The Rise of Integrative Health Approaches
In an era where personal health management is paramount, many individuals are combining traditional Western medicine with complementary and alternative therapies. Nearly half of U.S. adults have hypertension (high blood pressure), and a significant portion use dietary supplements [1.6.4, 1.6.2]. Lisinopril is a cornerstone medication for managing this condition, while ashwagandha is a popular adaptogenic herb known for its stress-reducing properties. This intersection of pharmacology and herbalism brings up a critical safety question: is it safe to combine them?
This article examines the evidence-based interactions between lisinopril, a powerful ACE inhibitor, and ashwagandha, a widely used herbal supplement, to provide clarity on the potential risks involved.
Understanding Lisinopril: An ACE Inhibitor
Lisinopril is an FDA-approved prescription medication belonging to a class of drugs called angiotensin-converting enzyme (ACE) inhibitors [1.4.3]. It is primarily used to treat high blood pressure (hypertension) and heart failure and to improve survival rates after a heart attack [1.4.4].
Mechanism of Action: Lisinopril works by blocking the action of ACE, an enzyme responsible for converting angiotensin I into angiotensin II [1.4.1]. Angiotensin II is a potent substance that narrows blood vessels, causing blood pressure to rise [1.4.1, 1.4.4]. By inhibiting its production, lisinopril helps to:
- Relax and widen blood vessels: This allows blood to flow more smoothly, reducing blood pressure [1.4.3].
- Decrease aldosterone levels: Aldosterone is a hormone that causes the body to retain salt and water. Lowering it helps reduce fluid volume in the bloodstream, further decreasing blood pressure [1.4.1].
- Reduce the heart's workload: By making it easier for the heart to pump blood, lisinopril is beneficial in treating heart failure [1.4.3].
Common side effects can include a dry cough, dizziness, and headache. It's a highly effective medication but also interacts with various other substances, making it crucial to manage its use carefully.
Understanding Ashwagandha: The Adaptogenic Herb
Ashwagandha (Withania somnifera) is an evergreen shrub native to Asia and Africa, and it is a foundational herb in traditional Ayurvedic medicine [1.3.4]. As an "adaptogen," it is believed to help the body resist and adapt to physical and mental stress [1.3.4]. It is most commonly used for conditions related to stress, such as anxiety and insomnia [1.3.4, 1.5.3].
Potential Effects on the Body: Ashwagandha contains chemicals that may help calm the brain, reduce inflammation, and alter the immune system [1.3.4]. Crucially, some studies suggest that ashwagandha may lower blood pressure [1.3.2, 1.3.5]. While often considered beneficial, this effect is the primary source of concern when combining it with antihypertensive drugs.
The Core Question: Can I Take Ashwagandha and Lisinopril Together?
The answer requires careful consideration of two main potential interactions: the risk of excessively low blood pressure and the potential for liver strain.
1. Potential for Additive Hypotensive Effects The most significant and documented concern is the potential for an additive effect on blood pressure. Since both lisinopril and ashwagandha can lower blood pressure, taking them together increases the risk of hypotension (abnormally low blood pressure) [1.2.5, 1.3.1].
Hypotension is defined as a blood pressure reading below 90/60 mmHg [1.3.1]. Symptoms can include:
- Dizziness or lightheadedness [1.2.5]
- Fainting (syncope)
- Confusion
- Weakness [1.3.1]
- Blurred vision
- Nausea
While some studies on ashwagandha's effect on blood pressure are preliminary, the potential interaction is classified as 'moderate' and warrants close monitoring [1.2.2, 1.3.2]. Your healthcare provider must be informed if you plan to take both so they can monitor your blood pressure closely [1.3.1].
2. Risk of Liver Complications (Hepatotoxicity) A secondary, but serious, concern is the potential for liver injury. Though rare, products containing ashwagandha have been associated with liver injury in some individuals [1.2.1, 1.5.4]. Lisinopril can also affect the liver in some cases [1.2.1]. Combining two substances that are both potentially hepatotoxic can theoretically increase that risk [1.2.2, 1.2.7].
Patients should be advised to watch for signs and symptoms of liver damage, such as:
- Yellowing of the skin or eyes (jaundice) [1.2.1]
- Dark urine or pale stools [1.2.1]
- Abdominal pain and nausea [1.2.1]
- Unusual fatigue or loss of appetite [1.2.1]
If you experience any of these symptoms, you should contact your doctor immediately.
Comparison Table: Lisinopril vs. Ashwagandha
| Feature | Lisinopril | Ashwagandha |
|---|---|---|
| Type | Prescription Medication (ACE Inhibitor) [1.4.3] | Herbal Supplement (Adaptogen) [1.3.4] |
| Primary Use | High blood pressure, heart failure [1.4.3] | Stress, anxiety, insomnia [1.5.3] |
| Mechanism | Blocks angiotensin-II production, relaxing blood vessels [1.4.1] | May calm the brain, reduce inflammation, lower cortisol [1.3.4, 1.3.6] |
| Effect on BP | Lowers blood pressure (intended effect) [1.4.1] | May lower blood pressure (potential effect) [1.3.5] |
| Regulation | FDA-approved and regulated prescription drug [1.4.3] | Sold as a dietary supplement; not FDA-approved for treating conditions [1.3.5] |
| Key Risks | Hypotension, dry cough, hyperkalemia (high potassium) | Stomach upset, drowsiness, potential liver issues, hormonal changes [1.5.4] |
Who Should Be Especially Cautious with Ashwagandha?
Beyond its interaction with lisinopril, ashwagandha is not suitable for everyone. Certain populations should avoid it or use it with extreme caution:
- Pregnant Women: It may be unsafe during pregnancy, with some evidence suggesting it could cause miscarriages [1.5.4].
- People with Autoimmune Diseases: Because it can make the immune system more active, it could worsen conditions like rheumatoid arthritis (RA), lupus (SLE), or multiple sclerosis (MS) [1.5.4].
- Individuals with Thyroid Disorders: Ashwagandha may increase thyroid hormone levels, which can interfere with medications or worsen existing thyroid conditions [1.5.4, 1.5.6].
- Those with Hormone-Sensitive Prostate Cancer: The herb might increase testosterone levels [1.5.1].
- People Undergoing Surgery: Ashwagandha can slow the central nervous system, which could dangerously interact with anesthesia. It's recommended to stop taking it at least two weeks before surgery [1.5.4].
Conclusion: Prioritize Medical Guidance
So, can you take ashwagandha and lisinopril? The evidence points to a clear need for caution. The potential for a combined effect leading to dangerously low blood pressure is a significant risk that requires professional monitoring. The theoretical risk of liver strain further complicates the matter.
Never start, stop, or combine medications and supplements without first consulting a healthcare professional. Your doctor or pharmacist can evaluate your overall health status, review all your medications and supplements, and advise you on the safest course of action. They may need to monitor your blood pressure and conduct liver function tests if you decide to proceed [1.2.2]. While integrating natural supplements into your health regimen can be beneficial, safety must always be the top priority.
For more information on drug interactions, consult authoritative sources like the National Institutes of Health (NIH).
