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Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum)

Plant adaptogen from Ayurvedic medicine, supplement. Not registered as medicine in EU or AEMPS

ATC code: A11JA-TULSI

Brand names – supplements: Now Holy Basil, Organic India Tulsi, Himalaya Holy Basil, New Chapter Holy BasilSupplements are not tested in clinical trials and are not registered as medications.

Updated · Methodology

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

D

Immune support and respiratory infection care

Not recommended

Holy basil (tulsi) is an Ayurvedic herb whose supplement extracts are promoted to strengthen immunity and prevent colds and flu. There is no convincing evidence that tulsi lowers how often people catch respiratory infections or how severe they get; the available studies are few and of low quality. A common cold gets better with rest, fluids and time, vaccination protects against flu, and a doctor may prescribe antivirals for people at higher risk. At usual doses tulsi is well tolerated, but its benefit for immunity has not been confirmed

Sources

  1. Liver Tox NIDDK: Tulsi (Ocimum sanctum) hepatotoxicity profile (2020)
D

Stress and anxiety

Not recommended

Tulsi (holy basil) is sold as an «Ayurvedic adaptogen» against stress and anxiety. Evidence base is weak: several small Indian RCTs showed heterogeneous results on stress scales; no large international RCTs. 2010 approved no health claim for tulsi. 2022 and SEP 2014 list SSRIs and CBT for anxiety disorders; tulsi is in no international guideline. If tulsi was recommended for clinically significant anxiety instead of psychotherapy and an antidepressant, consider seeking a second opinion. Important: high-dose tulsi extracts have caused isolated drug-induced liver injury cases.

Sources

  1. Liver Tox NIDDK: Tulsi (Ocimum sanctum) hepatotoxicity profile (2020)
  2. NICE: Depression in adults: treatment and management (NG222) (2022)

ICD-10: F41.9 · ICD-11: 6B0Z

D

Type 2 diabetes mellitus

Not recommended

Holy basil, or tulsi (Ocimum sanctum), is a plant from Ayurveda sold as a supplement to lower blood sugar in type 2 diabetes. Studies have not shown a convincing benefit for this use, and the evidence base for taking tulsi in type 2 diabetes is lacking. Blood sugar drops reliably with changes to diet, physical activity, weight loss and medications of proven effectiveness that a doctor selects.

Sources

  1. ADA: Standards of Care in Diabetes 2024 – pharmacologic approaches to glycemic treatment (2024)

ICD-10: E11 · ICD-11: 5A11

How to read tiers A–F
  • AStrong evidence – first or second line in international guidelines
  • BRecommended in selected cases
  • CStudy data contradict each other
  • DBenefit not proven, no documented harm
  • FDocumented harm, or risk without benefit

Mechanism of action

Tulsi leaves contain essential oils (eugenol up to 70%, cineole, methyl eugenol), flavonoids (orientin, vicenin) and ursolic acid. In animal models tulsi extract modulates the HPA axis and shows hypoglycaemic, anti-inflammatory and immunomodulatory effects. The human mechanism is not confirmed in RCTs with hard endpoints. AEMPS does not register tulsi as a medicine. LiverTox 2020 describes rare drug-induced liver injury cases with high-dose tulsi extracts.

Safety

Contraindications

  • Pregnancy and lactation
  • Children under 18
  • Warfarin and other anticoagulant therapy (bleeding risk via platelet aggregation inhibition)
  • Diabetes on insulin or sulfonylurea (hypoglycaemia risk)
  • Planned surgery (discontinue 2 weeks before – bleeding risk)
  • Active liver disease

Serious adverse effects

  • Drug-induced liver injury (DILI) – isolated cases with high-dose extracts
  • Bleeding in warfarin and antiplatelet patients
  • Hypoglycaemia in DM patients on insulin

Common adverse effects

  • Nausea
  • Heartburn
  • Allergic skin reactions
  • Blood glucose reduction

Pregnancy: can you take Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum)?

No RCT data in pregnancy. In Ayurvedic tradition tulsi is classed as a herb with possible abortifacient action (increases uterine tone in animal models). AEMPS does not register. Avoid in pregnancy.

Breastfeeding: can you take Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum)?

No data on milk transfer. Lactating women should avoid.

Calculate RID

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

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Frequently asked

What is Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum) used for?

Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum) is evaluated for the following indications with varying evidence strength: Stress and anxiety (evidence tier D), Immune support and respiratory infection care (evidence tier D), Type 2 diabetes mellitus (evidence tier D). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum)?

Common side effects of Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum) (≥ 1 in 100): Nausea, Heartburn, Allergic skin reactions, Blood glucose reduction. See the Safety section for uncommon and serious reactions.

Is Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum) safe during pregnancy?

No RCT data in pregnancy. In Ayurvedic tradition tulsi is classed as a herb with possible abortifacient action (increases uterine tone in animal models). AEMPS does not register. Avoid in pregnancy.

Is Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum) compatible with breastfeeding?

No data on milk transfer. Lactating women should avoid.

Who should not take Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum)?

Holy basil, tulsi (Ocimum sanctum, Ocimum tenuiflorum) is contraindicated in: Pregnancy and lactation; Children under 18; Warfarin and other anticoagulant therapy (bleeding risk via platelet aggregation inhibition); Diabetes on insulin or sulfonylurea (hypoglycaemia risk); Planned surgery (discontinue 2 weeks before – bleeding risk). Full list in the Safety section.

Other drugs in this group

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