Surgery & Anesthesia
Why surgical teams ask about adaptogen herbs: what NCCIH and a JAMA review say about bleeding, blood sugar and anesthesia, and what is and is not known for each plant.
Content last updated . This page has not been medically reviewed.
Safety first. Supplements can cause side effects and interact with medicines. Read mushroom safety and interactions before you use any mushroom product.
Short answer. Tell your surgeon, anesthesiologist and pharmacist about every supplement you take, well before the operation. NCCIH says certain dietary supplements may increase the risk of bleeding or affect your response to anesthesia, and advises talking to your providers as far in advance as possible. [1] The sources we read do not give a plant-by-plant stopping schedule for adaptogens, so your surgical team decides what is right for you.
"Adaptogen" is a contested term from Soviet-era research, not a regulatory category. The plants below are very different from one another. Information only, not medical advice.
Why this matters
NCCIH says dietary supplements may interact with your medications or pose risks if you have certain medical problems or are going to have surgery. [1] A 2001 review in JAMA looked at herbs that may pose a concern in the perioperative period, naming ginseng among eight commonly used herbal medications. [2] It described bleeding from ginseng and hypoglycemia (low blood sugar) from ginseng as direct effects. [2] That review is from 2001 and covers older literature, so treat it as background.What the sources say, plant by plant
| Plant | Surgery-related point in the source | Strength of evidence |
|---|---|---|
| Ashwagandha (Withania somnifera) | NCCIH: not recommended for people about to have surgery. [3] MSK: preclinical studies suggest sedative properties that may have additive effects; clinical relevance not yet determined. [4] | Agency advice; preclinical |
| Asian ginseng (Panax ginseng, root) | NCCIH: may interfere with blood clotting, and some evidence suggests it might lower blood sugar. [5] | Agency summary |
| Eleuthero (Eleutherococcus senticosus) | LactMed: may increase blood pressure, bleeding and blood sugar. [6] | Database summary |
| Rhodiola (Rhodiola rosea) | MSK advises talking to a provider if you take a blood thinner such as warfarin. [7] | Cautionary advice |
| Licorice root | MSK: may increase the metabolism and clearance of warfarin; clinical relevance not known. [8] | Reported; unclear relevance |
What a reader can do
- Make a complete list of supplements, teas and extracts, with the product name and what is in it. See how to prepare your supplement list for a procedure.
- Tell the surgical team, anesthesiologist and pharmacist, and tell them about blood thinners, diabetes medicines and sedatives. Read supplements before surgery and anesthesia and herbal supplements.
- Ashwagandha has its own page on surgery and autoimmune disease.
Frequently asked questions
Should I stop ashwagandha before surgery?
NCCIH says ashwagandha is not recommended for people who are about to have surgery. [3] Ask your surgical team when and how to handle it.
Does ginseng affect bleeding?
NCCIH says Asian ginseng may interfere with blood clotting. [5] Studies of ginseng with warfarin disagree. [9][10]
Can adaptogens affect anesthesia?
NCCIH says some supplements may affect your response to anesthesia. [1] We found no adaptogen-specific anesthesia guidance in the sources we read.
How early should I tell the team?
NCCIH says to talk to your providers as far in advance of the operation as possible. [1]
Do I tell them about tea and powders too?
Yes. NCCIH asks you to tell providers about all dietary supplements you take. [1]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Warfarin and ginseng: the trials disagree
- **American ginseng (Panax quinquefolius):** in a randomized, placebo-controlled trial of 20 healthy volunteers, American ginseng reduced warfarin's anticoagulant effect. [9] The authors noted this was young, healthy volunteers rather than patients on treatment doses. [9]
- **Korean red ginseng (a processed Panax ginseng):** in a randomized crossover trial of 25 patients with heart valve replacement on warfarin, there were no statistically significant differences in mean INR changes. [10]
- A third small randomized study in 25 stroke patients, comparing Panax ginseng plus warfarin with warfarin alone, found no statistically significant difference between groups, and the authors concluded it did not influence warfarin's action. [11] See ginseng, blood sugar and blood thinners.
These are small studies with different ginseng species and preparations, so they cannot be combined into one answer. That is why a pharmacist or the anticoagulation clinic should be told about any ginseng.
Limits and uncertainty
References
- NCCIH. Using Dietary Supplements Wisely. Read 2026-10-23.
- Herbal medicines and perioperative care. JAMA. 2001. Read 2026-10-23.
- NCCIH. Ashwagandha: Usefulness and Safety. Last updated March 2023. Read 2026-10-23.
- Memorial Sloan Kettering Cancer Center. Ashwagandha (About Herbs). Read 2026-10-23.
- NCCIH. Asian Ginseng: Usefulness and Safety. Last updated February 2025. Read 2026-10-23.
- Drugs and Lactation Database (LactMed). Eleuthero, 2006 entry as indexed in PubMed. Read 2026-10-23.
- Memorial Sloan Kettering Cancer Center. Rhodiola (About Herbs). Read 2026-10-23.
- Memorial Sloan Kettering Cancer Center. Licorice (About Herbs). Read 2026-10-23.
- Interaction between warfarin and American ginseng in healthy volunteers: a randomized, controlled trial. Ann Intern Med. 2004. Read 2026-10-23.
- Interaction between warfarin and Korean red ginseng in patients with cardiac valve replacement. 2010. Read 2026-10-23.
- Interaction between warfarin and Panax ginseng in ischemic stroke patients. 2008. Read 2026-10-23.