.5mg with anolides.

Adults (18 years and older):
Capsules: 1-6g daily of the whole herb has been used in capsule form.
Powder: 3g of powder taken twice times daily in boiled, warm milk has been used.
Tea/infusion: A tea has been made by simmering/boiling one part root in 10 parts water for 15-30 minutes and taken twice daily in the amount of 1/2 to 1 ounce at a time. 1-6g daily of the whole herb in tea form has been used.
Tincture/fluid extract: 2-4mL of tinctures or fluid extracts has been taken three times daily. May contain high concentrations of alcohol.
Milk decoction: 5tsp of dried herb in 1 cup boiling liquid, taken as 2-3 cups per day with raw sugar or honey, has been used.
Multi-herb formulas: 3-12g has been used in combination with other herbs.

Children (younger than 18 years):
Children 8-12 years-old have been given 2g daily in milk for 60 days with no toxicity.


Natural Standard Monograph (www.naturalstandard.com)
Copyright © 2008 Natural Standard Inc. Commercial distribution or reproduction prohibited.
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.