Withania somnifera

Pronunciation

Withania somnifera (With-aye-nee-ah Som-nee-fare-ah)

Summary

Withania somnifera (WS) is also commonly known as ashwagandha, “Indian Winter cherry” or “Indian Ginseng”. Its roots, leaves, and seeds have been historically used as a tonic to assist with stress, neuroprotection, arthritis, pain, and inflammation. It is one of the most highly regarded ayurvedic medicines (41). Withania somnifera extract contains numerous phytochemicals, such as alkaloids, flavonoids, steroidal lactones, saponins, neurotransmitters, essential and nonessential fatty acids, ergostane, and gamma amino butyric acid, which contribute to its many therapeutic effects (5).

Main Medical Uses

Evidence supports the use of WS for improving executive cognitive function, attention, information processing speed, and memory (11). Evidence also shows that it can improve working memory, reaction time, and social cognition in bipolar disorder (9). It can decrease joint pain (32), improve upper and lower body power in strength training, improve body composition (44, 45), and aerobic performance (33). Withania somnifera may help normalize markers of thyroid activity in subclinical hypothyroidism (39), treat male and female infertility (2, 5, 14), and decrease the severity of symptoms of Obsessive Compulsive Disorder (18), and schizophrenia (10). Evidence also supports the use of WS in managing chronic stress and anxiety (4, 8, 12, 31).

Ashwagandha herb in powder and solid plant form

Dosing and Administration

For an explanation of the classes of evidence, please see the Rating Scales for Evidence-Based Decision Support.

Adverse Effects

In respective doses listed above, the use of WS has been shown to be safe and without adverse effects in treating chronic stress and anxiety (4, 8, 12, 31), OCD (18), and male (2) and female infertility (14). Adverse events such as sleepiness, vivid dreams, dizziness, fatigue, nausea/upset stomach, diarrhea, flatulence, forearm rash, swelling in the feet, increase in depression, frequent urination, and nasal congestion have been reported, however, the incidence of these effects were not statistically significant, and considered as mild and transient in Bipolar Disorder and Schizophrenia (9, 10). Minor and temporary effects were recorded in 4% of the subjects being treated in subclinical hypothyroidism (39).

Proprietary Extracts

Associated Interactions and Depletions

Pharmacokinetics

Evidence on the absorption, metabolism, and excretion of WS is scarce. In vitro studies have shown that the phytoconstituents and crude extracts of WS do not seem to interact with CYP3A4, CYP2D6 (35), CYP1A2, or CYP2C9 (34). Increased bioavailability of glimepiride in rats, when used in combination with WS, suggests that WS may inhibit CYP2C9 (25).

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  1. Akula, K., Dhir, A., & Kulkarni, S. (2009). Effect of various antiepileptic drugs in a pentylenetetrazol-induced seizure model in mice. Methods and Findings in Experimental and Clinical Pharmacology, 31(7), 423-432.
  2. Ambiye, V. R., Langade, D., Dongre, S., Aptikar, P., Kulkarni, M., & Dongre, A. (2013). Clinical evaluation of the spermatogenic activity of the root extract of Ashwagandha (Withania somnifera) in oligospermic males: A pilot study. Evidence-Based Complementary and Alternative Medicine, 2013, 1-6.
  3. Andallu, B., & Radhika, B. (2000). Hypoglycemic, diuretic and hypocholesterolemic effect of winter cherry (Withania somnifera, Dunal) root. Indian Journal of Experimental Biology, 38(6), 607-609.
  4. Auddy, B., Hazra, J., Mitra, A., Abedon, B., & Ghosal, S. (2008). A standardized Withania somnifera extract significantly reduces stress-related parameters in chronically stressed humans: A double-blind, randomized, placebo-controlled study. Journal of American Nutraceutical Association, 11(1), 51-57.
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  6. Bodhankar, S., Devkar, S., Kandhare, A., Sloley, B., Jagtap, S., Lin, J., . . . Hegde, M. (2015). Evaluation of the bioavailability of major withanolides of Withania somnifera using an in vitro absorption model system. Journal of Advanced Pharmaceutical Technology and Research, 6(4), 159-164.
  7. Candelario, M., Cuellar, E., Reyes-Ruiz, J. M., Darabedian, N., Feimeng, Z., Miledi, R., . . . Limon, A. (2015). Direct evidence for GABAergic activity of Withania somnifera on mammalian ionotropic GABAA and GABAρ receptors. Journal of Ethnopharmacology, 171, 264-272.
  8. Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of Ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255-262.
  9. Chengappa, K. N., Bowie, C. R., Schlicht, P. J., Fleet, D., Brar, J. S., & Jindal, R. (2013). Randomized placebo-controlled adjunctive study of an extract of Withania somnifera for cognitive dysfunction in bipolar disorder. The Journal of Clinical Psychiatry, 74(11), 1076-1083.
  10. Chengappa, K. N., Brar, J. S., Gannon, J. M., & Schlicht, P. J. (2018). Adjunctive use of a standardized extract of Withania somnifera (Ashwagandha) to treat symptom exacerbation in schizophrenia. The Journal of Clinical Psychiatry, 79(5).
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  30. Patil, D., Gautam, M., Mishra, S., Karupothula, S., Gairola, S., Jadhav, S., . . . Patwardhan, B. (2013). Determination of withaferin A and withanolide A in mice plasma using high-performance liquid chromatography-tandem mass spectrometry: Application to pharmacokinetics after oral administration of Withania somnifera aqueous extract. Journal of Pharmaceutical and Biomedical Analysis, 80, 203-212.
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  34. Savai, J., Varghese, A., Pandita, N., & Chintamaneni, M. (2015a). In vitro assessment of CYP1A2 and 2C9 inhibition potential of Withania somnifera and Centella asiatica in human liver microsomes. Drug Metabolism and Personalized Therapy, 30(2), 137-141.
  35. Savai, J., Varghese, A., Pandita, N., & Chintamaneni, M. (2015b). Investigation of CYP3A4 and CYP2D6 interactions of Withania somnifera and Centella asiatica in human liver microsomes. Phytotherapy Research, 29(5), 785-790.
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  38. Shah, P. C., Trivedi, N. A., Bhatt, J. D., & Hemavathi, K. G. (2006). Effect of Withania somnifera on forced swimming test induced immobility in mice and its interaction with various drugs. Indian Journal of Physiology and Pharmacology, 50(4), 409-415.
  39. Sharma, A. K., Basu, I., & Singh, S. (2018). Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: A double-blind, randomized placebo-controlled trial. The Journal of Alternative and Complementary Medicine, 24(3), 243-248.
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  42. Sontakke, S., Thawani, V., Saoji, A., Goswami, V. S., & Agnihotri, A. (2013). Effects of Withania somnifera in patients of schizophrenia: A randomized, double blind, placebo controlled pilot trial study. Indian Journal of Pharmacology, 45(4), 417-418.
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  44. Wankhede, S., Langade, D., Joshi, K., Sinha, S. R., & Bhattacharyya, S. (2015). Examining the effect of Withania somnifera supplementation on muscle strength and recovery: A randomized controlled trial. Journal of the International Society of Sports Nutrition, 12(1).
  45. Ziegenfuss, T., Kedia, A., Sandrock, J., Raub, B., Kerksick, C., & Lopez, H. (2018). Effects of an aqueous extract of Withania somnifera on strength training adaptations and recovery: The STAR trial. Nutrients, 10(11), 1807.