ArticleLiver international : official journal of the International Association for the Study of the Liver2020
Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 4 of them syntheses that pooled it.
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57 citing papers in PubMed, 4 syntheses or guidelines pooled it, 102 citations in OpenAlex.
- Adjunctive Ashwagandha (Nutrients · 2026Pooled it
- A Systematic and Ethnobotanical Review of Ashwagandha's ( Withania Somnifera ) Teratogenic and Abortifacient Potentials.Phytotherapy research : PTR · 2026Pooled it
- Effects ofNutrients · 2026Pooled it
- Effects ofNutrients · 2023Pooled it
- Efficacy and safety of ashwagandha root extract in children and adolescents with mild attention-deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled trial.Journal of medicine and life · 2026Trial
- Ashwagandha Root Extract Stabilises Physiological Stress Responses in Male and Female Team Sports Athletes During Pre-Season Training.Nutrients · 2026Trial
- Effects of Root Extract of Ashwagandha (Withania somnifera) on Perception of Recovery and Muscle Strength in Female Athletes.European journal of sport science · 2025Trial
- Review
- The contemporary epidemiology, causes, and management of drug-induced liver injury.Hepatology communications · 2026Review
- Potential Adverse Effects of Ashwagandha: A Critical Review of Preclinical and Clinical Evidence.Phytotherapy research : PTR · 2026Review
- Evaluating the Safety of Ashwagandha as a Food Additive: A Focus on Reproductive, Thyroid, and Immune System Effects.Phytotherapy research : PTR · 2026Review
- Ashwagandha: Is It Safe? Part 2: A Preclinical Evidence Review.Phytotherapy research : PTR · 2026Review
- Spontaneous Reports of Suspected Adverse Reactions to Ashwagandha: Analysis of Data From the Italian Nutrivigilance System.Phytotherapy research : PTR · 2026Article
- Safety of 12-Months Administration of Ashwagandha ( Withania somnifera ) Standardized Root Extract in Healthy Adults: A Prospective, Observational Study.Phytotherapy research : PTR · 2026Observational
- Common Causes of Drug-Induced Liver Injury in 2025.The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology · 2026Review
- The interplay of Ashwagandha with hormonal dynamics and gut microbiota in women with breast cancer: a tri-axial perspective.Journal of natural medicines · 2026Review
- Back to the Roots: Safety and Tolerability of Standardised Ashwagandha (Pharmaceuticals (Basel, Switzerland) · 2026Review
- Review
- The Clinical Implications of Ashwagandha (Nutrients · 2026Review
- Efficacy and Safety of Herbal Supplements with Anxiolytic, Antidepressant, and Sedative Action: A Review of Clinical Data and Toxicological Risks.Pharmaceuticals (Basel, Switzerland) · 2026Review
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Authors and funding
8 authors at 5 institutions in 2 countries.
Funding
Abstract
BACKGROUND &
aimsAshwagandha (Withania somnifera) is widely used in Indian Ayurvedic medicine. Several dietary supplements containing ashwagandha are marketed in the US and Europe, but only one case of drug-induced liver injury (DILI) due to ashwagandha has been published. The aim of this case series was to describe the clinical phenotype of suspected ashwagandha-induced liver injury.
methodsFive cases of liver injury attributed to ashwagandha-containing supplements were identified; three were collected in Iceland during 2017-2018 and two from the Drug-Induced Liver Injury Network (DILIN) in 2016. Other causes for liver injury were excluded. Causality was assessed using the DILIN structured expert opinion causality approach.
resultsAmong the five patients, three were males; mean age was 43 years (range 21-62). All patients developed jaundice and symptoms such as nausea, lethargy, pruritus and abdominal discomfort after a latency of 2-12 weeks. Liver injury was cholestatic or mixed (R ratios 1.4-3.3). Pruritus and hyperbilirubinaemia were prolonged (5-20 weeks). No patient developed hepatic failure. Liver tests normalized within 1-5 months in four patients. One patient was lost to follow-up. One biopsy was performed, showing acute cholestatic hepatitis. Chemical analysis confirmed ashwagandha in available supplements; no other toxic compounds were identified. No patient was taking potentially hepatotoxic prescription medications, although four were consuming additional supplements, and in one case, rhodiola was a possible causative agent along with ashwagandha.
conclusionsThese cases illustrate the hepatotoxic potential of ashwagandha. Liver injury is typically cholestatic or mixed with severe jaundice and pruritus, but self-limited with liver tests normalizing in 1-5 months.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.