For most healthy adults, ashwagandha root extract causes few side effects in short-term use. The most common are mild stomach upset, loose stools, nausea and drowsiness, and the NIH describes it as well tolerated for up to about three months. The rarer risks are liver injury and thyroid overactivity, and people who are pregnant, have thyroid, liver or autoimmune conditions, take certain medications, or have surgery coming up should skip it or ask a doctor first.
Key takeaways
- Common side effects are mild and digestive (stomach upset, loose stools, nausea) or drowsiness. In a 1,002-person, 8-week trial, side effects were no more frequent with ashwagandha than with placebo.
- Liver injury is rare, but NIH's LiverTox rates ashwagandha a "likely" cause of clinically apparent liver injury. It usually appears 2 to 12 weeks after starting and usually resolves after stopping.
- Ashwagandha can raise thyroid hormone levels, and case reports describe thyrotoxicosis. People with thyroid conditions or on thyroid medication should talk to a doctor first.
- Denmark banned ashwagandha in food supplements in 2023, and France's food safety agency (ANSES) advised several groups, including pregnant women, to avoid it in 2024.
- Most controlled trials ran 8 to 12 weeks. Safety over many months or years is not well established.
Common side effects: mostly digestive and mild
The research below concerns ashwagandha as an ingredient, not any finished MAXIS product.
The NIH Office of Dietary Supplements (ODS) and the National Center for Complementary and Integrative Health (NCCIH) list the same short set of common effects: stomach upset, diarrhea or loose stools, nausea or vomiting, and drowsiness. LiverTox notes that digestive upset is more likely at large doses.
The largest safety trial to date gives a sense of scale. In a 2026 multicenter study, 1,002 adults with stress took 600 mg per day of a standardized root extract or a placebo for 8 weeks. Adverse events were reported by 5.6% of the ashwagandha group and 9.2% of the placebo group, with no serious events. Nausea occurred in 2.0% on ashwagandha versus 3.2% on placebo, and liver, kidney and blood tests stayed in normal ranges. A 2026 systematic review of 23 randomized trials (2,317 healthy adults, 125 to 600 mg per day) reached a similar conclusion: mild digestive discomfort, headache and drowsiness were infrequent and showed up in comparison groups too.
Drowsiness deserves a note of its own. France's ANSES pointed to sedation seen in clinical trials and advised against using ashwagandha when driving or operating machinery, or alongside other drugs that depress the central nervous system.
| Side effect | How common | What to do |
|---|---|---|
| Stomach upset, loose stools, nausea | The most often reported; in the largest trial, nausea was 2.0% on ashwagandha vs 3.2% on placebo | Usually mild. Stop if it persists or is severe. |
| Drowsiness | Reported in trials; listed by NIH and ANSES | Do not drive if you feel sleepy. Ask a doctor before combining with sedatives. |
| Headache, dry mouth | Infrequent; 0.2% and 1.4% on ashwagandha in the largest trial, no higher than placebo | Usually passes. Stop if it persists. |
| Liver injury (jaundice, itching, dark urine) | Rare; known from case reports and small case series | Stop immediately and see a doctor. Do not restart. |
| Thyroid overactivity (palpitations, weight loss, shakiness) | Rare; a handful of case reports | Stop and see a doctor for thyroid testing. |
Ashwagandha and the liver: rare but real
Clinical trials have not reported liver enzyme rises with ashwagandha, but case reports have built up since the first in 2017. LiverTox, the NIH database on drug-induced liver injury, now gives ashwagandha a likelihood score of B, meaning a likely cause of clinically apparent liver injury.
The pattern is fairly consistent. Injury usually shows up 2 to 12 weeks after starting, typically with jaundice and itching, and is mostly cholestatic (affecting bile flow) or mixed. Most cases are mild to moderate and resolve within one to four months of stopping, though jaundice can last for weeks.
- Iceland and the US (2020). Five people aged 21 to 62 developed jaundice after taking ashwagandha supplements for roughly two weeks to four months. None developed liver failure, and liver tests normalized in the four who were followed up.
- India (2023). Doctors at three centers identified 23 people with ashwagandha-related liver injury and described 8 who had taken single-ingredient products. Five of the eight had underlying chronic liver disease, and the three who arrived with acute-on-chronic liver failure died.
The lesson from these series is that the most severe outcomes have occurred mainly in people with pre-existing liver disease. Product quality is also a factor: LiverTox notes that some products may be mixed, mislabeled or adulterated, although in several cases testing confirmed ashwagandha alone.
Ashwagandha and the thyroid
Ashwagandha appears able to raise thyroid hormone levels. In an 8-week trial of 50 adults with subclinical hypothyroidism, 600 mg per day of root extract lowered TSH and raised T3 and T4 compared with placebo. That shift may be unwanted in someone whose thyroid is already overactive or who takes thyroid hormone.
Case reports point the same way. The ODS describes three women aged 32 to 73 who developed thyrotoxicosis (too much thyroid hormone) while taking ashwagandha, one at an unusually high 1,950 mg per day, and all recovered after stopping. A 2024 report described a previously healthy 47-year-old man who developed painless thyroiditis about two months after starting ashwagandha, with fatigue, night fevers and weight loss that improved once he stopped. NCCIH does not recommend ashwagandha for people with thyroid disorders.
Who should not take ashwagandha
- Pregnant or breastfeeding people. NCCIH says to avoid it during pregnancy and breastfeeding. Concerns stem partly from reports of possible miscarriage, though the American Herbal Pharmacopoeia disputes that evidence.
- People with thyroid conditions, for the reasons above.
- People with autoimmune conditions. NCCIH does not recommend it for autoimmune disorders.
- People with liver disease, given the severe cases seen in this group.
- Men with hormone-sensitive prostate cancer. Ashwagandha may raise testosterone, so the ODS and NCCIH advise caution.
- Anyone scheduled for surgery. NCCIH advises against use before surgery.
What Denmark and France decided
Denmark banned ashwagandha in food supplements in 2023, following a 2020 risk assessment by the Technical University of Denmark that could not set a safe intake level. The Danish food authority now treats any product containing ashwagandha as illegal to sell as food, citing possible effects on sex hormones and reproduction, metabolism, the immune system and the central nervous system.
In an opinion signed in April 2024, France's ANSES advised people with thyroid, liver or heart disease or hyperandrogenism, pregnant women, and people on sedatives or other central nervous system depressants not to take ashwagandha supplements. As a precaution, it extended that to breastfeeding women and anyone under 18. ANSES said the available data were too weak to define a risk-free intake, and it had received eight adverse event reports in France between 2009 and September 2023.
Medication interactions
The ODS and NCCIH list possible interactions with:
- Thyroid hormone medications
- Sedatives (and, per NCCIH, anticonvulsants)
- Immunosuppressants
- Diabetes medications
- Blood pressure medications
These interactions are flagged as possible rather than well quantified, which is a reason to check with a doctor or pharmacist before starting, not a reason to assume they don't matter.
How long is ashwagandha safe to take?
Most controlled trials lasted 8 to 12 weeks, and the ODS describes ashwagandha as well tolerated for up to about three months while noting that safety over many months or years is unknown. The 2026 systematic review found trials of up to 180 days and called longer-term data limited. A 2026 observational study followed 191 adults on a standardized root extract for 12 months and reported 18 mild adverse events with no meaningful change in liver enzymes, but it had no placebo group. Treat use beyond three months as less well studied, and review it with a healthcare professional. For more on dosing and extract types, see our KSM-66 ashwagandha guide, and for how it compares with another popular herb, see ashwagandha vs. tongkat ali.
Signs to stop and see a doctor
- Yellowing of the skin or eyes, dark urine, pale stools or unusual itching
- Persistent nausea, loss of appetite, abdominal pain or unusual tiredness
- A racing heart or palpitations, shakiness, unexplained weight loss or night fevers
- Drowsiness that interferes with driving or work
Liver and thyroid problems in the case reports generally improved after stopping, and LiverTox advises against restarting after a liver reaction.
Where MAXIS Ashwagandha+ fits
MAXIS Ashwagandha+ provides, per 2 capsules, 600 mg KSM-66® ashwagandha root extract, 400 mg Eury Gold 28® tongkat ali, 200 mg velvet bean seed extract (15% L-Dopa), 50 mg tribulus, 50 mg muira puama and 50 mg maca. It helps the body adapt to stress and supports energy, stamina and healthy hormone balance.†
The label carries the cautions discussed above. It is not for anyone under 18, pregnant or breastfeeding. Consult a healthcare provider before use if you have a thyroid, autoimmune or hormone-sensitive condition (including prostate concerns); if you take thyroid medication, sedatives, immunosuppressants, blood pressure medication, MAOIs, antipsychotics or Parkinson's medication (it contains L-Dopa from velvet bean); or if you are scheduled for surgery within two weeks.
Do not combine it with MAXIS Men's Vitality, which contains 120 mg Shoden® ashwagandha root extract per serving.
KSM-66® is a registered trademark of Ixoreal Biomed Inc.
FAQ
Is ashwagandha safe to take every day?
In trials, daily use for up to about three months was generally well tolerated by healthy adults. Data beyond that are limited, so daily use over many months is less well studied.
Can ashwagandha damage your liver?
Rarely. Liver injury has been documented in case reports and small case series, mostly appearing 2 to 12 weeks after starting and usually resolving after stopping. The most serious cases occurred mainly in people with existing liver disease.
Should I take ashwagandha if I have a thyroid condition?
Talk to your doctor first. Ashwagandha can raise thyroid hormone levels and may interact with thyroid medication, and NCCIH does not recommend it for people with thyroid disorders.
Why is ashwagandha banned in Denmark?
Danish authorities concluded that a safe intake level could not be established, citing possible effects on hormones, reproduction and other body systems, and banned it in food supplements in 2023.
References
- NIH Office of Dietary Supplements (2025). Ashwagandha: Is it helpful for stress, anxiety, or sleep? Fact Sheet for Health Professionals. National Institutes of Health. ods.od.nih.gov
- National Center for Complementary and Integrative Health (2023). Ashwagandha: Usefulness and Safety. NCCIH. nccih.nih.gov
- National Institute of Diabetes and Digestive and Kidney Diseases (2024). Ashwagandha. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. ncbi.nlm.nih.gov/books/NBK548536
- Björnsson HK, Björnsson ES, Avula B, Khan IA, Jonasson JG, Ghabril M, Hayashi PH, Navarro V (2020). Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network. Liver International. PubMed 31991029
- Philips CA, Valsan A, Theruvath AH, et al. (2023). Ashwagandha-induced liver injury: A case series from India and literature review. Hepatology Communications. PubMed 37756041
- Sharma AK, Basu I, Singh S (2018). Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. Journal of Alternative and Complementary Medicine. PubMed 28829155
- Hayashi M, Hamada H, Azuma SI, Hayashi K (2024). Painless Thyroiditis by Withania somnifera (Ashwagandha). Cureus. PubMed 38559552
- Pakhale K, Salve J, Ademola J, Parraca J, Langade D (2026). Safety of 8-Week Administration With Ashwagandha (Withania somnifera) Root Extract in Adults With Stress and Anxiety: Findings From a Prospective, Randomized, Multi-Center, Double-Blinded, Placebo-Controlled Study. Phytotherapy Research. PubMed 41943502
- Coope OC, Willems MET, Levington A, Tallon MJ, Roman-Viñas B, Spurr TJ (2026). Back to the Roots: Safety and Tolerability of Standardised Ashwagandha (Withania somnifera) Root Extract in Healthy Adults: A Systematic Review of Biomarkers and Adverse Events. Pharmaceuticals. PubMed 42198398
- Salve J, Kale S, Prajapati BL, Sparavigna A, Savant M, Ademola J, Langade D (2026). Safety of 12-Months Administration of Ashwagandha (Withania somnifera) Standardized Root Extract in Healthy Adults: A Prospective, Observational Study. Phytotherapy Research. PubMed 41063394
- ANSES (2024). Avis relatif aux risques liés à l'utilisation des préparations de Withania somnifera (L.) Dunal dans les compléments alimentaires (Saisine n° 2021-SA-0077). French Agency for Food, Environmental and Occupational Health & Safety. anses.fr
- Fødevarestyrelsen (n.d.). Ashwagandha i kosttilskud og drikkevarer. Danish Veterinary and Food Administration. foedevarestyrelsen.dk
†These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
