MedlinePlus Herbs and Supplements: Ginseng (American ginseng, Asian ginseng, Chinese ginseng, Korean red ginseng, Panax ginseng: Panax spp. including P. ginseng C.C. Meyer and P. quinquefolius L., excluding Eleutherococcus senticosus)

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Ginseng (American ginseng, Asian ginseng, Chinese ginseng, Korean red ginseng, Panax ginseng: Panax spp. including P. ginseng C.C. Meyer and P. quinquefolius L., excluding Eleutherococcus senticosus)

Contents of this page:
Background Synonyms Evidence Dosing	Safety Interactions Methodology Selected references

Ginseng

BackgroundReturn to top

The term ginseng refers to several species of the genus Panax . For more than 2,000 years, the roots of this slow-growing plant have been valued in Chinese medicine. The two most commonly used species are Asian ginseng ( Panax ginseng C. A. Meyer), which is almost extinct in its natural habitat but is still cultivated, and American ginseng ( P . quinquefolius L.), which is both harvested from the wild and cultivated. Panax ginseng should not be confused with Siberian ginseng ( Eleutherococcus senticosus ). In Russia, Siberian ginseng was promoted as a cheaper alternative to ginseng and was believed to have identical benefits. However, Siberian ginseng does not contain the ginsenosides found in the Panax species, which are believed to be active ingredients and have been studied.

SynonymsReturn to top

General: Acetylenic alcohol, acidid polysaccharides, acupuncture-moxibustion, aglycones, Allheilkraut, American ginseng (AG), American wild ginseng, Araliaceae (family), Asian ginseng, Asiatic ginseng, chikusetsaponin-L8, chikusetsu ginseng, chosen ninjin, CPPQ (coarse polysaccharide from Panax quinquefolium), CVT-E002, dae-jo-hwan (DJW), dwarf ginseng, Eleutherococcus senticosus , five-fingers, five-leaf ginseng, G115®, ginsan, ginsenan PA (phagocytosis-activating polysaccharide), ginseng acidic polysaccharide, ginseng radix, ginseng saponins, ginseng tetrapeptide, Ginsengwurzel (German), ginsenoside, ginsenosides (Rb1, Rb2, Rc, Rd, Re, Rf and Rg1), ginsenosides compound (shen-fu), GTTC (Ginseng and Tang-kuei Ten Combination), hakusan, hakushan, higeninjin, hongshen, hua qi shen, hungseng, hungsheng, hunseng, insam, jenseng, jenshen, jinpi, kao-li-seng, Korean ginseng, Korea red ginseng (KRG), Kraftwurzel (German), man root, memory enhancer, minjin, nhan sam, ninjin, ninzin, niuhan, North American ginseng, notoginsenoside, oleanolic acid, Oriental ginseng, otane ninjin, panax de chine, Panax ginseng , Panax ginseng C.A. Meyer, Panax notoginseng , Panax psuedoginseng Wall. var. notoginseng, Panax psuedoginseng var. major, Panax psuedoginseng , Panax quinquefolium , Panax spp., Panax trifolius L., panax vietnamensis (Vietnamese Ginseng), panaxadial, panaxans, panaxatriol, panaxydol, panaxynol, panaxytriol, pannag, polyacetylenic compounds, poly-furanosyl-pyranosyl-sacchariedes, proprietary ginseng root extract (Cold-FX, CV Technologies Inc., Edmonton, AB), protopanaxadiol ginsenosides, quinqueginsin, racine de ginseng, red ginseng, renshen, sam, sanchi ginseng, san-pi, sang, schinsent, sei yang seng, shanshen, shen-fu, shen-sai-seng, shenghaishen, shenlu, shenshaishanshen, siyojin, stress-buster, sun ginseng, t'ang-sne, tartar root, tienchi ginseng, to-kai-san, triterpenoids, true ginseng, tyosenninzin, vanillic acid, Vietnamese ginseng, Western ginseng, Western sea ginseng, white ginseng, wild ginseng, woodsgrown (wild-stimulated) ginseng root, xi shen, xi yang shen, yakuyo ninjin, yakuyo ninzin, yang shen, yeh-shan-seng, yuan-seng, yuansheng, zhuzishen.

Panax ginseng synonyms: Aralia (botanical synonym), Aralia ginseng Mey, Araliaceae (family), Asian ginseng, Asiatic ginseng, Chinese ginseng, G115®, Gincosan (a combination of 120mg Ginkgo biloba and 200mg Panax ginseng ), Ginsai®, ginseng asiatique, ginsengjuuri, ginseng radix, ginseng root, Japanese ginseng, jintsam, Korean ginseng, Korean Panax ginseng, Korean red, Korean red ginseng, kuhuang shenmai injection (KHSM), ninjin, Oriental ginseng, Panax, Panax ginseng , Panax ginseng C. Meyer, Panax schinseng , Panax schinseng Nees, Panax spp., radix ginseng rubra, red ginseng, ren shen (TCM), renshen (TCM), Renxian, sang, schinsent, seng, shen, shenmai, shenmai huoxue decoction (SMHXD), shenmai injection (SMI), shengmai, shengmai chenggu capsule, shengmai injection (SI), shengmai san (SMS), shengmai-san, shengmaisan, shengmaiyin, white ginseng.

American ginseng synonyms: American ginseng, amerikan ginseng, amerikanischer Ginseng, amerikkalainen ginseng, Anchi ginseng, Aralia quinquefolia Decne. & Planch (botanical synonym), Araliaceae (family), Canadian ginseng, CVT - E 002, five fingers, five leafed ginseng, garantoquen, ginseng, ginseng d'Amerique, ginsenosides poly-furanosyl-pyranosyl-saccharides, man-root, man's health, North American ginseng, Occidental ginseng, Ontario ginseng, Panax quincefolium, Panax quinquefolium, Panax quinquefolius , redberry, red berry, ren shen, sang, shang (TCM), tartar root, TCM, tienchi ginseng, western ginseng, wild American ginseng, Wisconsin ginseng, xi yang shen.

Siberian ginseng synonyms: Acanthopanax senticosus , ci wu jia, ciwujia, devil's bush, devil's shrub, eleuthera, eleuthero, eleuthero ginseng, eleutherococ, eleutherococci radix, Eleutherococcus , Eleutherococcus senticosus , phytoestrogen, shigoka, touch-me-not, wild pepper, wu-jia, wu-jia-pi, ussuri, ussurian thorny pepperbrush.

Note: Siberian ginseng is not covered in this review. Avoid confusing Panax ginseng species with Eleutherococcus senticosus , which is also known as Siberian ginseng. Other species may be referred to as ginseng as well, but they are either from a different family or genus. Examples include Eleutherococcus senticosus (Siberian ginseng), Pseudostellaria heterophylla (prince ginseng), Angelica sinensis (female ginseng, or dong quai), Withania somnifera (Indian ginseng or ashwagandha), Pfaffia paniculata (Brazilian ginseng), Lepidium meyenii (Peruvian ginseng or maca), Gynostemma pentaphyllum (southern ginseng or jiaogulan).

EvidenceReturn to top

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence	Grade^*
Heart conditions Ginseng appears to have antioxidant effects that may benefit patients with heart disorders. Some studies suggest that ginseng also reduces oxidation of low-density lipoprotein (LDL or "bad") cholesterol and brain tissue. Better studies are needed to make a firm recommendation.	B
High blood sugar/glucose intolerance Several studies suggest ginseng may lower blood sugar levels in patients with type 2 diabetes before and after meals. These results are promising, especially because ginseng does not seem to lower blood sugar to dangerous levels. Future research should focus on the long-term effects of ginseng in managing blood sugar levels.	B
Immune system enhancement Several studies report that ginseng may boost the immune system, improve the effectiveness of antibiotics in people with acute bronchitis, and enhance the body's response to flu vaccines. Additional studies are needed before a clear conclusion can be reached.	B
Type 2 diabetes (adult-onset) Several human studies report that ginseng may lower blood sugar levels in patients with type 2 diabetes. Long-term effects are not clear, and it is not known what doses are safe or effective. People with diabetes should seek the care of a qualified healthcare practitioner and should not use ginseng instead of more proven therapies. Effects of ginseng in type 1 diabetes ("insulin dependent") are not well studied.	B
Aplastic anemia Weak studies suggest that ginseng in combination with other herbs may improve cell activity, immune function, and red and white blood cell counts in patients with aplastic anemia. Other studies have found decreases in blood cell counts. High-quality studies of ginseng alone are needed.	C
Attention deficit hyperactivity disorder (ADHD) Early small studies suggest that American ginseng may help treat attention deficit hyperactivity disorder in children. However, there is currently not enough evidence to support this use of ginseng.	C
Birth outcomes (anoxemic encephalopathy) There is currently not enough evidence to support the use of ginseng for this condition. High-quality studies are needed to understand this relationship.	C
Bronchodilator Limited research suggests that ginseng has positive effects on breathing. Further studies are needed in this area.	C
Cancer chemotherapy Early studies suggest that ginseng injections may help patients undergoing chemotherapy for various types of cancer. Ginseng may improve body weight, quality of life, and the immune response. Although this evidence is promising, the effect of ginseng alone is not clear. More research using ginseng alone is needed.	C
Cancer prevention A few studies report that ginseng taken by mouth may lower the risk of developing some cancers, especially if ginseng powder or extract is used. Study results are controversial, and more research is needed before a clear conclusion can be reached.	C
Cardiovascular risk reduction Current evidence does not support the use of ginseng to reduce the risk of heart disease. Some evidence suggests that ginseng may improve blood pressure, blood sugar levels, and cholesterol. High-quality studies are needed.	C
Chronic hepatitis B Early studies show that ginseng may improve some aspects of liver function but not others. More research is needed in this area.	C
Chronic obstructive pulmonary disease (COPD) Ginseng was reported to improve lung function and exercise capacity in patients with COPD. Further research is needed to confirm these results.	C
Congestive heart failure Based on limited research, it is unclear if ginseng improves congestive heart failure. High-quality studies looking at the effect of ginseng alone are needed.	C
Coronary artery disease Several studies from China report that ginseng in combination with various other herbs may reduce symptoms of coronary artery disease. Without further evidence on the effects of ginseng specifically, a firm conclusion cannot be reached.	C
Dementia Early small studies report that Fuyuan mixture, an herbal combination that contains ginseng, may improve symptoms of multi-infarct dementia. The effects of ginseng alone are not clear, and no firm conclusion can be drawn.	C
Diabetic complications (kidney damage) Early evidence suggests that a form of ginseng not commonly available in the United States may improve kidney damage in patients with diabetes. Some research suggests that Panax notoginseng may be as effective as the prescription drug Ticlid®. However, more research is needed.	C
Erectile dysfunction Early studies suggest that ginseng may help treat erectile dysfunction. Additional high-quality studies are needed.	C
Exercise performance Athletes commonly use ginseng as a potential way to improve stamina. However, it remains unclear if ginseng taken by mouth significantly affects exercise performance. Many studies have been published in this area, with mixed results. Better studies are necessary before a clear conclusion can be reached.	C
Fatigue A few studies using ginseng extract G115® (with or without multivitamins) report improvements in patients with fatigue of various causes. However, these results are early, and studies have not been high quality.	C
Fistula (anal) Early evidence in infants with peri-anal abscesses or anal fistulas suggests that GTTC (Ginseng and Tang-kuei Ten Combination) may speed up recovery. Further research is needed to confirm these results.	C
Heart damage (cardiac bypass complications) Early studies suggest that ginseng may have a positive effect on complications of cardiac bypass surgery, including decreasing damage to the lining of the digestive tract. Well-designed studies are needed before a strong recommendation can be made.	C
High blood pressure Early research suggests that ginseng may lower blood pressure (systolic and diastolic). It is not clear what doses may be safe or effective. Well-conducted studies are needed to confirm these early results.	C
High cholesterol Several low-quality studies have examined the effects of Panax ginseng on cholesterol levels. Results are mixed. More studies are needed to understand the effects of ginseng on cholesterol levels.	C
Idiopathic thrombocytopenic purpura (refractory) Combination herbal products containing ginseng may help treat refractory idiopathic thrombocytopenic purpura, a blood disorder that does not respond well to treatment. Studies that use ginseng alone are needed.	C
Intracranial pressure (ICP) Early research reports that Xuesaitong injection (XSTI), a preparation of Panax notoginseng , may help decrease pressure inside the skull and benefit coma patients. Further study is needed to confirm these results.	C
Kidney dysfunction (hemorrhagic fever with renal syndrome) A combination of herbs that included ginseng was not better than treatment with a conventional medicine plus traditional Chinese medicine. More research is needed in this area because the effects of ginseng alone are unknown.	C
Liver protection Early studies suggest that ginseng may have protective effects on the liver. Additional human study is warranted in this area.	C
Lung conditions Several studies have looked at the effects of ginseng in a variety of lung conditions. Early results are promising, but many studies have used combination products, making it difficult to evaluate the effect of ginseng. More research using ginseng alone is needed in this area.	C
Male infertility Early evidence suggests that ginseng may improve male fertility by increasing the number and movement of sperm. Further studies are needed to determine what dose may be safe and effective.	C
Menopausal symptoms Based on limited research, it is unclear if ginseng may help treat menopausal symptoms. Some studies report improvements in depression and sense of well-being, without changes in hormone levels.	C
Mental performance Several studies report that ginseng may modestly improve thinking or learning. Benefits have been seen both in healthy young people and in older ill patients. Effects have also been reported with a combination of ginseng and Ginkgo biloba . However, some mixed results have also been reported. Therefore, even though most available evidence supports this use of ginseng, better research is needed before a strong recommendation can be made.	C
Methicillin-resistant Staphylococcus aureus (MRSA) In patients treated with Hochu-ekki-to, which contains ginseng and several other herbs, urinary MRSA has been reported to decrease after 10 weeks. Further study of ginseng alone is necessary in order to draw firm conclusions.	C
Mood and cognition in post-menopausal women A review of several studies suggested that ginseng may improve mood and anxiety in postmenopausal women. Additional studies are needed before a firm conclusion may be drawn.	C
Neurological disorders Early studies suggest that ginseng may have beneficial effects on neurological disorders. High-quality studies are needed in this area.	C
Postoperative recovery (breast cancer) Early studies have tested the effect of a combination product containing ginseng on recovery after surgery among breast cancer patients. Results suggest no benefits in cell counts, but a slightly faster recovery of the iron-carrying component of red blood cells (called hemoglobin). Studies using ginseng alone are needed.	C
Pregnancy problems (intrauterine growth retardation) Early studies have found that components of Panax ginseng might be useful in treating intrauterine growth retardation. Larger, well-designed studies are needed in this area.	C
Premature ejaculation Early studies suggest that applying an herbal combination containing Panax ginseng on the penis may help treat premature ejaculation. However, because ginseng was tested with other herbs, its individual effects are unclear.	C
Quality of life There is early evidence that Panax ginseng or American ginseng may help improve quality of life in both healthy and ill patients, although effects may not be long-lasting unless ginseng is taken continually. More research is needed in this area before a firm conclusion can be reached.	C
Radiation therapy side effects Early studies suggest that ginseng may improve fatigue and measures of well-being among patients receiving radiation therapy. However, there is not enough evidence to recommend the use of Panax ginseng or American ginseng for this use.	C
Respiratory infections Ginseng (CVT-E002) may be safe, well tolerated, and potentially effective for preventing acute respiratory illnesses caused by the flu or the respiratory syncytial virus. More study is needed in this area.	C
Sexual arousal (in women) Early studies suggest that a product containing Panax ginseng , L-arginine, Ginkgo biloba , damiana, and multivitamin/minerals may improve sexual function in menopausal women and women with decreased sex drives. Studies with Panax ginseng alone are needed before strong recommendations can be made.	C
Viral myocarditis Poorly described research in patients treated with Shenmai and Shengmai injection (a ginseng preparation) report that there may be some improvement in heart function. More studies are needed before a clear conclusion can be drawn.	C
Well-being Several studies have examined the effects of ginseng (with or without multivitamins) on overall well-being in healthy and ill patients, for up to 12 weeks. Most studies are not high quality, and results are mixed. It remains unclear if ginseng is beneficial for well-being in any patient.	C

*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acrocyanosis (circulatory insufficiency of the extremities), adaptogen, adrenal tonic, aerobic fitness, aggression, aging, AIDS/HIV, air pollution protection, alcoholism, allergy, altitude (mountain) sickness, Alzheimer's disease, amnesia, antibacterial, antidepressant, antifungal, anti-infective, anti-inflammatory, antioxidant, antipsychotic, antitumor, anxiety, appetite stimulant, asthma, atherosclerosis, autoimmune disorders, bile flow stimulant, bleeding disorders, breast cancer, breast enlargement, breathing difficulty, burns, cancer, cardiomyopathy, central nervous system diseases, chronic cough, chronic fatigue syndrome, colitis, convulsions, demulcent, diabetic nerve pain, dialysis, digestive complaints, diuretic (water pill), dizziness, dysentery, dyspnea (shortness of breath), earache, female infertility, fetal development, fever, fibromyalgia, frequent urination, gastritis, gastrointestinal motility, gynecology-related disorders, hair tonic, hangovers, head injury (severe intractable), headaches, heart attack, hemolytic anemia, herpes, hoarse voice, improved memory and thinking after menopause, improvement of blood supply, improving resistance to disease, inflammation (systemic inflammatory reaction syndrome), influenza, insomnia, irritability, ischemia-reperfusion injury prevention, ischemic injury (brain), ischemic stroke, jaundice, Kaposi's sarcoma, kidney disease, learning, leukemia, liver diseases, long-term debility, longevity, low back pain, lumbar disc herniation, lung cancer, lung conditions, lymphoma (Burkitt's and Hodgkin's lymphoma), malaise, malignant tumors, migraine, mood enhancement, morphine tolerance, multiple myeloma, muscle weakness, nausea, neuralgia (pain due to nerve damage or inflammation), neurasthenia, neuroblastoma, neurodegenerative diseases, neuroprotective, organ dysfunction (multiple organ failure), organ prolapse, ovulation disorders, oxygen absorption, pain relief, palpitations, Parkinson's disease, physical work capacity, pneumonia, postherpetic neuralgia, prostate cancer, Pseudomonas infection in cystic fibrosis, psycho-asthenia, pulmonary edema, qi-deficiency and blood-stasis syndrome in heart disease (Eastern medicine), rehabilitation, rheumatism, salivary stimulant, scar healing (acne), sciatica, sedative, sexual symptoms, skin care, skin irritation (mucus membranes), spleen disorders, stimulant, stomach cancer, stomach ulcers, stomach upset, stress, strokes, sweating, tonic, toxicity, tuberculosis, upper respiratory tract infection, vein clots, vitality, vomiting, weight loss, wound healing, wrinkle prevention.

DosingReturn to top

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

Many different doses are used traditionally. Practitioners sometimes recommended that after using ginseng continuously for 2-3 weeks, people should take a break for 1-2 weeks. Long-term dosing should not exceed 1 gram of dry root daily.

Capsules containing 100-200 milligrams of a standardized ginseng extract (4% ginsenosides) have been taken by mouth once or twice daily for up to 12 weeks. 0.5-2 grams of dry ginseng root, taken daily by mouth in divided doses, has also been used. E . senticosus dry extract at a dose of 300 milligrams daily was used for eight weeks to improve quality of life in elderly patients. A ginseng root extract has been studied in athletes for 28 days at a dose of 400 milligrams daily. Higher doses are sometimes given in studies or under the supervision of a qualified healthcare provider. A decoction of 1-2 grams added to 150 milliliters of water, has been taken by mouth daily. A 1:1 (grams per milliliter) fluid extract has been taken as 1-2 milliliters by mouth daily. 5-10 milliliters (about 1-2 teaspoons) of a 1:5 (grams per milliliter) tincture has been taken by mouth daily.

Panax ginseng tea may be made by soaking about 3,000 milligrams (3 grams) of chopped fresh root or 1,500 milligrams (1.5 grams) of dried root powder in about 5 ounces of boiling water for 5-15 minutes and then straining the tea. Some sources suggest consuming ginseng tea via the above method 3-4 times daily for 3-4 weeks.

When applied on the skin, 0.20 grams of SS-cream containing ginseng has been used to treat premature ejaculation.

Children (under 18 years old)

There is not enough scientific information available to recommend the safe use of ginseng in children.

SafetyReturn to top

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

People with known allergies to Panax species and/or plants in the Araliaceae family should avoid ginseng. Signs of allergy may include rash, itching, or shortness of breath. Inhalation of ginseng root dust has been associated with immediate and late-onset asthma.

Side Effects and Warnings

Ginseng has been well tolerated by most people in scientific studies when used at recommended doses, and serious side effects appear to be rare.

Based on limited evidence, long-term use may be associated with skin rash or spots, itching, diarrhea, sore throat, loss of appetite, excitability, anxiety, depression, or insomnia. Less common reported side effects include headache, fever, dizziness, chest pain, difficult menstruation, heartburn, heart palpitations, rapid heart rate, leg swelling, nausea/vomiting, or manic episodes in people with bipolar disorder.

Consumption of ginseng may increase or and decrease blood pressure. Caution should be used in those with high or low blood pressure or in those taking drugs for either of these conditions.

There is report of seizures after high consumption of energy drinks containing caffeine, guarana, and herbal supplements, including ginseng.

Based on human research, ginseng may lower blood sugar levels. This effect may be greater in patients with diabetes than in non-diabetics. Use cautiously in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

There are reports of nosebleeds and vaginal bleeding with ginseng use, although scientific study is limited in this area. There is also evidence in humans of ginseng reducing the effectiveness of the "blood thinning" medication warfarin (Coumadin®). Caution is advised in patients with bleeding disorders or taking drugs that may affect the risk of bleeding or blood clotting. Dosing adjustments may be necessary.

Several cases of severe drops in white blood cell counts were reported in people using a combination product containing ginseng in the 1970s; this may have been due to contamination.

Ginseng may have estrogen-like effects and has been associated with reports of breast tenderness, loss of menstrual periods, vaginal bleeding after menopause, breast enlargement (reported in men), difficulty developing or maintaining an erection, or increased "sexual responsiveness." Avoid use of ginseng in patients with hormone sensitive conditions, such as breast cancer, uterine cancer, or endometriosis.

A severe life-threatening rash known as Stevens-Johnson syndrome occurred in one patient and may have been due to contaminants in a ginseng product. A case report describes liver damage (cholestatic hepatitis) after taking a combination product containing ginseng.

High doses of ginseng have been associated with rare cases of temporary swelling of blood vessels in the brain (cerebral arteritis), abnormal dilation of the pupils of the eye or confusion.

Pregnancy and Breastfeeding

Ginseng has been used traditionally in pregnant and breastfeeding women. Animal studies and early human research suggests that ginseng may be safe, although safety has not been clearly established in humans. Therefore, ginseng use cannot be recommended during pregnancy or breastfeeding. Neonatal death and the development of male characteristics in a developing baby girl after her mother was exposed to ginseng during pregnancy has been reported.

Many tinctures contain high levels of alcohol and should be avoided during pregnancy.

InteractionsReturn to top

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Research in humans suggests that American ginseng may reduce the anticoagulant (blood thinning) effects of warfarin (Coumadin®). In addition, based on limited animal research, and individual reports of nosebleeds and vaginal bleeding in humans, ginseng may increase the risk of bleeding when taken with other drugs that increase the risk of bleeding. Examples include aspirin, anticoagulants ("blood thinners") such as heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®). In contrast, there is a case of the effectiveness of the "blood thinner" warfarin (Coumadin®) being reduced when taken at the same time as ginseng.

Based on human research, ginseng may lower blood sugar levels. This effect may be greater in patients with diabetes than in non-diabetic individuals. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or injection should be monitored closely by a qualified healthcare provider. Medication adjustments may be needed.

Headache, tremors, mania, or insomnia may occur if ginseng is combined with prescription anti-depressant drugs called monoamine oxidase inhibitors (MAOIs), such as isocarboxazid (Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®).

Ginseng may alter the effects of blood pressure or heart medications, including calcium channel blockers such as nifedipine (Procardia®). There is a reported case of decreased effects of the diuretic drug furosemide (Lasix®) when used with ginseng. A Chinese study reports that the effects of the cardiac glycoside drug digoxin (Lanoxin®) may be increased when used with ginseng in patients with heart failure. Do not combine ginseng with heart or blood pressure medications without first talking to a qualified healthcare provider.

There is limited laboratory evidence that ginseng may contain estrogen-like chemicals and may affect medications with estrogen-like or estrogen-blocking properties. This has not been well demonstrated in humans.

In theory, ginseng may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious side effects. A pharmacist should be consulted before taking any herbs or supplements.

The analgesic effect of opioids may be inhibited by ginseng. Ginseng may interact with sedatives.

Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®). In early research, ginseng has been reported to increase removal of alcohol from the blood, although this has not been well substantiated.

Ginseng may also interact with cholesterol-lowering, anti-cancer, antiviral, antipsychotic, erectile dysfunction, immunomodulator, and glucocorticoid drugs, as well as caffeine.

Interactions with Herbs and Dietary Supplements

Based on human research, ginseng may lower blood sugar levels. This effect may be greater in patients with diabetes than in non-diabetic individuals. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Headache, tremors, mania, and insomnia may occur if ginseng is combined with supplements that have monoamine oxidase inhibitor (MAOI) activity or that interact with MAOI drugs.

Based on case reports, ginseng may raise or lower blood pressure. Use cautiously if combining ginseng with other products that affect blood pressure.

There is early evidence that ginseng may increase the QTc interval (thus increasing the risk of abnormal heart rhythms) and decrease diastolic blood pressure two hours after ingestion in healthy adults. Therefore, caution is advised with other agents that may cause abnormal heart rhythms.

Based on limited animal research and anecdotal reports of nosebleeds and vaginal bleeding in humans, ginseng may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , some cases with garlic, and fewer cases with saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

In theory, ginseng may decrease the effects of diuretic herbs, such as horsetail or licorice. Ginseng may interact with sedatives or other supplements that affect the central nervous system.

In theory, ginseng may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may be too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system, such as cat's claw or echinacea.

There is limited laboratory evidence that ginseng may contain estrogen-like chemicals and may affect agents with estrogen-like or estrogen-blocking properties. This has not been proven in humans.

Ginseng may also interact with cholesterol-lowering, anti-inflammatory, anti-cancer, antiviral, antipsychotic, steroid, glucocorticoid, immunomodulator, and erectile dysfunction herbs and supplements as well as DHEA, caffeine, mate, and guarana.

Methodology Return to top

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cynthia Dacey, PharmD (Natural Standard Research Collaboration); Ivo Foppa, MD, ScD (University of South Carolina); Sadaf Hashmi, MD, MPh (Johns Hopkins School of Hygiene and Public Health); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Natural Standard Research Collaboration); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).

Methodology details

Selected references Return to top

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Buettner C, Yeh GY, Phillips RS, et al. Systematic review of the effects of ginseng on cardiovascular risk factors. Ann Pharmacother 2006;40(1):83-95.
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Ito TY, Polan ML, Whipple B, et al. The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status. J Sex Marital Ther 2006 Oct-Dec;32(5):369-78.
Jiang X, Williams KM, Liauw WS, et al. Effect of St John's wort and ginseng on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects. Br J Clin Pharmacol 2004;57(5):592-599.
Kim JH, Park CY, Lee SJ. Effects of sun ginseng on subjective quality of life in cancer patients: a double-blind, placebo-controlled pilot trial. J Clin Pharm Ther 2006 Aug;31(4):331-4.
Rotem C, Kaplan B. Phyto-Female Complex for the relief of hot flushes, night sweats and quality of sleep: randomized, controlled, double-blind pilot study. Gynecol Endocrinol 2007 Feb;23(2):117-22.
Shao KD, Zhou YH, Shen YP, et al. Treatment of 37 patients with refractory idiopathic thrombocytopenic purpura by shengxueling. Chin J Integr Med 2007 Mar;13(1):33-6.

March 01, 2008.

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