The short answer
Possibly. In a case report from Ottawa, Canada, a 69-year-old kidney transplant patient developed acute rejection after taking ashwagandha, and the transplanted kidney had to be removed. The patient was on tacrolimus, mycophenolate and prednisone, and tacrolimus levels were in range. The doctors proposed that ashwagandha stimulated the immune system, working against the medicines.
This is one case, and one case cannot prove cause. We found no study of ashwagandha with steroids alone. If you take a transplant medicine, a steroid or any other immunosuppressant, tell your prescribing doctor before you start ashwagandha, including in mixed products.
Sold in India as Pangraf (tacrolimus), Panimun Bioral (ciclosporin), Mycept (mycophenolate), Azoran (azathioprine), Medrol (methylprednisolone) and Dexona (dexamethasone).
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Acute kidney transplant rejection and loss of the kidney after ashwagandha[1][2] | Proposed immune stimulation; tacrolimus levels were in range | May work against tacrolimus, mycophenolate and steroids | Case report |
| Named by a US health agency as a possible interaction with immunosuppressants[3] | Not stated | Not quantified | Theoretical by mechanism |
| Root extract changed CYP3A4 in human liver cells[4][2][8] | CYP3A4 modulation in primary human hepatocytes | Could change tacrolimus levels; direction in people not known | In vitro |
| No reversible blocking of liver enzymes by root or leaf extracts[5] | No CYP inhibition at the strengths tested | Does not rule out induction or immune effects | In vitro |
| Liver injury from ashwagandha products[6] | Not established | Herb safety context, not an interaction | Case report |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Case report, Canada, 2020 Case report
Nephrologists at the Ottawa Hospital describe a kidney transplant patient on tacrolimus, mycophenolate and prednisone who developed acute rejection after starting ashwagandha. Tacrolimus levels were in the target range, so the authors proposed that ashwagandha stimulated the immune system. The transplanted kidney had to be removed. Memorial Sloan Kettering's herb monograph lists the case, in a 69-year-old patient. A single case cannot show that ashwagandha caused the rejection.[1]
Laboratory study, United States, 2025 In vitro
At Auburn University, water and 70% ethanol extracts of ashwagandha root and leaf were tested on cultured human liver cells. The ethanol root extract changed the expression and activity of CYP3A4, an enzyme the tacrolimus label lists among those whose inducers can lower tacrolimus levels. Lab findings like this show a possible route for an interaction. They do not show that one happens in people.[4]
Laboratory study, United States, 2025 In vitro
A second Auburn study tested four root and leaf extracts against seven liver enzymes, including CYP3A4/5. None blocked them in a reversible way at the strengths tested. This does not cover enzyme induction or effects on the immune system.[5]
Case series, India, 2023 Case report
Liver specialists in India described 8 people with liver injury after single-herb ashwagandha products. Five already had chronic liver disease, and three of them developed acute-on-chronic liver failure and died. This is about ashwagandha's own risk to the liver, not about these medicines.[6]
What your doctor may watch for
- Tacrolimus levels and kidney function, which transplant teams already check. The tacrolimus label recommends drug-level monitoring for everyone taking it.[7]
- Signs that your underlying condition is flaring, such as a change in transplant tests or a return of symptoms the steroid was controlling.[1]
- Yellow eyes or skin, dark urine or itching, which can be signs of liver injury.[6]
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, ashwagandha (name of product, ingredients and how much) along with my transplant medicine or steroid. There is a reported case of kidney transplant rejection in a patient who took ashwagandha. Should I take it at all, and should my drug levels or kidney tests be checked?”
Withheld until review
Questions people ask
Can I take ashwagandha with Wysolone (prednisolone) or other steroids?
We found no study of ashwagandha with a steroid on its own. In the transplant case, prednisone was one of three medicines the patient took. Ask your prescribing doctor before you start.[1]
Does taking them at different times change the concern?
We found no study of a time gap. In the transplant case, tacrolimus levels were in range, and the authors' proposed explanation was an effect on the immune system, not on drug levels.[1]
Related
Giloy with immunosuppressants and steroids
Not tested together. Giloy has been linked to autoimmune-like liver injury, which matters for people whose immune system is being treated.
InteractionNeem and transplant medicines (immunosuppressants)
In lab tests, neem blocked the liver enzymes that clear tacrolimus, which could raise its levels. We found no study of neem with transplant medicines.
InteractionMulethi (licorice) and steroid medicines like prednisolone
Glycyrrhizin from mulethi slowed the clearance of prednisolone in six men. A European regulator advises against licorice with corticosteroids.
InteractionAshwagandha and statins for cholesterol
Not studied in people. In the lab, an ashwagandha root extract changed CYP3A4, an enzyme named in atorvastatin's interaction warnings.
Sources
- Sriperumbuduri S, Umar MS, Lajoie-Starkell G, Fairhead TR, Hiremath S. Ashwagandha and kidney transplant rejection. Kidney Int Rep. 2020;5(12):2375-2378. PMID 33305135.
- Memorial Sloan Kettering Cancer Center. About Herbs: Ashwagandha.
- National Center for Complementary and Integrative Health (US). Ashwagandha.
- McDonald KL, Raichura Z, Pondugula SR, Marney L, Yang L, Choi J, Salamat JM, Brandes MS, Neff C, Adams K, Farmer G, Dennis C, Maier CS, Soumyanath A, Arnold RD, Calderón AI. Ashwagandha (Withania somnifera) plant extracts affect the cytochrome P450 system and cytotoxicity of primary human hepatocytes. J Diet Suppl. 2025;22(4):613-639. PMID 40551718.
- Raichura Z, Heck K, Choi J, Yang L, Brandes M, Marney L, Mangaña AA, Neff C, Maier CS, Soumyanath A, van Breemen RB, Arnold RD, Calderón AI. Evaluation of reversible cytochrome P450 inhibition by Withania somnifera leaf and root extracts. Drug Metab Dispos. 2025;53(2):100024. PMID 40023576.
- 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;7(10):e0270. PMID 37756041.
- Tacrolimus capsules, US prescribing information (DailyMed).
- Prograf (tacrolimus), US prescribing information (DailyMed), drug interactions table for strong CYP3A inducers.
Updated 4 November 2026
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