Quick answer

NIH's complementary health center says Panax ginseng taken by mouth in recommended amounts for up to 6 months appears safe for most people. Trouble sleeping is its most common side effect, and other reported effects are mostly mild. The warfarin label says it may lessen warfarin's effect, so anyone on medicine should ask first.^1,2

Key facts

Trouble sleeping is the most common side effect of Asian ginseng.¹
A review of 65 randomized trials found 135 minor adverse events in the 40 trials that looked for them, and no serious ones.³
NIH's liver injury database says ginseng alone is an unlikely cause of liver injury, and notes that it can change how the liver handles some medicines.⁴
The warfarin label lists ginseng among the botanicals that may decrease warfarin's effect.²
Most ginseng trials lasted less than 3 months, and questions have been raised about long-term safety.¹

The side effects people report most

Trouble sleeping is the most common side effect of Asian ginseng.^1,4

Other reported side effects are usually mild, such as headache, nausea, diarrhea in the morning and nosebleeds. In trials, side effects with ginseng alone were about as common as with placebo.^4,5

In a 4-week trial in healthy adults taking 1 or 2 g a day of root extract, mild events such as indigestion, hot flashes, trouble sleeping and constipation were reported in both the ginseng and placebo groups, and no serious reactions or significant blood test changes were found. A review of 65 randomized trials found 135 minor adverse events in the 40 trials that looked for them, and no serious ones.^3,6

Those trial numbers have limits. The healthy-volunteer trial lasted 4 weeks, and the review covered trials of many different products, most with unclear methods. Side effects with ginseng alone were about as common as with placebo in the trials gathered by an older review, but that review also found that blends containing ginseng were linked to more serious events that could rarely be traced to one ingredient.^3,5,6

Because trouble sleeping is the effect most often named, it is worth noticing how you sleep in the first weeks. If it keeps you awake, tell your doctor or pharmacist.^1,4

Rare reactions: rash, allergy and the liver

Uncommon side effects include severe rash, liver damage and severe allergic reactions. In one trial, a woman taking 2 g a day stopped after 7 days because of a widespread rash and itching.^1,7

Ginseng alone is an unlikely cause of liver injury, but it can change how the liver handles some medicines. Liver injury has been reported 1 to 3 months after people taking imatinib or raltegravir added ginseng, and they later took the same medicine again, without ginseng, with no liver injury.⁴

LiverTox scores ginseng E, meaning an unlikely cause of liver injury by itself. The concern is indirect. Laboratory studies found that different ginsenosides affect the liver enzymes that break down medicines, and some may inhibit one of them, CYP 3A4, enough to raise or lower the activity of other drugs.⁴

Stop taking it and get medical help if you develop a widespread rash with itching, swelling of the face or throat, or yellow skin or eyes.^1,4

Blood sugar, clotting and the immune system

Asian ginseng might lower blood sugar. In one study, single doses of 200 or 400 mg lowered blood glucose in healthy young adults.^1,8

Asian ginseng may worsen autoimmune conditions and interfere with blood clotting.¹

NIH's complementary health center advises anyone with diabetes to talk to their provider before using Asian ginseng. If you take a medicine that lowers blood sugar, ask your pharmacist whether ginseng matters for you.¹

Medicines

Ask your pharmacist or doctor first

The warfarin label lists ginseng among the botanicals that may decrease warfarin's effect, and says the INR, the blood test that guides the dose, should be checked more often when starting or stopping botanicals. MedlinePlus also names ginseng among the herbal products that may interact with warfarin.^2,4,9

On the medicine's label

A study of 24 healthy people who took one dose of warfarin along with Asian ginseng, St John's wort, ginkgo or ginger found that ginseng modestly raised the rate at which the body cleared S-warfarin, to 1.14 times the control level, without directly changing warfarin's action. The authors said studies in people who actually take warfarin are needed, so it does not settle the question.¹⁰

NIH's complementary health center says Asian ginseng might interact with certain medicines, and asks anyone who takes any medicine to talk to a health care provider before using ginseng. Ask your pharmacist about any other medicine you take.¹

Pregnancy, breastfeeding and children

Some studies suggest Asian ginseng may be unsafe in pregnancy, because one of its compounds caused birth defects in animals. Little is known about whether it is safe while breastfeeding.^1,11

A systematic review of the evidence found one cohort study with no adverse effects from Panax ginseng during pregnancy, and no human studies of breastfeeding. It also found laboratory evidence that isolated ginsenosides can harm animal embryos, at levels far above those from normal use, and conflicting evidence on whether ginseng acts like estrogen. Its advice was to use caution, especially in the first trimester and while breastfeeding.¹¹

NIH's complementary health center adds that some experts recommend against ginseng for infants and children.¹

Daily use and how long

No upper limit has been set for ginseng. Taken by mouth in recommended amounts for up to 6 months, it appears safe for most people, but questions have been raised about its long-term safety.¹

The trials behind these findings ran for 4 to 16 weeks, and NIH's complementary health center notes that most ginseng trials had fewer than 200 participants and lasted less than 3 months. Long-term safety has not been established.^1,6,12

Who should ask first

Ask first if you take warfarin or another blood thinner^1,2
Ask first if you have diabetes or take medicine that lowers blood sugar¹
Ask first if you have an autoimmune condition¹
Ask first if you take any prescription medicine, because ginseng can change how the liver handles some of them⁴
Ask first if you are pregnant or breastfeeding, or if the person taking it is a child^1,11

Questions people ask

Is Panax ginseng safe to take every day?

For up to 6 months in recommended amounts it appears safe for most people, according to NIH's complementary health center. Trials ran 4 to 16 weeks, so safety over years is not known, and some people should ask first because of medicines or pregnancy.^1,6,12

Is Panax ginseng safe for diabetics?

Ask your doctor first. NIH's complementary health center says some evidence suggests Asian ginseng might lower blood sugar, and in one study single doses of 200 or 400 mg lowered blood glucose in healthy young adults within hours.^1,8

Are Panax ginseng side effects different for men and women?

The sources we read do not describe different side effects by sex. The 4-week safety trial enrolled healthy men and women together. Women who are pregnant or breastfeeding are the group NIH singles out to ask first.^1,6

Does Panax ginseng interact with blood thinners?

The warfarin label lists ginseng among botanicals that may decrease warfarin's effect, and asks for the INR to be checked more often when starting or stopping them. NIH's complementary health center also says ginseng may interfere with blood clotting. Ask your pharmacist if you take any blood thinner.^1,2

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Sources

This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.