Can I Take Ashwagandha With Jardiance (Empagliflozin)?

What Jardiance Does and Why Women Take It

Empagliflozin is an SGLT2 inhibitor that blocks glucose reabsorption in the kidney, causing roughly 70 grams of glucose to spill into the urine each day at the 10 mg dose. The FDA has approved it for type 2 diabetes, to reduce cardiovascular death in adults with type 2 diabetes and established heart disease, and to slow chronic kidney disease progression.

Women use Jardiance across several life stages and conditions.

Reproductive-Age Women With Type 2 Diabetes or PCOS-Related Metabolic Disease

PCOS affects 6 to 12 percent of reproductive-age women in the United States and is strongly linked to insulin resistance. SGLT2 inhibitors are not a first-line PCOS treatment, but some women with coexisting type 2 diabetes and PCOS are prescribed empagliflozin off-label for metabolic control. Because PCOS already involves androgen excess, any supplement that raises testosterone matters enormously in this group.

Perimenopausal and Postmenopausal Women

Cardiovascular risk rises sharply after menopause. The EMPA-REG OUTCOME trial showed a 38 percent relative risk reduction in cardiovascular death for empagliflozin versus placebo in adults with type 2 diabetes and high cardiovascular risk. Many of the women in that trial were postmenopausal, which is why cardiologists and internists increasingly prescribe Jardiance to women in this life stage for heart protection, not just glucose control.

A Note on Evidence Gaps for Women

The EMPA-REG OUTCOME trial enrolled approximately 35 percent women, which is better than many cardiovascular trials but still means most outcome data is driven by male participants. Sex-specific subgroup analyses suggest the cardiovascular benefit holds for women, but we do not have strong female-only pharmacokinetic data on how hormonal fluctuations across the menstrual cycle or menopausal transition alter empagliflozin exposure. That evidence gap is real, and you deserve to know it.

What Ashwagandha Does in the Female Body

Ashwagandha (Withania somnifera) is an Ayurvedic adaptogen. Its active compounds, withanolides, primarily modulate the hypothalamic-pituitary-adrenal (HPA) axis, reducing cortisol, and also interact with thyroid signaling and steroid-hormone pathways.

Cortisol and Blood-Glucose Lowering

Cortisol is a counter-regulatory hormone: it raises blood glucose by stimulating hepatic gluconeogenesis and impairing peripheral insulin sensitivity. A 60-day randomized controlled trial published in the Indian Journal of Psychological Medicine found that 600 mg per day of ashwagandha root extract reduced serum cortisol by 27.9 percent compared with placebo. If cortisol falls, hepatic glucose output falls too. Stacked with an SGLT2 inhibitor that is already urinating out glucose, the net hypoglycemic effect may be greater than either agent alone.

This is a pharmacodynamic interaction: the two agents act through different molecular targets but their downstream effect on blood glucose points the same direction.

Thyroid-Hormone Elevation

A 2018 pilot study in the Journal of Alternative and Complementary Medicine found that 600 mg of ashwagandha daily for eight weeks significantly increased serum T3 and T4 in adults with subclinical hypothyroidism. Empagliflozin itself is not known to alter thyroid hormones. But if you are perimenopausal, already on levothyroxine, or have Hashimoto's thyroiditis (which disproportionately affects women, at a 7 to 10:1 female-to-male ratio), adding ashwagandha may push thyroid levels out of range and create symptoms that look a lot like perimenopause itself: palpitations, insomnia, heat intolerance, and irregular periods.

Testosterone and Androgen Pathways

Several trials have examined ashwagandha and testosterone. A 16-week trial in healthy men showed a 15 percent increase in testosterone with 600 mg daily. Data in women are far thinner. One small 2015 study found improvements in sexual function in women taking ashwagandha, and the researchers noted modest increases in DHEA-S, which is an androgen precursor. For a woman without PCOS, a slight androgen bump may be benign or even welcome if libido is the goal. For a woman with PCOS who already has elevated androgens, it could worsen hirsutism, acne, or menstrual irregularity.

The Interaction: Pharmacokinetic vs. Pharmacodynamic

A clean way to think about this pairing is to separate the two types of interaction.

Pharmacokinetic (PK) interaction means one substance changes how your body absorbs, distributes, metabolizes, or excretes the other. Empagliflozin is metabolized mainly by UGT1A3, UGT1A8, UGT1A9, and UGT2B7 enzymes. Ashwagandha's withanolides have shown some CYP3A4 and CYP2C9 activity in in vitro studies, but those enzymes are not the primary route for empagliflozin. Natural Medicines Comprehensive Database rates the ashwagandha-blood-glucose-lowering drug combination as having a moderate interaction, driven by pharmacodynamic rather than pharmacokinetic concerns. No peer-reviewed clinical trial has demonstrated that ashwagandha meaningfully changes empagliflozin plasma levels.

Pharmacodynamic (PD) interaction means the two agents produce overlapping or opposing biological effects. Here is where the real concern lives:

| Effect | Empagliflozin | Ashwagandha | Combined signal | |---|---|---|---| | Blood glucose | Lowers (glycosuria) | May lower (cortisol reduction) | Additive lowering | | Cortisol | Neutral | Reduces | Net cortisol reduction | | Thyroid hormones | Neutral | May raise T3/T4 | Potential hyperthyroid symptoms | | Testosterone | Neutral | May raise | Androgen excess risk in PCOS | | Blood pressure | Modest lowering (natriuresis) | May lower slightly | Additive hypotension possible |

The biggest real-world risk for most women is not dramatic hypoglycemia from the empagliflozin-ashwagandha combination alone. SGLT2 inhibitors rarely cause hypoglycemia as monotherapy because they are glucose-dependent. The risk climbs when you add insulin or a sulfonylurea to the picture. If your regimen already includes one of those, layering in ashwagandha's cortisol-lowering effect deserves careful monitoring.

Blood-Glucose Monitoring: What to Watch

Empagliflozin, unlike sulfonylureas, does not force insulin secretion, so frank hypoglycemia from the duo is uncommon but not impossible. Watch for:

• Fasting glucose trending below 80 mg/dL consistently
• Post-meal glucose dropping below 70 mg/dL
• Symptoms of low blood sugar: shakiness, sweating, confusion, or unusual fatigue

If you use a continuous glucose monitor (CGM), look at your overnight trough values in the first two to four weeks after starting ashwagandha. CGM data from women with type 2 diabetes show that nocturnal hypoglycemia is often the first sign of a glucose-lowering stack getting too aggressive.

If you are checking fingerstick glucose only, fasting morning readings twice weekly for the first month is a reasonable minimum. Bring the log to your next provider visit.

Thyroid Monitoring for Women on Jardiance

If you have a personal or family history of thyroid disease, or if you are in perimenopause (when thyroid disorders become substantially more common), thyroid function testing before starting ashwagandha and again at eight to twelve weeks is worth discussing with your provider.

The American Thyroid Association notes that thyroid disorders affect women at five to eight times the rate of men, and hypothyroidism worsens insulin resistance and dyslipidemia, conditions that often coexist with the metabolic profile that led to a Jardiance prescription in the first place. If ashwagandha nudges your thyroid hormones upward while you are on a stable levothyroxine dose, you may feel transiently hyperthyroid: racing heart, poor sleep, and anxiety that you might misattribute to perimenopause or stress.

A simple TSH (and free T4 if TSH shifts) at baseline and at eight weeks is practical and inexpensive.

PCOS-Specific Considerations

Women with PCOS deserve their own paragraph here. Your hormonal terrain is already marked by elevated androgens, insulin resistance, and frequently disrupted cortisol rhythms. Empagliflozin addresses the insulin resistance piece. Ashwagandha, through cortisol reduction, may also help with adrenal androgen excess (the subset of PCOS driven by elevated DHEA-S from the adrenal glands rather than the ovaries).

That sounds like a potential benefit, and some integrative practitioners do combine adaptogens with insulin sensitizers in PCOS for exactly this reason. The evidence is not yet there in the form of a well-powered RCT. A 2023 review in Phytomedicine examined adaptogen use in PCOS and concluded that while ashwagandha showed promise for stress-related androgen elevation, no trials have specifically evaluated it alongside SGLT2 inhibitors in PCOS populations. You would be in uncharted territory, and tracking your androgen panel (total testosterone, free testosterone, DHEA-S) before and after starting the combination is sensible.

Who This Combination Is Reasonable For vs. Who Should Avoid It

Reasonable Candidates (with monitoring)

• Women on empagliflozin 10 mg or 25 mg for type 2 diabetes as monotherapy, with well-controlled glucose (HbA1c 6.5 to 7.5 percent), who want ashwagandha for stress or sleep
• Postmenopausal women on Jardiance for heart failure or CKD protection with no thyroid disease and no concurrent sulfonylurea or insulin
• Women with PCOS-related type 2 diabetes who have normal thyroid function, normal androgen levels (on treatment), and provider agreement to monitor labs

Higher-Caution Groups

• Women on empagliflozin plus insulin or a sulfonylurea (glipizide, glimepiride, glyburide): the additive glucose lowering is harder to predict
• Women with subclinical or overt hypothyroidism or hyperthyroidism on medication: ashwagandha's thyroid-stimulating effect may destabilize a previously stable dose
• Women with PCOS who still have elevated testosterone or DHEA-S: ashwagandha's androgen-modulating activity could worsen hirsutism or acne
• Women trying to conceive: see the pregnancy section below

Contraindicated Together

No absolute contraindication between the two agents exists in published guidelines. The caution is conditional, not categorical.

Pregnancy, Lactation, and Contraception

This section is required reading if you could become pregnant.

Empagliflozin in Pregnancy

The FDA label for Jardiance states that empagliflozin should be discontinued when pregnancy is detected. Animal studies at exposures approximately 4 times the maximum recommended human dose showed fetal renal toxicity. Human data are limited; a pharmacovigilance analysis suggests increased risk of adverse outcomes, though confounding by underlying diabetes is difficult to eliminate. ACOG recommends against SGLT2 inhibitor use in pregnancy and advises transition to insulin as the preferred glucose-lowering agent once pregnancy is confirmed.

If you are of reproductive age and on Jardiance, use reliable contraception. An unintended pregnancy on empagliflozin requires immediate contact with your prescriber to transition your diabetes management.

Ashwagandha in Pregnancy

Traditional Ayurvedic medicine has historically classified ashwagandha as an herb to avoid in pregnancy due to its potential to stimulate uterine contractions. Animal data show abortifacient effects at high doses. Human safety data in pregnancy are essentially absent. Avoid ashwagandha during pregnancy.

Lactation

No human lactation transfer data exist for empagliflozin. Animal data show transfer into milk. Because the developing infant kidney may be harmed, the FDA label advises against breastfeeding while taking Jardiance. Ashwagandha's transfer into human breast milk has not been studied; the absence of data is not evidence of safety, and avoidance during breastfeeding is the prudent position.

Dose, Timing, and Practical Guidance

If your provider approves the combination after reviewing your full medication list and labs, here is a practical starting framework:

1. Start ashwagandha at the lowest studied dose. Most trials showing cortisol reduction used 300 to 600 mg of a standardized root extract (KSM-66 or Sensoril are the most studied forms). Do not begin at 1,200 mg.
2. Separate timing if desired, but there is no evidence it changes the PD interaction. Unlike some drug-supplement pairs with CYP competition, the concern here is systemic hormone modulation, not absorption competition. Taking ashwagandha at bedtime and Jardiance in the morning is fine but will not prevent the physiological overlap.
3. Log your fasting glucose for four weeks. If you use a CGM, review the trend line at two weeks.
4. Check TSH at eight weeks if you have any thyroid history.
5. Tell your prescriber at your next visit. Many providers do not ask about supplements. You need to volunteer this.

What the Evidence Actually Proves vs. What Is Extrapolated

Honesty matters here. The specific claim "ashwagandha interacts with empagliflozin" has no dedicated clinical trial behind it. What does have direct evidence:

• Ashwagandha lowers cortisol in humans (Chandrasekhar et al., 2012, n=64)
• Ashwagandha raises T3 and T4 in adults with subclinical hypothyroidism (Sharma et al., 2018, n=50)
• Empagliflozin lowers fasting plasma glucose and HbA1c in type 2 diabetes (EMPA-REG OUTCOME, n=7,020)
• SGLT2 inhibitors as a class rarely cause hypoglycemia as monotherapy, with rates not significantly different from placebo in the EMPA-REG trial

What is extrapolated: the additive blood-glucose lowering when both are combined, the degree of thyroid shift in women with normal thyroid function on empagliflozin, and the testosterone dynamic in women with PCOS on SGLT2 inhibitors. These are mechanistically plausible concerns, not proven clinical outcomes in this specific combination.

Dr. Maya Okafor, MD, WomanRx editorial board (OB-GYN and metabolic women's health), reviewed this article and noted: "The question I get most often from women on Jardiance who want to add ashwagandha is whether it will tank their blood sugar. The honest answer is: probably not dramatically on its own, but if they are also on a sulfonylurea or insulin, I want to see their glucose log before I say yes. The thyroid piece is often overlooked, and for my perimenopausal patients it is the part I take most seriously."

Talking to Your Provider: What to Say

Many women hesitate to mention supplements because they expect dismissal. A direct, specific conversation works better than a general "I'm thinking about trying some herbs." Try this:

• "I am currently taking empagliflozin [dose] for [indication]. I want to add ashwagandha 300 to 600 mg for cortisol and sleep. Can we check my TSH and a fasting glucose today so we have a baseline, and then recheck in eight weeks?"

That framing is specific, shows you have done your research, and makes it easy for your provider to say yes with a monitoring plan rather than a reflexive no.