Athletic endurance
Not recommended
Dietary supplements, plant adaptogens (local classification)
ATC code: A11JA-ASHWAGANDHA (Ashwagandha (Withania somnifera) – local code)
Brand names – supplements
KSM-66 Ashwagandha, Sensoril Ashwagandha, Ashwagandha Now Foods, Solgar Ashwagandha
Supplements are not tested in clinical trials and are not registered as medications.
Ashwagandha is the root of the Indian plant Withania somnifera, used in Ayurveda as a «rasayana» (rejuvenator) for over 3000 years. Active constituents include withanolides (steroidal lactones), withanosides, and alkaloids. Cellular models describe HPA axis modulation (cortisol reduction), GABAergic and serotonergic activity, and immunomodulation. Bioavailability of active withanolides in humans is low and depends on extract form.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Ashwagandha is marketed in fitness communities for muscle strength, VO2max, and testosterone enhancement. Five to seven small RCTs (Wankhede 2015, Ziegenfuss 2018) in trained men aged 18-45 show 1-RM squat and bench press gains of 10-15% and testosterone increases of 14-22% versus placebo. Studies are small (40-60 participants), last 8-12 weeks, and some were industry-funded. IOC, AIS, and ACSM sports nutrition guidelines do not list ashwagandha as an evidence-based ergogenic agent.
Not recommended
Ashwagandha is sold for sleep improvement and reduced sleep onset latency. Five RCTs (Langade 2019, Salve 2019, Deshpande 2020) with about 400 participants combined show 15-25 minute reduction in sleep onset and improvements in PSQI in patients with mild insomnia. Studies are small and short (8-10 weeks). insomnia guidelines do not list ashwagandha. CBT-I remains first line for chronic insomnia.
Not recommended
Ashwagandha (Withania somnifera) is an Ayurvedic adaptogen, the most studied over-the-counter supplement for stress reduction. Meta-analyses from 2014-2022 (Pratte, Salve, Lopresti) based on 8-12 small clinical trials show significant reductions in the Perceived Stress Scale (PSS-10) and a 20-30% reduction in salivary cortisol versus placebo. The effect is dose-dependent: the most common dose is 300-600 mg of standardized KSM-66 extract (5% withanolides) once or twice daily. Evidence quality is moderate: small samples (60-130 participants), short studies (8-12 weeks), and high risk of bias. and guidelines for anxiety and stress do not currently include ashwagandha. It is relatively safe in healthy adults, but rare cases of drug-induced liver injury and thyroid stimulation have been reported; ashwagandha is contraindicated in hyperthyroidism, autoimmune disease, and pregnancy. For persistent stress, it is more useful to address sleep, physical activity, and screen for an anxiety disorder or depression. If ashwagandha is taken on its own for stress, do not expect miracles; for marked symptoms, consult a clinician.
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Contraindicated in pregnancy: teratogenicity and abortifacient effects are described in animal models.
Not recommended during breastfeeding: safety data are unavailable.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Ashwagandha (Withania somnifera) is evaluated for the following indications with varying evidence strength: Stress and anxiety (evidence tier D), Insomnia (evidence tier D), Athletic endurance (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ashwagandha (Withania somnifera) (≥ 1 in 100): GI discomfort, nausea, diarrhoea, Drowsiness, sedation, Headache, Rash. See the Safety section for uncommon and serious reactions.
FDA category N. Contraindicated in pregnancy: teratogenicity and abortifacient effects are described in animal models.
Not recommended during breastfeeding: safety data are unavailable.
Ashwagandha (Withania somnifera) is contraindicated in: Pregnancy (teratogenicity in animal models); Breastfeeding; Hyperthyroidism and nodular goiter; Hormone-dependent tumours; Autoimmune disease (RA, SLE, MS). Full list in the Safety section.