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Objective <p>Drug-induced liver injury (DILI) is a significant global health concern, and herbal medicines are increasingly being used to treat herb-induced liver injury (HILI). Withania somnifera (<i>Ashwagandha</i>), which is widely used for its health benefits, has been associated with emerging cases of liver toxicity. This systematic review synthesizes the literature regarding the clinical presentation, diagnostic findings, treatment strategies, and outcomes of <i>Ashwagandha</i>-induced liver injury.</p> Methods <p>A systematic search of PubMed, Medline, Google Scholar, ScienceDirect, and Web of Science was conducted following PRISMA guidelines. Case reports and series documenting <i>Ashwagandha</i>-associated liver injury were included. The extracted data included patient demographics, symptoms, liver function tests, imaging findings, treatment interventions, and outcomes. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of the included reports.</p> Results <p>The analysis was performed on 19 studies involving 26 patients. The mean age was 37.8 ± 15.1 years, with 53.9% of patients being male. The most reported symptoms were jaundice (88.5%) and pruritus (72.9%). Liver injury manifests as hepatocellular, cholestatic, or mixed patterns, with elevated bilirubin, AST, and ALT levels. Most cases demonstrate probable or possible causality on the basis of RUCAM scores (Roussel Uclaf Causality Assessment Method). Discontinuation of <i>Ashwagandha</i> led to recovery in most cases, although severe cases required intensive care or liver transplantation.</p> Conclusion <p>Despite its apparent safety, <i>Ashwagandha</i> can cause liver damage and injury. These findings underscore the importance of vigilant clinical assessment, early recognition, and prompt discontinuation of the supplement in suspected cases.</p>

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Ashwagandha-induced liver injury: a systematic review of case reports

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月22日

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  • Razaz Felemban,
  • Lama Aljefri,
  • Yasmenah Shaheen,
  • Gadi Sindi,
  • Mohammed Albadri,
  • Jawad I. Bukhari,
  • Yaser Younus,
  • Ghassan Dahlawi,
  • Khulud Abudawood

摘要

Objective

Drug-induced liver injury (DILI) is a significant global health concern, and herbal medicines are increasingly being used to treat herb-induced liver injury (HILI). Withania somnifera (Ashwagandha), which is widely used for its health benefits, has been associated with emerging cases of liver toxicity. This systematic review synthesizes the literature regarding the clinical presentation, diagnostic findings, treatment strategies, and outcomes of Ashwagandha-induced liver injury.

Methods

A systematic search of PubMed, Medline, Google Scholar, ScienceDirect, and Web of Science was conducted following PRISMA guidelines. Case reports and series documenting Ashwagandha-associated liver injury were included. The extracted data included patient demographics, symptoms, liver function tests, imaging findings, treatment interventions, and outcomes. The Joanna Briggs Institute critical appraisal tool was used to assess the quality of the included reports.

Results

The analysis was performed on 19 studies involving 26 patients. The mean age was 37.8 ± 15.1 years, with 53.9% of patients being male. The most reported symptoms were jaundice (88.5%) and pruritus (72.9%). Liver injury manifests as hepatocellular, cholestatic, or mixed patterns, with elevated bilirubin, AST, and ALT levels. Most cases demonstrate probable or possible causality on the basis of RUCAM scores (Roussel Uclaf Causality Assessment Method). Discontinuation of Ashwagandha led to recovery in most cases, although severe cases required intensive care or liver transplantation.

Conclusion

Despite its apparent safety, Ashwagandha can cause liver damage and injury. These findings underscore the importance of vigilant clinical assessment, early recognition, and prompt discontinuation of the supplement in suspected cases.