{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T22:02:32Z","timestamp":1779919352593,"version":"3.53.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,27]]},"DOI":"10.7759\/cureus.109764","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:06:42Z","timestamp":1779916002000},"source":"Crossref","is-referenced-by-count":0,"title":["Ashwagandha (Withania somnifera)-Associated Liver Injury: A Scoping Review of Clinical Characteristics and Safety Considerations"],"prefix":"10.7759","author":[{"given":"Daniel","family":"McIntyre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phong","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Salloum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1177\/02698811231200023","article-title":"Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin\u00ae) in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial","volume":"37","author":"Smith SJ","year":"2023","unstructured":"Smith SJ, Lopresti AL, Fairchild TJ. Exploring the efficacy and safety of a novel standardized ashwagandha (Withania somnifera) root extract (Witholytin\u00ae) in adults experiencing high stress and fatigue in a randomized, double-blind, placebo-controlled trial. J Psychopharmacol. 2023, 37:1091-104. 10.1177\/02698811231200023","journal-title":"J Psychopharmacol"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.explore.2024.103062","article-title":"Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: a systematic review and meta-analysis","volume":"20","author":"Arumugam V","year":"2024","unstructured":"Arumugam V, Vijayakumar V, Balakrishnan A, et al.. Effects of Ashwagandha (Withania Somnifera) on stress and anxiety: a systematic review and meta-analysis. Explore (NY). 2024, 20:103062. 10.1016\/j.explore.2024.103062","journal-title":"Explore (NY)"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2020.03.012","article-title":"A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults","volume":"72","author":"Deshpande A","year":"2020","unstructured":"Deshpande A, Irani N, Balkrishnan R, Benny IR. A randomized, double blind, placebo controlled study to evaluate the effects of ashwagandha (Withania somnifera) extract on sleep quality in healthy adults. Sleep Med. 2020, 72:28-36. 10.1016\/j.sleep.2020.03.012","journal-title":"Sleep Med"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.12688\/f1000research.130932.2","article-title":"Effects of Ashwagandha ( Withania somnifera) standardized root extract on physical endurance and VO (2max) in healthy adults performing resistance training: an eight-week, prospective, randomized, double-blind, placebo-controlled study","volume":"12","author":"Verma N","year":"2023","unstructured":"Verma N, Gupta SK, Patil S, Tiwari S, Mishra AK. Effects of Ashwagandha ( Withania somnifera) standardized root extract on physical endurance and VO (2max) in healthy adults performing resistance training: an eight-week, prospective, randomized, double-blind, placebo-controlled study. F1000Res. 2023, 12:335. 10.12688\/f1000research.130932.2","journal-title":"F1000Res"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191911852","article-title":"Effects of acute ashwagandha ingestion on cognitive function","volume":"19","author":"Xing D","year":"2022","unstructured":"Xing D, Yoo C, Gonzalez D, et al.. Effects of acute ashwagandha ingestion on cognitive function. Int J Environ Res Public Health. 2022, 19:11852-2022. 10.3390\/ijerph191911852","journal-title":"Int J Environ Res Public Health"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.3390\/molecules14072373","article-title":"Steroidal lactones from Withania somnifera, an ancient plant for novel medicine","volume":"14","author":"Mirjalili MH","year":"2009","unstructured":"Mirjalili MH, Moyano E, Bonfill M, Cusido RM, Palaz\u00f3n J. Steroidal lactones from Withania somnifera, an ancient plant for novel medicine. Molecules. 2009, 14:2373-93. 10.3390\/molecules14072373","journal-title":"Molecules"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.3390\/pharmaceutics15041057","article-title":"Ashwagandha (Withania somnifera)-current research on the health-promoting activities: a narrative review","volume":"15","author":"Mikulska P","year":"2023","unstructured":"Mikulska P, Malinowska M, Ignacyk M, et al.. Ashwagandha (Withania somnifera)-current research on the health-promoting activities: a narrative review. Pharmaceutics. 2023, 15:1057-2023. 10.3390\/pharmaceutics15041057","journal-title":"Pharmaceutics"},{"key":"ref8","unstructured":"Ashwagandha market size and share analysis - growth trends and forcast. (2025). Accessed. December 7, 2025: https:\/\/www.mordorintelligence.com\/industry-reports\/ashwagandha-market."},{"key":"ref9","unstructured":"Ashwagandha supplements market (2025-2033). (2025). Accessed. December 7, 2025: https:\/\/www.grandviewresearch.com\/industry-analysis\/ashwagandha-supplements-market-report."},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1504267","article-title":"Emergency department visits for adverse events related to dietary supplements","volume":"373","author":"Geller AI","year":"2015","unstructured":"Geller AI, Shehab N, Weidle NJ, et al.. Emergency department visits for adverse events related to dietary supplements. N Engl J Med. 2015, 373:1531-40. 10.1056\/NEJMsa1504267","journal-title":"N Engl J Med"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1016\/0168-8278(90)90124-a","article-title":"Criteria of drug-induced liver disorders. Report of an international consensus meeting","volume":"11","author":"B\u00e9nichou C","year":"1990","unstructured":"B\u00e9nichou C. Criteria of drug-induced liver disorders. Report of an international consensus meeting. J Hepatol. 1990, 11:272-6. 10.1016\/0168-8278(90)90124-a","journal-title":"J Hepatol"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.2957\/kanzo.58.448","article-title":"A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha","volume":"58","author":"Inagaki K","year":"2017","unstructured":"Inagaki K, Mori N, Honda Y, Takaki S, Tsuji K, Chayama K. A case of drug-induced liver injury with prolonged severe intrahepatic cholestasis induced by Ashwagandha. Kanzo. 2017, 58:448-54. 10.2957\/kanzo.58.448","journal-title":"Kanzo"},{"key":"ref13","unstructured":"The drug development process. (2018). Accessed. December 7, 2025: https:\/\/www.fda.gov\/patients\/learn-about-drug-and-device-approvals\/drug-development-process."},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302348","article-title":"Too little, too late: ineffective regulation of dietary supplements in the United States","volume":"105","author":"Starr RR","year":"2015","unstructured":"Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015, 105:478-85. 10.2105\/AJPH.2014.302348","journal-title":"Am J Public Health"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14393","article-title":"Ashwagandha-induced liver injury: a case series from Iceland and the US drug-induced liver injury network","volume":"40","author":"Bj\u00f6rnsson HK","year":"2020","unstructured":"Bj\u00f6rnsson HK, Bj\u00f6rnsson ES, Avula B, et al.. Ashwagandha-induced liver injury: a case series from Iceland and the US drug-induced liver injury network. Liver Int. 2020, 40:825-9. 10.1111\/liv.14393","journal-title":"Liver Int"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.7078","article-title":"Ashwagandha-induced acute liver injury: a case report","volume":"11","author":"T\u00f3th M","year":"2023","unstructured":"T\u00f3th M, Benedek AE, Longerich T, Seitz HK. Ashwagandha-induced acute liver injury: a case report. Clin Case Rep. 2023, 11:7078. 10.1002\/ccr3.7078","journal-title":"Clin Case Rep"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1097\/HC9.0000000000000270","article-title":"Ashwagandha-induced liver injury-a case series from India and literature review","volume":"7","author":"Philips CA","year":"2023","unstructured":"Philips CA, Valsan A, Theruvath AH, et al.. Ashwagandha-induced liver injury-a case series from India and literature review. Hepatol Commun. 2023, 7:0270. 10.1097\/HC9.0000000000000270","journal-title":"Hepatol Commun"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1097\/MJT.0000000000001466","article-title":"Ashwagandha-associated acute liver failure requiring liver transplantation","volume":"30","author":"Suryawanshi G","year":"2023","unstructured":"Suryawanshi G, Abdallah M, Thomson M, Desai N, Chauhan A, Lim N. Ashwagandha-associated acute liver failure requiring liver transplantation. Am J Ther. 2023, 30:80-3. 10.1097\/MJT.0000000000001466","journal-title":"Am J Ther"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.4997\/JRCPE.2021.409","article-title":"Drug-induced hepatocellular injury due to herbal supplement ashwagandha","volume":"51","author":"Ireland PJ","year":"2021","unstructured":"Ireland PJ, Hardy T, Burt AD, Donnelly MC. Drug-induced hepatocellular injury due to herbal supplement ashwagandha. J R Coll Physicians Edinb. 2021, 51:363-5. 10.4997\/JRCPE.2021.409","journal-title":"J R Coll Physicians Edinb"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.26717\/BJSTR.2025.62.009719","article-title":"Ashwagandha-associated acute liver injury: a case report and literature review","volume":"62","author":"Zhuang D","year":"2025","unstructured":"Zhuang D, Zhang D, Paulus F, Waring D, Riordan SM. Ashwagandha-associated acute liver injury: a case report and literature review. Biomed J Sci Tech Res. 2025, 62:54425-9. 10.26717\/BJSTR.2025.62.009719","journal-title":"Biomed J Sci Tech Res"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.30433","article-title":"A case of supplement-induced hepatitis","volume":"14","author":"Pusec CM","year":"2022","unstructured":"Pusec CM, Wolsky R, Llerena C, Sura P. A case of supplement-induced hepatitis. Cureus. 2022, 14:30433. 10.7759\/cureus.30433","journal-title":"Cureus"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.71576","article-title":"Ashwagandha-induced hepatic injury: a case report","volume":"16","author":"Almuzghi F","year":"2024","unstructured":"Almuzghi F, Abdelmalik A, Abuhlaiga M. Ashwagandha-induced hepatic injury: a case report. Cureus. 2024, 16:71576. 10.7759\/cureus.71576","journal-title":"Cureus"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20053921","article-title":"Liver dangers of herbal products: a case report of ashwagandha-induced liver injury","volume":"20","author":"Lubarska M","year":"2023","unstructured":"Lubarska M, Ha\u0142asi\u0144ski P, Hryhorowicz S, et al.. Liver dangers of herbal products: a case report of ashwagandha-induced liver injury. Int J Environ Res Public Health. 2023, 20:3921-2023. 10.3390\/ijerph20053921","journal-title":"Int J Environ Res Public Health"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.12788\/fp.0409","article-title":"Supplements are not a synonym for safe: suspected liver injury from ashwagandha","volume":"40","author":"Vazirani S","year":"2023","unstructured":"Vazirani S, Kothari A, Fujimoto J, Gomez M. Supplements are not a synonym for safe: suspected liver injury from ashwagandha. Fed Pract. 2023, 40:315-9. 10.12788\/fp.0409","journal-title":"Fed Pract"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000001369","article-title":"Ashwagandha-induced liver injury: self-reports on commercial websites as useful adjunct tools for causality assessment","volume":"116","author":"Weber S","year":"2021","unstructured":"Weber S, Gerbes AL. Ashwagandha-induced liver injury: self-reports on commercial websites as useful adjunct tools for causality assessment. Am J Gastroenterol. 2021, 116:2151-2. 10.14309\/ajg.0000000000001369","journal-title":"Am J Gastroenterol"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.17235\/reed.2023.10080\/2023","article-title":"Changing perspectives: unveiling the risks of ashwagandha-induced hepatotoxicity","volume":"117","author":"Casiano-Manzano S","year":"2025","unstructured":"Casiano-Manzano S, Torres-Larrubia M, Masa-Caballero A, Jim\u00e9nez-Colmenarez Z, Mart\u00edn-Noguerol E, Fern\u00e1ndez-Bermejo M, Sol\u00eds-Mu\u00f1oz P. Changing perspectives: unveiling the risks of ashwagandha-induced hepatotoxicity. Rev Esp Enferm Dig. 2025, 117:288-9. 10.17235\/reed.2023.10080\/2023","journal-title":"Rev Esp Enferm Dig"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.3390\/ph16081129","article-title":"Herb-induced liver injury by Ayurvedic ashwagandha as assessed for causality by the updated RUCAM: an emerging cause","volume":"16","author":"Bokan G","year":"2023","unstructured":"Bokan G, Glamo\u010danin T, Mavija Z, Vidovi\u0107 B, Stojanovi\u0107 A, Bj\u00f6rnsson ES, Vu\u010di\u0107 V. Herb-induced liver injury by Ayurvedic ashwagandha as assessed for causality by the updated RUCAM: an emerging cause. Pharmaceuticals (Basel). 2023, 16:1129-2023. 10.3390\/ph16081129","journal-title":"Pharmaceuticals (Basel)"},{"key":"ref28","unstructured":"FDA Adverse Event Reporting System (FAERS) database. (2017). Accessed. December 8, 2025: https:\/\/www.fda.gov\/drugs\/drug-approvals-and-databases\/fda-adverse-event-reporting-system-faers-database."},{"key":"ref29","unstructured":"VigiAccess. (2025). Accessed. December 8, 2025: https:\/\/www.vigiaccess.org\/."},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.crtox.2021.02.002","article-title":"DNA damage by withanone as a potential cause of liver toxicity observed for herbal products of Withania somnifera (ashwagandha)","volume":"2","author":"Siddiqui S","year":"2021","unstructured":"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, 2:72-81. 10.1016\/j.crtox.2021.02.002","journal-title":"Curr Res Toxicol"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1080\/19390211.2025.2514458","article-title":"Ashwagandha (Withania somnifera) plant extracts affect the cytochrome P450 system and cytotoxicity of primary human hepatocytes","volume":"22","author":"McDonald KL","year":"2025","unstructured":"McDonald KL, Raichura Z, Pondugula SR, et al.. Ashwagandha (Withania somnifera) plant extracts affect the cytochrome P450 system and cytotoxicity of primary human hepatocytes. J Diet Suppl. 2025, 22:613-39. 10.1080\/19390211.2025.2514458","journal-title":"J Diet Suppl"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32689","article-title":"AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury","volume":"77","author":"Fontana RJ","year":"2023","unstructured":"Fontana RJ, Liou I, Reuben A, Suzuki A, Fiel MI, Lee W, Navarro V. AASLD practice guidance on drug, herbal, and dietary supplement-induced liver injury. Hepatology. 2023, 77:1036-65. 10.1002\/hep.32689","journal-title":"Hepatology"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.02.014","article-title":"EASL clinical practice guidelines: drug-induced liver injury","volume":"70","year":"2019","unstructured":"EASL clinical practice guidelines. drug-induced liver injury. J Hepatol. 2019, 70:1222-61. 10.1016\/j.jhep.2019.02.014","journal-title":"J Hepatol"},{"key":"ref34","unstructured":"Scratching the itch. management of pruritus in cholestatic liver disease. (2024). Accessed: December 16, 2025: https:\/\/www.aasld.org\/liver-fellow-network\/core-series\/clinical-pearls\/scratching-itch-management-pruritus-cholestatic."},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.08.018","article-title":"High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial","volume":"64","author":"Larsen FS","year":"2016","unstructured":"Larsen FS, Schmidt LE, Bernsmeier C, et al.. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol. 2016, 64:69-78. 10.1016\/j.jhep.2015.08.018","journal-title":"J Hepatol"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20703","article-title":"AASLD position paper: the management of acute liver failure","volume":"41","author":"Polson J","year":"2005","unstructured":"Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005, 41:1179-97. 10.1002\/hep.20703","journal-title":"Hepatology"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jceh.2023.01.008","article-title":"Liver transplantation for acute liver failure- indication, prioritization, timing, and referral","volume":"13","author":"Biswas S","year":"2023","unstructured":"Biswas S, Shalimar. Liver transplantation for acute liver failure- indication, prioritization, timing, and referral. J Clin Exp Hepatol. 2023, 13:820-34. 10.1016\/j.jceh.2023.01.008","journal-title":"J Clin Exp Hepatol"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.06.006","article-title":"Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure","volume":"137","author":"Lee WM","year":"2009","unstructured":"Lee WM, Hynan LS, Rossaro L, et al.. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology. 2009, 137:856-64, 864.e1. 10.1053\/j.gastro.2009.06.006","journal-title":"Gastroenterology"},{"key":"ref39","unstructured":"Questions and answers on dietary supplements. (2024). Accessed. December 13, 2025: https:\/\/www.fda.gov\/food\/information-consumers-using-dietary-supplements\/questions-and-answers-dietary-supplements."},{"key":"ref40","unstructured":"Guidance for Industry. questions and answers regarding adverse event reporting and recordkeeping for dietary supplements as required by the Dietary Supplement and Nonprescription Drug Consumer Protection Act. (2018). Accessed: December 13, 2025: https:\/\/www.fda.gov\/regulatory-information\/search-fda-guidance-documents\/guidance-industry-questions-and-answers-rega...."},{"key":"ref41","unstructured":"Part 111- current good manufacturing practice in manufacturing, packing, labeling, or holding operations for dietary supplements. (2025). Accessed. December 13, 2025: https:\/\/www.ecfr.gov\/current\/title-21\/chapter-I\/subchapter-B\/part-111."},{"key":"ref42","unstructured":"Dietary supplement labeling guide. (2005). Accessed. December 13, 2025: https:\/\/www.fda.gov\/food\/dietary-supplements-guidance-documents-regulatory-information\/dietary-supplement-labeling-guide."}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/495805-ashwagandha-withania-somnifera-associated-liver-injury-a-scoping-review-of-clinical-characteristics-and-safety-considerations","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:06:45Z","timestamp":1779916005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/495805-ashwagandha-withania-somnifera-associated-liver-injury-a-scoping-review-of-clinical-characteristics-and-safety-considerations"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,27]]},"references-count":42,"URL":"https:\/\/doi.org\/10.7759\/cureus.109764","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,27]]}}}