Adaptogen Safety & Interactions
Adaptogen safety in plain language - ingredient-by-ingredient cautions from NIH, medication interactions, pregnancy, surgery, and when to get help. Natural does not mean risk-free.
Content last updated . This page has not been medically reviewed.
"Natural" does not mean risk-free. Adaptogen ingredients are active plants, and several have documented side effects and medication interactions. This page summarizes what NIH's National Center for Complementary and Integrative Health (NCCIH) says about five commonly sold ingredients. It is education, not personal medical advice. Talk with a pharmacist or clinician before you start, especially if you take medication, are pregnant or breastfeeding, have a health condition, or have surgery planned.
Cautions by ingredient (from NIH summaries)
| Ingredient | Time frame NIH describes | Side effects named | Cautions and interactions named |
|---|---|---|---|
| Ashwagandha | May be safe short term (up to 3 months); not enough information on long-term safety [1] | Drowsiness, stomach upset, diarrhea, vomiting; rare cases linked to liver injury [1] | Avoid in pregnancy and while breastfeeding; not recommended before surgery or with autoimmune or thyroid disorders; may interact with diabetes, blood pressure, immunosuppressant, sedative, anti-seizure and thyroid medicines; people with hormone-sensitive prostate cancer should avoid it [1] |
| Asian ginseng | Short-term oral use (up to 6 months) appears safe for most people; long-term safety questioned [2] | Insomnia most common; uncommon: severe rash, liver damage, severe allergic reactions [2] | May worsen autoimmune disorders, interfere with blood clotting, and lower blood sugar; may interact with medicines; some experts advise against use in infants, children, and in pregnancy or breastfeeding [2] |
| Rhodiola | Possibly safe for up to 12 weeks [3] | Dizziness, headache, insomnia, dry mouth or excess saliva [3] | Interaction with losartan (a blood pressure drug) reported; little known about pregnancy or breastfeeding; people with or at risk of depression should consult a provider [3] |
| Licorice root | Generally considered safe as a food ingredient [4] | Glycyrrhizin can cause serious effects such as irregular heartbeat and cardiac arrest, especially in large amounts or long term [4] | Risk higher with high salt intake, hypertension, heart or kidney conditions; interactions with corticosteroids reported; large amounts in pregnancy are unsafe; deglycyrrhizinated (DGL) products might be safe up to 4 months [4] |
| Astragalus | May be safe orally (up to 60 g per day for as long as 4 months in studies); no thorough safety evaluation [5] | Not detailed in the NIH summary | Avoid with autoimmune diseases; may interact with immune-suppressing medicines; some animal research suggests toxicity to the fetus in pregnancy [5] |
Other adaptogen ingredients on this site (eleuthero, holy basil, schisandra, amla, shatavari, maca) were not covered by an NIH summary we could read, so we do not list safety claims for them. Absence of a warning is not evidence of safety.
Documented interactions vs theoretical concerns
Some interactions are documented in reports (for example rhodiola with losartan, licorice with corticosteroids). [3][4] Others are described by NIH as possible, based on how the herb is thought to act (for example ashwagandha and thyroid or diabetes medicines). [1] Treat both as reasons to ask a pharmacist, and do not assume an ingredient you do not see listed is safe with your medicines.Pregnancy, breastfeeding and children
NIH advises avoiding ashwagandha in pregnancy and breastfeeding, and describes pregnancy concerns for Asian ginseng, licorice and astragalus. [1][2][4][5] For many other adaptogens, safety data in pregnancy, breastfeeding and children are limited or absent.Surgery, bleeding and blood sugar
NIH does not recommend ashwagandha before surgery, and says Asian ginseng may interfere with blood clotting and may lower blood sugar. [1][2] Tell your surgical team and pharmacist about every supplement.Liver, thyroid and hormone-sensitive conditions
Liver injury has been linked, rarely, to ashwagandha and, uncommonly, to Asian ginseng. [1][2] Ashwagandha is not recommended with thyroid disorders, and may raise testosterone, so people with hormone-sensitive prostate cancer should avoid it. [1] Stop and seek care for yellowing of the skin or eyes, dark urine, or severe stomach pain.Contamination and product quality
See Quality. A label cannot be assumed to match the contents.Do not use adaptogens to replace medical care
Fatigue, low mood, poor sleep or high stress can have medical causes. See Adrenal fatigue claims for why "adrenal fatigue" is not a recognized diagnosis, and why true adrenal insufficiency needs a doctor. [6][7]Getting help
In the US, Poison Control (1-800-222-1222) can advise about taking too much of a supplement. Call 911 for collapse, seizure, trouble breathing, or inability to wake someone. [8]In this section
- Side Effects by Ingredient
- Medication Interactions
- Pregnancy & Breastfeeding
- Children & Teenagers
- Thyroid Conditions
- Autoimmune Conditions & Immunosuppressant Medicines
- Liver & Kidney Conditions
- Blood Pressure & Blood Sugar Considerations
- Surgery & Anesthesia
- Combining Supplements
- When to Seek Medical Help
Dashed labels are guides in preparation. We link a page only when it has real, sourced content.
Frequently asked questions
Are adaptogens safe to take with medication?
Not automatically. NIH names possible or reported interactions for several of them. Ask a pharmacist or clinician before combining. [9]
Can I take adaptogens while pregnant or breastfeeding?
NIH advises avoiding ashwagandha, and raises pregnancy concerns for several others. Ask your clinician. [1]
References
- National Center for Complementary and Integrative Health (NIH). Ashwagandha: Usefulness and Safety. Page dated March 2023.
- National Center for Complementary and Integrative Health (NIH). Asian Ginseng: Usefulness and Safety. Page dated February 2025.
- National Center for Complementary and Integrative Health (NIH). Rhodiola: Usefulness and Safety. Page dated April 2025.
- National Center for Complementary and Integrative Health (NIH). Licorice Root: Usefulness and Safety. Page dated April 2025.
- National Center for Complementary and Integrative Health (NIH). Astragalus: Usefulness and Safety. Page dated May 2025.
- Endocrine Society. Adrenal Fatigue. Patient resource, January 25, 2022.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Symptoms & Causes of Adrenal Insufficiency & Addison's Disease.
- Poison Control (America's Poison Centers). poison.org. Help line 1-800-222-1222; online tool; call 911 for collapse, seizure, trouble breathing or inability to wake.
- National Center for Complementary and Integrative Health (NIH). Using Dietary Supplements Wisely.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.