Quick answer
NIH's liver injury database rates ashwagandha a likely cause of rare liver injury, usually starting 2 to 12 weeks after people begin taking it. Most cases cleared within 1 to 4 months of stopping, but a few were fatal or needed a transplant, mainly in people who already had liver disease. Ask your doctor first if you have liver disease.1,2,3
Key facts
- NIH's LiverTox database rates ashwagandha a likely cause of rare liver injury, usually showing up 2 to 12 weeks after starting.1
- NCCIH says liver injury from ashwagandha is rare, but that a number of cases have linked it to supplements.2
- A 2020 case series of 5 adults and a 2023 series from India both describe a mostly cholestatic pattern, with jaundice and itching.4,5
- The reported deaths and the transplant were mostly in people with chronic liver disease.1,5,6
- In a safety trial of 1,002 adults taking ashwagandha for 8 weeks, liver blood tests did not change.7
What do NIH sources say about ashwagandha and the liver?
Three NIH sources agree that the liver concern is real and uncommon. NCCIH says it is rare, but that there have been a number of cases linking liver injury to ashwagandha supplements. The Office of Dietary Supplements reports adverse effects on liver function in its sheet for health professionals. LiverTox, the NIH database on liver injury from medicines and supplements, gives the most detail.1,2,3
Rare cases of liver injury have been linked to ashwagandha, usually starting 2 to 12 weeks after people began taking it, with jaundice and itching. Most resolved within 1 to 4 months of stopping, but a few were fatal or needed a liver transplant, mainly in people who already had liver disease.1,3
In five reported cases of liver injury, people had taken 450 to 1,350 mg a day for 1 week to 4 months.3
What do the published case reports look like?
Because the reaction is rare, most of what is known comes from published cases. The three collections below are the largest we read, and they describe a similar pattern.4,5,6
| Source | Who | What was reported |
|---|---|---|
| Iceland and US case series, 2020 | 5 adults aged 21 to 62 | Jaundice, itching and nausea after 2 to 12 weeks; mostly a cholestatic or mixed pattern; no liver failure; tests back to normal within 1 to 5 months in four, and one patient lost to follow-up |
| India case series, 2023 | 8 people on single-ingredient products, from 23 with ashwagandha-linked injury | Cholestatic hepatitis was most common; five had chronic liver disease, and three of them developed acute-on-chronic liver failure and died; one case progressed to chronic injury |
| Scoping review, 2026 | 25 patients in 13 publications | Injury after weeks of use, usually cholestatic; most recovered over weeks to months; one liver failure needing a transplant and three deaths in people with cirrhosis |
The Iceland series checked the supplements in the lab and confirmed ashwagandha in the products it could test. Four of its five patients were also taking other supplements, and in one case rhodiola was a possible cause alongside ashwagandha. NIH likewise notes that some products in the cases were combinations and that contents were not checked by a laboratory every time, so a single ingredient cannot always be named with certainty.3,4
Does the liver signal show up in trials?
Not so far. The largest trial we read, in 1,002 adults, gave a root extract for 8 weeks and found no change in liver or kidney blood tests. A smaller trial in 80 healthy adults reached the same result. Neither is built to catch a reaction that happens only rarely, and NIH describes the liver concern through case reports, not trials.3,7,8
In an 8-week trial of 1,002 adults, 28 side effects were recorded among the 498 people taking 600 mg a day and 46 among the 504 taking placebo. The most common were nausea, dry mouth and headache, and liver and kidney blood tests did not change.7
Who seems to be at greater risk?
The sources do not identify who will react. What the reports do show is where the worst outcomes fell. LiverTox says the fatal and transplant cases were mainly in people who already had liver disease. The India series and the 2026 scoping review give the same picture, with deaths in people who had chronic liver disease or cirrhosis. NIH adds that some reported cases were in people with pre-existing liver disease.1,3,5,6
The signs described in the reports are yellow skin or eyes, itching, nausea, lethargy and abdominal discomfort. They are worth raising with a doctor, together with the name of any supplement you take, because a liver specializt will ask about it.3,4
Who should ask a doctor first?
- Anyone with liver disease, or who has ever had jaundice or abnormal liver tests, should ask a doctor before using ashwagandha.1
- Anyone taking a medicine that can affect the liver should ask a pharmacist whether adding a supplement changes the picture.
- Anyone who develops yellowing of the skin or eyes, severe itching or dark urine while taking a supplement should ask a doctor promptly and bring the bottle.3
- Anyone planning surgery or a procedure should tell the care team about it, because NCCIH does not recommend ashwagandha before surgery.
Questions people ask
Is liver damage from ashwagandha common?
NIH describes it as rare. LiverTox rates ashwagandha a likely cause of rare injury, and a trial of 1,002 adults found no change in liver blood tests over 8 weeks.1,7
How soon after starting ashwagandha does liver injury appear?
LiverTox says it usually starts 2 to 12 weeks after people begin taking it. The Iceland case series found the same range.1,4
Does the liver recover after stopping ashwagandha?
In most reports it did, within 1 to 4 months, according to LiverTox. A few cases were fatal or needed a transplant, mainly in people who already had liver disease.1
Does ashwagandha cause drowsiness, diarrhea or headaches?
NCCIH lists drowsiness, stomach upset, diarrhea and vomiting, and NIH lists loose stools, nausea and drowsiness. In the 1,002-adult trial, headache was among the most common events, and fewer events were recorded on ashwagandha than on placebo.2,3,7
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Sources
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Ashwagandha. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. Last update December 3, 2024. Opened 2026-10-07.
- National Center for Complementary and Integrative Health. Ashwagandha. Last updated March 2023. Opened 2026-10-07.
- National Institutes of Health, Office of Dietary Supplements. Ashwagandha: Is it helpful for stress, anxiety, or sleep? Fact Sheet for Health Professionals. Updated May 2, 2025. Opened 2026-10-07.
- Bjornsson HK, Bjornsson ES, Avula B, et al. Ashwagandha-induced liver injury: a case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020;40(4):825-829. Opened 2026-10-11.
- Philips CA, Valsan A, Theruvath AH, et al. Ashwagandha-induced liver injury: a case series from India and literature review. Hepatol Commun. 2023;7(10):e0270. Opened 2026-10-11.
- McIntyre D, Nguyen P, Kim Y, Meyer B, Salloum M. Ashwagandha (Withania somnifera)-associated liver injury: a scoping review of clinical characteristics and safety considerations. Cureus. 2026;18(5):e109764. Opened 2026-10-11.
- Pakhale K, Salve J, Ademola J, Parraca J, Langade D. Safety of 8-Week Administration With Ashwagandha (Withania somnifera) Root Extract in Adults With Stress and Anxiety: Findings From a Prospective, Randomized, Multi-Center, Double-Blinded, Placebo-Controlled Study. Phytother Res. 2026;40(8):5005-5015. Opened 2026-10-07.
- Verma N, Gupta SK, Tiwari S, Mishra AK. Safety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers. Complement Ther Med. 2021;57:102642. Opened 2026-10-07.
This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.