Not all of it is safe, and the unsafe parts are unsafe in specific, documented ways. Putting a non-sterile preparation onto the eye has caused corneal ulcers and permanent blindness. Traditional eye cosmetics such as kajal and surma have poisoned infants with lead. Metal-containing oral formulations have been found to contain lead, mercury, and arsenic at toxic concentrations, and Ayurvedic products have caused liver injury severe enough to require hospital care. A supervised procedure using tested materials, delivered alongside ophthalmic care, is a different proposition from any of that. This page tells you how to tell them apart.
Complementary-care boundary: Nothing on this page should be read as a reason to delay ophthalmic assessment. A red, painful eye with blurred vision is an emergency and needs a slit lamp examination the same day, not a herbal remedy. Ayurvedic therapy does not replace antimicrobial treatment for an infected cornea, pressure-lowering therapy in glaucoma, anti-VEGF injections, retinal surgery, or cataract surgery. The most serious safety failure in this field is not a bad ingredient. It is time lost.
Two Separate Risk Categories, Routinely Confused
There are two distinct kinds of risk here, and patients and practitioners slide between them constantly. The first is what goes on or into the eye: drops, washes, powders, oils, medicated ghee, and anything applied to the ocular surface or the lid margin. The second is what goes into the body: oral herbal formulations, metal-based bhasma preparations, and the interactions they create with prescribed drugs.
They fail differently. Ocular risk fails fast and locally. A contaminated wash can produce a corneal infection within a day or two, and a corneal infection can scar the visual axis permanently within a week. Systemic risk fails slowly and silently. Lead accumulates over months. Liver injury from a herbal product often declares itself only when fatigue, nausea, and jaundice appear, by which point the exposure has been going on for weeks.
The confusion matters because reassurance about one category gets applied to the other. A practitioner who says the oil is food-grade is telling you something about ingestion, not about sterility at the ocular surface. A supplier who says the herb is natural is telling you nothing about heavy metal content. When you assess safety, assess each route separately, and accept an answer only about the route you asked about.
Risk at the Ocular Surface: Microbial Keratitis Is the Central Warning
This is the single most important warning on this site
If you take one thing from this page, take this: do not put any non-sterile preparation on your eye. Not a home-made triphala wash. Not an oil decanted into an unsterilized bottle. Not a powder, a paste, or a leaf extract. The cornea is thin, avascular, and unforgiving. A microbial keratitis that begins as irritation can destroy the visual axis in days and leave a scar that only a transplant will address.
The evidence for this is not theoretical
A prospective Ugandan cohort of 313 patients with microbial keratitis found that 60 percent had used traditional eye medicine before presenting. Most infections were fungal, most were already severe on arrival, and at three months 30 percent were blind in the affected eye and 9 percent had lost the eye entirely. Prior use of traditional eye medicine was independently associated with presenting in a worse state. An earlier case-control study in the British Journal of Ophthalmology found a significant association between corneal ulceration, particularly peripheral ulceration, and the use of African traditional eye medicines. A systematic review of traditional eye remedies in sub-Saharan Africa and a descriptive review of the global literature reach the same conclusion.
Why home-made eye washes are the worst offender
A decoction made in a domestic kitchen has no sterility assurance, no preservative system, and no control over pH or osmolarity. It is stored in a container that is reused, often at room temperature, and applied with fingers or a cup that touches the lid margin. Every one of those steps introduces organisms. Triphala eyewash recipes circulate widely online, and they are among the most dangerous pieces of advice in this field.
Contact lens wearers are at markedly higher risk
A lens is a reservoir and a scaffold. Any organism introduced onto the ocular surface has somewhere to sit and multiply, and the lens itself causes small epithelial defects that give bacteria and fungi a way in. Nobody wearing contact lenses should be using any unsterile ocular preparation, and lenses should be out for the duration of any ocular procedure and its recovery.
Fungal and amoebic infection is the worst case
Plant-derived material carries fungal spores, and water carries Acanthamoeba. Fungal keratitis and Acanthamoeba keratitis are harder to diagnose, slower to treat, and far more likely to end in transplant or loss of the eye than a straightforward bacterial ulcer. They are also strongly associated with plant matter and with water exposure, which is exactly what improvised eye preparations supply.
Even oil on a healthy eye is not neutral
Medicated ghee applied to the ocular surface causes transient blurring and can leave a residue that disturbs the tear film. On an intact epithelium in a supervised setting this is usually a nuisance rather than a hazard. On an eye with an epithelial defect, a recent surgical wound, or an active infection, it is a genuinely bad idea, and distinguishing those states requires an examination.
What a responsible clinic does differently
It uses pharmaceutical-grade, single-patient preparations with a known source and expiry date. It does not reuse materials between patients. It examines the eye before each session and stops if the surface is compromised. It never asks you to prepare anything at home for ocular use. If the preparation cannot be named and traced, it does not go near the eye.
Risk Inside the Body: Heavy Metals in Oral Formulations
Bhasma preparations contain metals by design
A significant branch of Ayurvedic pharmacy, rasa shastra, deliberately incorporates processed metals and minerals into medicines. Bhasmas made from lead, mercury, arsenic, iron, copper, and zinc are not contaminants in these products; they are the intended ingredients. Traditional processing is said to render them safe. Analytical chemistry does not consistently support that, and the clinical literature contains repeated poisonings traced to these preparations.
The JAMA internet-purchase study
Researchers bought Ayurvedic medicines from US and Indian websites and tested them. One-fifth of the products contained detectable lead, mercury, or arsenic, and among the rasa shastra products the proportion was higher still. Several would have delivered doses well above accepted regulatory limits if taken as directed. That study is nearly two decades old, and the market it describes is the same market patients buy from today.
The scoping review confirms the pattern
A systematic scoping review of heavy metals in Indian traditional systems of medicine gathered the published analytical and clinical evidence and reached the same conclusion: contamination and intentional metal content are both real, reporting is inconsistent, and integrative practitioners need to treat these products as a recognized exposure source rather than as inert.
Case reports keep accumulating
Severe lead poisoning following Ayurvedic herbal medicine has been reported in a child, a fatal case has been described in an adult with Parkinson's disease taking Ayurvedic supplements, and adult lead poisoning from non-prescription Ayurvedic medication has been documented in Germany. Public health authorities in New York City investigated lead poisoning in pregnant women who had used Ayurvedic medications from India. These are not isolated curiosities. They are a recurring pattern.
Lead poisoning does not announce itself
Early symptoms are abdominal pain, constipation, fatigue, irritability, headache, and difficulty concentrating, all of which get attributed to something else. Anemia may be the first laboratory abnormality. By the time peripheral neuropathy or cognitive change is obvious, the exposure has usually been prolonged. If you have been taking an unverified Ayurvedic preparation and feel unwell in any of these ways, ask for a blood lead level.
Pregnancy and childhood raise the stakes sharply
Lead crosses the placenta, and there is no established safe blood lead concentration in a child. Exposure in pregnancy and early childhood carries risks to neurodevelopment that are not reversible. Nobody who is pregnant, trying to conceive, breastfeeding, or giving a preparation to a child should take an Ayurvedic product whose metal content is unknown.
What to insist on
Ask directly whether any product you are given contains bhasma or any metal-based ingredient, and ask to see third-party heavy metal testing for the specific lot. A clinic that dispenses oral formulations should be able to answer both questions without hesitation. If the answer is vague, or the product has no manufacturer on the label, do not take it.
Kajal, Surma and Kohl: Lead Applied at the Eyelid Margin
These are cosmetics, and they are a documented lead source
Kajal, surma, kohl, and the related preparation tiro are traditional eye cosmetics applied to the lid margin, sometimes to the conjunctival surface, and in some communities to the eyes of newborns. Many formulations are lead sulfide based. They are sold in the United States through ethnic grocery and import channels, and they are one of the better-characterized non-paint sources of childhood lead exposure.
The pediatric literature is specific
A 2024 Pediatrics paper reviewed traditional eye cosmetics and cultural powders as a source of lead exposure in children. Public health investigations have documented childhood lead exposure associated with kajal imported from Afghanistan in New Mexico, and infant lead poisoning associated with tiro from Nigeria in Massachusetts. In each instance the product looked ordinary, was used out of cultural habit, and was not suspected until a blood lead level was checked.
Applying it near the eye is not a low-dose route
Parents often assume that a cosmetic used around the eye is barely absorbed. It is not that simple. The material transfers to the fingers, onto other surfaces, and into the mouth, particularly with small children. It also drains through the nasolacrimal system. The result is a household-wide exposure rather than a small local one.
There is no safe formulation you can identify by looking
Lead content varies enormously between products and between batches of the same product, and the label is not a guide. Some are labeled lead-free and are not. Because you cannot tell by inspection, the only defensible position is not to use these products at all, and not to accept them as gifts for a baby.
What to do if a product has been used
Stop using it, keep the container, and ask your physician or your child's pediatrician for a blood lead level. Take the container with you, because public health departments can test it and can identify a source affecting other families. This is worth doing even if nobody feels unwell, because early lead exposure is usually asymptomatic.
Netra will not use or recommend any of these
No kajal, surma, kohl, or similar traditional eye cosmetic is used in this practice, and none will be recommended for any purpose, cosmetic or therapeutic. That is a firm position rather than a cautious one, and it applies regardless of what the product is called or who supplied it.
Hepatotoxicity and Herb-Induced Liver Injury
Herbal and dietary supplements are now a major cause of drug-induced liver injury
Over the past two decades, herbal and dietary supplements have moved from a curiosity to one of the leading identified causes of drug-induced liver injury in Western case series. Ayurvedic formulations appear repeatedly in that literature. The injury pattern ranges from asymptomatic enzyme elevation through hepatitis to, in a small number of cases, acute liver failure requiring transplantation.
Ashwagandha is the best-documented example
Withania somnifera is among the most widely sold Ayurvedic herbs in the United States, and it has an accumulating hepatotoxicity signal. Cases assessed with the updated RUCAM causality instrument have been published, and a scoping review has now gathered the reported clinical characteristics. Typical presentation is jaundice with a cholestatic or mixed pattern, appearing weeks to a few months after starting, and usually resolving after the product is stopped.
It is not only ashwagandha
Acute hepatitis has been reported in association with Tinospora cordifolia, commonly sold as guduchi or giloy, and a case of herb-induced liver injury from an Ayurvedic medicine presenting with severe lactic acidosis has been described. Multi-herb formulations make attribution harder still, because when a product contains a dozen ingredients nobody can say which one caused the injury.
Combination products raise the risk in a specific way
Polyherbal preparations increase the number of potential hepatotoxins, the chance of adulteration, and the difficulty of stopping the right thing. They also make the dose of any single constituent unknowable. If you are going to take anything, fewer ingredients from a traceable manufacturer is safer than a proprietary blend.
Who should be more careful
Anyone with existing liver disease, hepatitis B or C, significant alcohol use, or who takes medications with their own hepatic burden should treat herbal formulations with real caution. So should anyone on multiple prescription drugs, because a herb-induced injury superimposed on a drug-induced one is harder to untangle and slower to recover from.
Monitoring is straightforward and worth doing
If you start an oral Ayurvedic formulation and intend to stay on it, baseline liver enzymes and a repeat at six to eight weeks is a reasonable precaution and costs very little. Stop the product and contact your physician promptly if you develop unexplained fatigue, nausea, right upper abdominal discomfort, dark urine, pale stools, or yellowing of the eyes or skin.
How to Reduce Your Risk If You Decide to Proceed
Most people reading this page have already decided to try something, and telling them not to is less useful than telling them how to do it with the risk pushed as low as it will go. The good news is that nearly all the documented harm in this field comes from a short list of avoidable practices: unsterile material on the eye, untested oral products, traditional cosmetics, and treatment that runs in parallel with conventional care instead of alongside it.
Avoid those four and you have removed most of the danger. What remains is the ordinary risk of any hands-on therapy: transient blurring, mild irritation, an occasional allergic reaction to a botanical, and the cost of time. Those are risks a reasonable adult can accept. The ones below are not, and the list is how you keep them out.
- Have a current ophthalmic examination before any ocular procedure, and tell the practitioner what it showed
- Never apply anything to your eye that you prepared yourself, and refuse any home eyewash protocol
- Ask whether ocular materials are pharmaceutical-grade, single-patient, in date, and traceable to a manufacturer
- Decline any preparation containing bhasma or a metal-based ingredient unless lot-specific heavy metal testing is shown
- Never use kajal, surma, kohl, or any traditional eye cosmetic, and never on a child
- Give the practitioner a full list of prescription drugs, over-the-counter medicines, and supplements, including doses
- Keep every prescribed eye treatment exactly as your ophthalmologist ordered it unless that ophthalmologist changes it
- Take contact lenses out before any ocular procedure and leave them out until the eye is comfortable
- Consider baseline and follow-up liver enzymes if you start a long-term oral formulation
- Agree in advance on what would stop the treatment, and keep the name and lot number of everything you are given
No amount of care makes an unverified product safe, and no safeguard compensates for a delayed diagnosis. If a practitioner resists any item on this list, that resistance is the answer to your safety question, and the right response is to leave rather than to negotiate.
Interactions With Prescribed Medication
Herbal does not mean inert
Plant constituents are pharmacologically active, and many of them act on the cytochrome P450 enzymes and drug transporters that determine how much of a prescribed drug reaches your bloodstream. That is the same mechanism by which one prescription drug interferes with another. The difference is that nobody is checking, because the supplement is not on your medication list.
Hypoglycemic agents
Several herbs used in Ayurvedic practice, including bitter melon, fenugreek, gymnema, and some cinnamon preparations, have glucose-lowering effects of their own. Added to metformin, a sulfonylurea, a GLP-1 agonist, or insulin, they can produce hypoglycemia. Patients with diabetic eye disease are precisely the group most likely to be taking both. If you start a herbal product, monitor your glucose more closely for the first few weeks and tell your prescriber.
Anticoagulants and antiplatelet drugs
Warfarin's interaction profile with foods and botanicals is extensive and well reviewed, and the direct oral anticoagulants are not immune either. Turmeric, ginger, garlic, ginkgo, and several other common ingredients affect platelet function or anticoagulant metabolism. The stakes in the eye are specific: a patient on anticoagulation who also has neovascular retinal disease is at risk of vitreous or subretinal hemorrhage, and that risk is not worth an uncontrolled addition.
Immunosuppressants
Transplant recipients and patients on systemic immunosuppression for uveitis or autoimmune disease are the highest-risk group of all. Tacrolimus, cyclosporine, and sirolimus have narrow therapeutic windows and are metabolized through pathways that botanicals readily disturb. Some Ayurvedic herbs are also promoted as immune stimulants, which is directly counter to the purpose of the treatment. Nobody in this group should take a herbal formulation without their transplant or rheumatology team's explicit agreement.
Glaucoma and cardiac medication
Topical beta-blockers are absorbed systemically, and patients on oral cardiac drugs may be closer to the edge than they realize. Botanicals with cardiovascular activity, and diuretic herbs that shift potassium, can add to that. Any patient on a carbonic anhydrase inhibitor should also be cautious with preparations that affect electrolytes or renal function.
Thyroid and psychiatric medication
Ashwagandha can raise thyroid hormone levels and has precipitated thyrotoxicosis in reported cases, which matters both for patients on levothyroxine and for those with thyroid eye disease. Sedating botanicals stack with benzodiazepines and with alcohol. Patients on lithium, antiepileptics, or antidepressants should have any new supplement reviewed by the prescriber rather than by the person selling it.
The practical rule
Treat every herbal product as a drug, because pharmacologically it is one. Put it on your medication list, bring the actual bottle to appointments, and tell your ophthalmologist, your primary care physician, and your pharmacist what you are taking. Pharmacists are underused here and are often the fastest route to a reliable answer about a specific interaction.
Contraindications to Ocular Procedures Specifically
Any active or suspected eye infection
Conjunctivitis, blepharitis with ulceration, a corneal infiltrate, or an eye that is red and painful rules out every ocular procedure until an ophthalmologist has examined it. Applying oil, ghee, or a wash to an infected eye traps organisms against the surface and delays the diagnosis. This is the contraindication that causes the most harm when it is ignored.
Corneal epithelial defect or recent abrasion
A break in the epithelium is an open door. Nothing non-sterile should touch an eye with an abrasion, a recurrent erosion, an exposure defect, or a neurotrophic cornea. Patients with reduced corneal sensation are especially vulnerable, because they will not feel the early pain that would otherwise send them for help.
Recent intraocular or ocular surface surgery
Cataract surgery, corneal transplant, glaucoma surgery including a filtering bleb, retinal surgery, and refractive procedures all need a protected healing period. A bleb in particular is a permanent thin-walled structure that must not meet unsterile fluid. Defer any ocular procedure until the operating surgeon says the eye has healed and explicitly agrees.
Angle-closure risk and uncontrolled pressure
A patient with narrow angles, a history of angle closure, or intraocular pressure that is not controlled should not have procedures involving sustained orbital pressure or prolonged lid closure without their ophthalmologist's agreement. Eye pain with halos, nausea, and blurred vision is an emergency, not a treatment reaction.
Active uveitis, scleritis, or an eye on immunosuppression
Inflammatory eye disease is managed with precisely titrated therapy, and the eye is more fragile than it looks. Add the interaction risk with immunosuppressants, and ocular procedures during an active flare are not appropriate. Once disease is quiet and the treating specialist agrees, the picture changes.
Severe surface breakdown, lid abnormality, allergy, pregnancy, and children
The most symptomatic dry eyes are sometimes least able to tolerate a procedure, because the surface is already compromised; filamentary keratitis, lagophthalmos, entropion, and ectropion need assessment first. Sesame, ghee, and specific botanicals cause allergic reactions. Procedures are not appropriate for young children, and in pregnancy they are deferred and oral formulations avoided altogether.
How US Regulation Actually Works, and What It Does Not Guarantee
These products are sold as dietary supplements, not drugs
Under the framework governing this market since 1994, dietary supplements are regulated far more like food than like medicine. There is no premarket review for safety or effectiveness. A manufacturer may bring a product to market on its own assessment, and the burden falls on the regulator to show afterward that it is unsafe or misbranded. That is the opposite of how a prescription drug reaches you.
What the rules do require
Manufacturers must follow current good manufacturing practice, label ingredients accurately, avoid claims to diagnose, treat, cure, or prevent disease, and report serious adverse events. These are real obligations and enforcement does happen. But compliance is checked mostly after the fact, inspections are limited relative to the size of the market, and imported products reach consumers through channels with little effective oversight.
What the rules do not guarantee
Nothing here assures you the bottle contains what the label says, at the stated dose, without lead, mercury, arsenic, pesticide residue, or an undeclared pharmaceutical. Analytical studies of this category have found all of those. The American College of Physicians has published a position paper arguing the framework needs modernizing, which tells you what the medical profession makes of the current arrangement.
Reassuring phrases that mean very little
"FDA registered facility" means a facility filed a registration; it is not an approval. "Natural," "traditional," and "used for thousands of years" say nothing about contamination. "Lab tested," with no named laboratory, analyte, or lot number, is marketing. What carries weight is a certificate of analysis for your specific lot, or verification by an independent program such as USP or NSF.
Practitioner regulation is thinner than patients assume
Ayurveda is not a separately licensed health profession in New Jersey or in most US states. There is no state board, no protected title, and no statutory scope of practice. Many capable practitioners hold another license, most often in acupuncture, and voluntary certification bodies exist, but no patient should assume state credentialing to diagnose or treat eye disease. Netra's clinicians work within their own licensure and do not diagnose or treat as ophthalmologists.
What this means for your decision
Regulation will not protect you here, so verification has to be yours. Prefer products with third-party testing and a traceable manufacturer, practitioners who show you that documentation unprompted, and an ophthalmologist who knows what you are taking.
When to Stop and Seek Ophthalmic Care Immediately
Some symptoms mean stop today and be examined today, not at the next appointment and not after finishing the course. A corneal infection can go from irritation to a sight-threatening ulcer within days, and the treatments that save the eye work far better early. If any of the following appears, stop every preparation, remove contact lenses, and contact an ophthalmologist or go to an emergency department.
- Eye pain that is worsening, or pain that wakes you or persists after the eye is closed and rested
- Redness that is increasing rather than settling, particularly redness concentrated around the cornea
- New blurring, a drop in vision, or a change that does not clear within an hour of a procedure
- A white, gray, or cloudy spot visible on the cornea, or any new opacity you can see in a mirror
- Marked light sensitivity, or an inability to keep the eye open in ordinary room light
- Thick or purulent discharge, or lids that are stuck together on waking
- A sensation that something is in the eye that does not resolve, especially with tearing and pain
- Sudden floaters, flashing lights, a curtain or shadow across the field, or any sudden field loss
- Halos around lights with nausea, vomiting, or severe headache, which may indicate acute angle closure
- Systemic warning signs while on an oral formulation: jaundice, dark urine, persistent nausea, unexplained fatigue, confusion, or abdominal pain
Take the actual containers of everything you have been using, including the oil, the ghee, and any oral products, and say plainly what was applied to the eye and when. That changes what the clinician looks for and what they culture. Do not soften the account to avoid disapproval.
Frequently Asked Questions on the Safety of Ayurvedic Eye Treatment
No. A home-made wash is not sterile, and the ocular surface is the wrong place to find that out. Plant material carries fungal spores and water carries Acanthamoeba, and both cause corneal infections that are difficult to treat and can end in a transplant or loss of the eye. If your eyes are irritated, use a preservative-free artificial tear from a sealed container and get the cause examined.
Long use tells you a practice is tolerable often enough to persist. It does not tell you the rate of rare serious harm, because nobody was counting. Lead poisoning from metal-based preparations and corneal ulceration from traditional eye medicine were both invisible until someone measured them.
Neither, on its own. The JAMA analysis found lead, mercury, or arsenic in products from both US and Indian manufacturers, so origin is not the variable that matters. What matters is whether the specific lot has been independently tested and the manufacturer is traceable. A personal import with no label and no lot number is the hardest case to verify.
Sometimes, but ask the right person with the full list in front of them. The combinations needing real care are diabetes medication, anticoagulants and antiplatelet drugs, immunosuppressants, thyroid replacement, and psychiatric medication. Bring the actual bottles to your pharmacist and physician, and never reduce a prescribed eye treatment to make room for a supplement.
No kajal, surma, kohl, or any traditional eye cosmetic. No home-made eye washes or patient-prepared ocular preparations. No bhasma or metal-containing formulations. No unlabeled or untraceable products. No advice to reduce, delay, or stop prescribed ophthalmic treatment, and no claim to reverse, cure, or regenerate any eye condition. If an ocular procedure is contraindicated, it is not performed, and you are told why.
Selected References for Scientific Support
- Hlakudi KF, Nkoana PMW. Global Prevalence and Clinical Consequences of Traditional Eye Medicine: A Descriptive Review. Clin Optom (Auckl). 2026. PubMed
- Chukwukwe IO, et al. Traditional Eye Remedies and Ocular Complications in Sub-Saharan Africa: A Systematic Review. Niger Med J. 2026. PubMed
- Lewallen S, Courtright P. Peripheral corneal ulcers associated with use of African traditional eye medicines. Br J Ophthalmol. 1995. PubMed
- Arunga S, et al. Epidemiology of Microbial Keratitis in Uganda: A Cohort Study. Ophthalmic Epidemiol. 2020. PubMed
- Hore P, Sedlar S. Traditional Eye Cosmetics and Cultural Powders as a Source of Lead Exposure. Pediatrics. 2024. PubMed
- Centers for Disease Control and Prevention. Childhood lead exposure associated with the use of kajal, an eye cosmetic from Afghanistan - Albuquerque, New Mexico, 2013. MMWR Morb Mortal Wkly Rep. 2013. PubMed
- Centers for Disease Control and Prevention. Infant lead poisoning associated with use of tiro, an eye cosmetic from Nigeria - Boston, Massachusetts, 2011. MMWR Morb Mortal Wkly Rep. 2012. PubMed
- Centers for Disease Control and Prevention. Lead poisoning in pregnant women who used Ayurvedic medications from India - New York City, 2011-2012. MMWR Morb Mortal Wkly Rep. 2012. PubMed
- Saper RB, et al. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008. PubMed
- Mukhopadhyay S, et al. Heavy Metals in Indian Traditional Systems of Medicine: A Systematic Scoping Review and Recommendations for Integrative Medicine Practice. J Altern Complement Med. 2021. PubMed
- Cericola G, et al. Case Report: Severe lead poisoning due to exposure to ayurvedic herbal medicine. Front Pediatr. 2025. PubMed
- Gryguc-Saxanoff A. Fatal Lead Toxicity From Ayurvedic Supplements in a Patient With Parkinson's Disease. Cureus. 2025. PubMed
- Acharya-Büch R, et al. A Case Report of Adult Lead Poisoning following the Use of Nonprescription Ayurvedic Medication in Germany. Complement Med Res. 2026. PubMed
- Bokan G, et al. Herb-Induced Liver Injury by Ayurvedic Ashwagandha as Assessed for Causality by the Updated RUCAM: An Emerging Cause. Pharmaceuticals (Basel). 2023. PubMed
- McIntyre D, et al. Ashwagandha (Withania somnifera)-Associated Liver Injury: A Scoping Review of Clinical Characteristics and Safety Considerations. Cureus. 2026. PubMed
- Sharma DS, et al. Herb-Induced Liver Injury by Ayurvedic Medicine With Severe Lactic Acidosis: A Case Report. Cureus. 2023. PubMed
- May K, et al. A Case Report of Acute Hepatitis Involving the Medicinal Herb Tinospora cordifolia Along with Other Variables. J Integr Complement Med. 2023. PubMed
- Talasaz AH, et al. Pharmacokinetic and Pharmacodynamic Interactions between Food or Herbal Products and Oral Anticoagulants: Evidence Review, Practical Recommendations, and Knowledge Gaps. Semin Thromb Hemost. 2025. PubMed
- Cline K, Beachy MW, Carr PW. Modernizing the Regulatory Framework for Dietary Supplements: A Position Paper From the American College of Physicians. Ann Intern Med. 2026. PubMed