Note: Adverse reactions with Ginseng usage are considered relatively rare and it is usually considered to have a low toxicity.

• Insomnia ²³
• Post menopausal Bleeding ^144,161,164
• Mastalgia ¹⁶⁴
• Headache (in conjunction with phenelzine intake) ¹⁶²
• Tremulousness (in conjunction with phenelzine intake) ¹⁶²
• Manic episodes (in conjunction with phenelzine intake) ^162,167,168
• Gestational diabetes ¹⁶⁵
• Hypertony ¹⁵⁹
• Diarrhea ¹⁵⁹
• Nervousness ¹⁵⁹
• Cerebral arteritis (one possible case reported) ¹⁷⁰
• May induce immunological unresponsiveness in one arm of the immune system ¹³⁴

^{Ginseng Abuse Syndrome – the cases reported on Ginseng abuse syndrome are controversial due to the possibility the ginseng consumed had adulterants, that the ginseng types are unknown including how they were processed, and that the reports may not have been verified. The following are the side effects reported for this Syndrome:}

• ^{Intoxication induced by Ginseng causing:158}

Adverse Reactions Studies:

A case of postmenopausal bleeding attributed to the use of topical ginseng is reported. Ginseng appears to have an estrogen-like effect on genital tissues. ¹⁴⁵

"… Thus, ginseng pretreatment can induce immunological unresponsiveness in one arm of the immune system. Such selective immunosuppression effect of the total saponins of ginseng may be related to their steroid-like structure." ¹³⁴

" ginseng may cause headache, tremulousness, and manic episodes in patients treated with phenelzine sulfate. Ginseng should also not be used with estrogens or corticosteroids because of possible additive effects." ¹⁶²

"…. at least 1 fatality has been attributed to contamination of a ginseng product with the potent and unpredictable herbal stimulant ephedra. While clear conclusions about the safety of ginseng cannot be drawn from the uncontrolled 1979 case series that coined the term "ginseng abuse syndrome." ¹⁶³

"ginseng can act as a mild stimulant and should probably be avoided in association with other stimulants or in patients with cardiovascular disease. Rare endocrinologic effects include mastalgia and postmenopausal bleeding, both of which cease with discontinuation of ginseng." ¹⁶⁴

"A case-control study of 88 pairs of women (matched only for age and parity) found a significantly lower rate of pregnancy-induced hypertension, but a 3-fold higher incidence of gestational diabetes among ginseng consumers." ¹⁶⁵

In a study with 227 volunteers receiving daily oral capsule doses of either placebo (113) or 100 mg of standardized ginseng extract Ginsana G 115 (114) for a period of 12 weeks laboratory values of 24 safety parameters showed no significant differences between the end and the beginning of the 12-week study in either of the groups. There were only 9 adverse events in the study, the principal one being insomnia." ¹³⁹

" The results suggested that Red Ginseng and digoxin had synergism for treatment of congestive heart failure, and Red Ginseng was an effective and safe adjuvant without any side effects." ¹⁶⁶

A "28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng. Cerebral angiograms showed "beading" appearance in the anterior and posterior cerebral and superior cerebellar arteries, consistent with cerebral arteritis. The close temporal association between intake of ginseng and cerebral arteries suggests a causal relationship." ¹⁷⁰

Other references on Adverse effects:

Dega H, Laporte JL, Frances C, Herson, Chosidow O: Ginseng as a cause for Stevens-Johnson syndrome? [letter] [see comments], Lancet, May 11, 1996, v347, n9011

Gonzalez-Seijo JC, Ramos YM, Lastra I: Manic episode and ginseng: report of a possible case [letter]. J Clin Psychopharmacol, Dec 1995 v15, n6

Chen KJ: "The effect and abuse syndrome of Ginseng.", J Tradit Chin Med, v1, n1, Sep 1981

Becker BN,Greene J: Evanson J, Chidsey G, Stone WU, et al: Ginseng induced diuretic resistance, JAMA, 1996, 276, 605-607

Hammond TG: Whitworth JA :Adverse reactions to ginseng [letter]., Med J Aust,May 2, 1991 v1 , n9

Dukes MN: Ginseng and mastalgia [letter], Br Med J, June 17, 1978, v1, n6127

Nielsen AS: Hypertension caused by ginseng tablets? (letter)]. [Danish]", Ugeskr Laeger, Feb 8, 1988, v150, n6

Body as a Whole – The possibility of an allergic reaction to the herb should be kept in mind during therapy; Headaches

Cardiovascular System –Palpitations

Digestive System – Nausea, Vomiting, Diarrhea

Endocrine System – Post menopausal Bleeding , Mastalgia, Immune system suppression

Metabolic and Nutritional – Gestational diabetes

Nervous System – Restlessness, Irritability, Insomnia

Skin and Appendages – Rash

Special Senses – Vertigo

As with all Herbs and Drugs, the potential for interaction by a variety of mechanisms (e.g., pharmacodynamic, pharmacokinetic drug inhibition or enhancement, etc) is a possibility.

• Ginseng is contraindicated in patients taking phenelzine sulfate. ^162,167,168

• Ginseng may be contraindicated if used with estrogens or corticosteroids. ¹⁶²

• Ginseng may be interact with the blood thinning medication warfarin, however this is not clinically proven. ¹⁷¹

• Traditionally Ginseng was thought to be incompatible with the intake of Faeces Trogopterori (Rhizoma Trogopterorum or Wu Ling Zhi)391, however this is under debate. ^160,169

• There has been one case reported of interaction with furosemide, however this may have been due to a germanium contaminant. ¹⁷⁴

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