Ashwagandha & Liver Injury: What to Tell Patients
November 2026
Reviewed 10/16/26 by the NatMed Clinical Team
Top Takeaways
Ashwagandha has been linked to rare but serious liver injury, including liver failure and death.
Advise patients to stop taking it and seek care at the first sign of liver symptoms, and to avoid it if they have liver disease.
A 44-year-old mother who had been taking ashwagandha gummies she found on social media is making headlines. She ended up in intensive care, required a liver transplant, and now has brain damage. Concerns about ashwagandha have been bubbling up for years – now is a good time to review the facts.
Does ashwagandha cause liver damage?
Rarely, yes. Ashwagandha has been linked to cases of cholestatic, hepatocellular, and mixed liver injuries wiith some reports of hepatic encephalopathy, liver failure requiring liver transplantation, and acute-on-chronic liver failure resulting in death. Symptoms typically started 5-180 days after initial use, though some cases began after more than a year. In most cases, liver enzymes normalized within 1-5 months after stopping ashwagandha.
Was ashwagandha the cause of liver failure in this case?
It’s suspected but not confirmed. The patient had been taking two ashwagandha gummies daily for about a year when she developed jaundice and was diagnosed with liver failure. Complications from the liver transplant left her with brain damage. Her case is still under investigation, but her medical team suspects the ashwagandha product may be the cause of liver failure.
Is ashwagandha safe for most people?
Ashwagandha has been used with apparent safety in doses of up to 1250 mg daily for up to 6 months. It seems to be safe for most adults when used appropriately, short-term. But several cases of liver injury have been reported with the use of typical ashwagandha doses. Watch for symptoms including dark urine, jaundice, nausea, abdominal pain, lethargy, and pruritus. Product quality is also an ongoing issue. Ashwagandha is sometimes substituted or adulterated with a similar plant, Withania coagulans, so patients should look for products verified by a reputable third party.
Who should avoid ashwagandha?
Specific patient populations should avoid ashwagandha altogether, including those with existing liver disease and those who are pregnant or breast-feeding. Also tell patients taking hepatotoxic drugs to be cautious.
What’s the bottom line?
Always ask about supplement use in any patient with unexplained liver damage. Tell patients taking ashwagandha to look out for symptoms of liver damage and to discontinue use and contact their healthcare provider immediately if any symptoms develop. Check out our recently updated ashwagandha monograph to learn more.