Ashwagandha

Ashwagandha, Indian ginseng winter cherry or orovale (Withania somnifera), is a woody evergreen shrub of the Solanaceae family distributed throughout Asia and Africa. Its name means in Sanskrit "horse smell". It contains steroid heterosides witanolides (witanosides I-VII, witaferin A, fisagulin D and coagulin Q), alkaloids (cuscohigrin, anahigrin, somnin, somniferin, withanin, tropin, pseudotropin and anaferin), amino acids and minerals, especially Ca, K, Mg and Al. ^{(Fitoterpaia.net, Jayasinha 1999)}

It is used in Ayurvedic medicine since millennia with multiple indications: anxiety, nervousness, insomnia, hypertension, edema, cough, bronchitis, type 2 diabetes, neurodegenerative diseases, rheumatism, improvement of uterine tone, lack of sexual desire, anorexia in children, wounds, conjunctivitis .... ^{(Fitoterpaia.net, Jayasinha 1999)}. Its use for stress, fatigue, anxiety and insomnia has increased in many countries of the world ^{(MedlinePlus 2023)}, although good quality studies are needed to firmly establish the clinical efficacy of ashwagandha for most of its indications. ^{(Akhgarjand 2022).} 
It has also been used to stimulate milk production. ^{(Geetha 1987, Mukherjee 1987, Narendranath 1986, Sholapurkar 1986, Subramaniam 1986, Bakshi 1986, Ghosh 1986, Rajarathnam 1986)}
Oral or topical cutaneous and ocular administration.

As of the time of the last update, we found no published data on its excretion in breast milk.

The only publications of its galactogogue effect date from 1986 and 1987, and are of very low and insufficient quality of its efficacy in increasing milk production ^{(Foong 2020)}. The best galactogogue is effective support and counseling during pregnancy and after delivery to achieve frequent demand breastfeeding with correct technique in a mother who retains her self-confidence. ^{(Brodribb 2018, Anderson 2013)}

Ashwagandha consumption for 2 to 3 months has been published to be safe for health, but studies on its long-term use and at different dosages are lacking ^{(MedlinePlus 2023, Verma 2021, Cheah 2021)}. Consumption of ashwagandha supplements is not without health risk. Although rare, cases of liver toxicity (with widely varying dosages), frequently cholestatic hepatitis with jaundice, of varying severity, from mild to fatal, have been published. ^{(Philips 2023, Bokan 2023, Suryawanshi 2023, Siddiqui 2021, Björnsson 2020)}

Given the lack of certain evidence of the efficacy of its indications and the rare but possible hepatic toxicity, its consumption is dispensable and more so during lactation, especially in cases of prematurity and during the neonatal period.

Because of its possible sedative effect, bed-sharing (co-sleeping) is not recommended if this plant is consumed during lactation.