Last update Nov. 20, 2023

Ashwagandha

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

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.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Groups

Ashwagandha belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Ashwagandha in its composition:

  • Ad Baby
  • Adrenoid™. Contains other elements than Ashwagandha in its composition
  • Calm Blend™. Contains other elements than Ashwagandha in its composition
  • Chasteberry Plus™. Contains other elements than Ashwagandha in its composition
  • One BE

References

  1. Philips CA, Valsan A, Theruvath AH, Ravindran R, Oommen TT, Rajesh S, Bishnu S, Augustine P; Liver Research Club India.. Ashwagandha-induced liver injury-A case series from India and literature review. Hepatol Commun. 2023 Sep 27;7(10). pii: e0270. Consulted on Nov. 19, 2023 Abstract Full text (link to original source)
  2. Suryawanshi G, Abdallah M, Thomson M, Desai N, Chauhan A, Lim N. Ashwagandha-Associated Acute Liver Failure Requiring Liver Transplantation. Am J Ther. 2023 Jan-Feb 01;30(1):e80-e83. Consulted on Nov. 19, 2023 Abstract
  3. Bokan G, Glamočanin T, Mavija Z, Vidović B, Stojanović A, Björnsson ES, Vučić V. Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause. Pharmaceuticals (Basel). 2023 Aug 10;16(8). pii: 1129. Consulted on Nov. 19, 2023 Abstract Full text (link to original source)
  4. MedlinePlus. Ashwagandha. Trusted Health information for you. 2023 Full text (link to original source)
  5. Jaspreet S, Ashish S. Breastfeeding, the Benefits of Lactation for Nursing Mother's Health along with the Challenges Associated with Lactation and Use of Natural Milk Energizing Supplements. Asian Research Journal of Gynaecology and ObstetricsVolume 6, Issue 1, Page 13-23, 2023; Article no.ARJGO.97704. Abstract Full text (link to original source)
  6. MedlinePlus. Ashwagandha. Información de salud para usted. 2023 Full text (link to original source)
  7. Akhgarjand C, Asoudeh F, Bagheri A, Kalantar Z, Vahabi Z, Shab-Bidar S, Rezvani H, Djafarian K. Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2022 Nov;36(11):4115-4124. Abstract
  8. Siddiqui S, Ahmed N, Goswami M, Chakrabarty A, Chowdhury G. DNA damage by Withanone as a potential cause of liver toxicity observed for herbal products of Withania somnifera (Ashwagandha). Curr Res Toxicol. 2021 Feb 16;2:72-81. Abstract Full text (link to original source)
  9. Verma N, Gupta SK, Tiwari S, Mishra AK. Safety of Ashwagandha Root Extract: A Randomized, Placebo-Controlled, study in Healthy Volunteers. Complement Ther Med. 2021 Mar;57:102642. Abstract Full text (link to original source)
  10. Cheah KL, Norhayati MN, Husniati Yaacob L, Abdul Rahman R. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLoS One. 2021 Sep 24;16(9):e0257843. Abstract Full text (link to original source)
  11. Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V. Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver Int. 2020 Apr;40(4):825-829. Abstract Full text (link to original source)
  12. Foong SC, Tan ML, Foong WC, Marasco LA, Ho JJ, Ong JH. Oral galactagogues (natural therapies or drugs) for increasing breast milk production in mothers of non-hospitalised term infants. Cochrane Database Syst Rev. 2020 May 18;5:CD011505. Abstract Full text (link to original source)
  13. ABM: Brodribb W. ABM Clinical Protocol #9: Use of Galactogogues in Initiating or Augmenting Maternal Milk Production, Second Revision 2018. Breastfeed Med. 2018 Jun;13(5):307-314 Abstract Full text (link to original source) Full text (in our servers)
  14. Anderson PO. The galactogogue bandwagon. J Hum Lact. 2013 Abstract
  15. Jayasinha P, Warnasuriya D, Dissanayake H. Ashwagandha (Withania somnifera). A literatura survey. Medicinal and Aromatic Plant Series No.4. Information Services Centre. Industrial Technology Institute. Colombo, Sri Lanka. 1999 Abstract Full text (link to original source)
  16. Mukherjee S. A double blind trial with Lactare - a lactagogue. Indian Medical Gazette 1987;September:308-9.
  17. Geetha AS, Rao AP. Lactare in lactation. Antiseptic 1987;84:520-22.
  18. Rajarathnam S, Vijaya, Rathnakumar. Lactare (herbal galactagogue) to improve lactation- a clinical study of 75 cases. TTK Pharma Limited, Madras 1986.
  19. Narendranath KA, V. Anuradha S, Mahalingam S, Sanjeeva Rao I. Effect of herbal galactagogue (Lactare), a pharmacological and clinical observation. Medicine and Surgery 1986;26: 4, 19--22
  20. Subramaniam K, Murthy M, Mahalingam S, Narendranath K. A combined clinical study of Lactare (a herbal galactagogue). In: 10th World Congress of Natural Medicines; 1986; Malaga, Spain. 1986.
  21. Bakshi R, Salvi V, Walvekar V, Soonawalla RP. A comparative study of the efficacy of an allopathic and an ayurvedic galactogogue. Journal of Obstetrics and Gynaecology of India 1986;33(3):330-93.
  22. Ghosh S, Chakraborty S, MItra J, Ghosh KK. Study on lactare- a herbal galactagogue. Indian Medical Gazette 1986;November:379-81.
  23. Sholapurkar ML. "Lactare‟ for improving Lactation. Indian Pract., 1986; 39: 1023-6.

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