Panax Ginseng and medications.
Panax Ginseng is in the Distil supplement database, evidence Grade B. The page below lists every medication we have explicitly assessed it against.
Panax ginseng, also sold as Korean or red ginseng, is taken as a standardised extract of 200 to 400mg with 3 to 5% ginsenosides, or 1 to 2g of whole root. It is a stimulating adaptogen with Grade B evidence for fatigue reduction (Jin 2020), erectile dysfunction (Lee 2021, Ho 2026) and blood glucose regulation (Shishtar 2014), and Grade C for cognition: the supportive cognition evidence is a single-dose study in healthy young adults (Reay 2005), and the Cochrane review of ginseng for cognition concluded the evidence for a cognitive benefit in healthy people is not convincing. The honest read on the rest: the fatigue trials were mostly in people with a chronic illness, the erectile-function improvements are consistent across trials but modest, sitting below the threshold usually taken as clinically important on the standard questionnaires, and the blood glucose effect is a small drop in fasting glucose. Real, moderate, and mostly from small trials. Several interactions matter. It may modestly affect warfarin, so INR should be monitored. It should be avoided with MAOIs. Because it is stimulating, it is best avoided or used cautiously in anyone with a history of bipolar disorder or mania, and watched alongside stimulant medication. Practical notes: take it earlier in the day, since it can disturb sleep, and start at the lower end given the mild stimulant effect.
Below are the 16 documented pairs we have explicitly assessed for Panax Ginseng: 15 amber and 1 green. The pairs cluster around 5 mechanisms: Blood-test (assay) interference, CYP induction, Additive glucose lowering, MAOI pressor (blood-pressure surge), and Additive sympathomimetic activity. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Last reviewed 28 August 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Blood-test (assay) interference
Amber Does interact with Digoxin?
Asian (Panax) ginseng can throw off the blood test that measures your digoxin level, making the reading look higher or lower than it really is rather than changing the actual amount of digoxin in your body. Because digoxin has a narrow safe range and doses are adjusted from that blood test, a misleading result matters. If you take Panax ginseng, tell whoever checks your digoxin level so the result can be read correctly, and do not adjust your digoxin dose yourself.
Evidence: Supported by human study data.
CYP induction
Amber Does interact with Acenocoumarol?
Ginseng may work against vitamin-K-based blood thinners like acenocoumarol and lower your INR, which would reduce protection against clots. The evidence is mixed between ginseng types: the trial that found an INR reduction used AMERICAN ginseng, and a separate trial of Asian Panax ginseng found no effect on warfarin at all. If you take acenocoumarol, discuss ginseng with your anticoagulant clinic and keep your INR monitored rather than starting it on your own.
Evidence: Limited human data, from small studies or case reports, alongside a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Warfarin sodium?
Ginseng tends to work against warfarin rather than with it. Some people on warfarin see their INR drop when they add ginseng, which can leave them under-protected against clots. The evidence is mixed between ginseng types, so if you take warfarin, tell your anticoagulation clinic before starting ginseng and ask for an INR check a couple of weeks in.
Evidence: Supported by human study data.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive glucose lowering
Amber Does interact with Gliclazide?
Ginseng can lower blood sugar a little on its own. Gliclazide already lowers blood sugar and can cause hypos, so adding ginseng may push your glucose lower than expected. The combination is usually manageable, but monitor your blood sugar, especially in the first few weeks, and your doctor may need to adjust the gliclazide dose.
Evidence: Limited human data, from small studies or case reports, alongside a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Insulin glargine?
Ginseng can lower blood sugar a little on its own. Insulin is a strong blood-sugar-lowering medicine, so adding ginseng may increase the chance of a hypo. If you use insulin, monitor your blood sugar more closely when you start or stop ginseng, and your doctor may need to adjust your insulin dose.
Evidence: Limited human data, from small studies or case reports, alongside a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Metformin?
Ginseng can lower blood sugar a little, and metformin lowers it too, so the two may add up. Metformin on its own rarely causes hypos, so the combination is generally low risk, but it is still worth monitoring your blood sugar when you start ginseng or change the dose.
Evidence: Limited human data, from small studies or case reports, alongside a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
MAOI pressor (blood-pressure surge)
Amber Does interact with Isocarboxazid?
Ginseng has been reported once to clash with the MAOI phenelzine, in a short case report whose detail we cannot check at source. Isocarboxazid is the same type of irreversible MAOI, so the same caution applies. If you take isocarboxazid, do not start ginseng without talking to the doctor who manages your antidepressant.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Linezolid?
Ginseng has been reported to clash with the older MAOI phenelzine, and linezolid is an antibiotic that also acts as an MAOI. Ginseng's mild stimulant-like effects could add to that. If you are taking linezolid, check with the doctor who prescribed it before starting ginseng.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Moclobemide?
Ginseng has been reported once to clash with the older MAOI phenelzine, in a short case report whose detail we cannot check at source, so we apply a lighter version of the same caution to moclobemide, which acts on the same enzyme but reversibly. Moclobemide is much less prone to the blood-pressure reactions that make the older MAOIs risky: in a human comparison it took about sixteen times more dietary tyramine to push blood pressure up on moclobemide than on phenelzine. If you take moclobemide, it is still worth checking with the doctor who manages your antidepressant before starting ginseng.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Phenelzine?
There is a single published case report of an interaction between ginseng and the MAOI phenelzine. It is a short letter with no abstract we can check, so we do not repeat the symptoms often quoted from it, and a later systematic review records only that the two may interact. The reason is not understood, but ginseng has mild stimulant-like effects on the nervous system that can clash with MAOIs. If you take phenelzine, do not start ginseng without talking to the doctor who manages your antidepressant.
Evidence: Limited human data, from small studies or case reports, alongside a known mechanism.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Selegiline?
Ginseng has been reported to clash with the older MAOI phenelzine. Selegiline is a more selective MAOI, so the concern is weaker, but ginseng's mild stimulant-like effects could still add up. If you take selegiline, check with the doctor who prescribed it before starting ginseng.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Tranylcypromine?
If you take tranylcypromine, discuss ginseng with your prescriber rather than starting it on your own: panax ginseng has been linked to a reaction in a single case report involving the MAOI phenelzine, and that report is a short letter with no abstract we can check, so we do not repeat the symptoms usually quoted from it; tranylcypromine is the same drug class, so it is worth caution.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Green Does interact with Rasagiline?
The ginseng and MAOI caution comes from a single old case report involving phenelzine, an MAOI that blocks the enzyme handling blood-pressure-raising amines, and rasagiline at its licensed Parkinson's dose blocks a different form of that enzyme, so we treat this pair as safe to combine. In human tyramine challenge tests people taking rasagiline did not develop the blood pressure rises seen with the older MAOIs, which is why rasagiline is prescribed without the dietary restrictions those drugs require. Keep to the dose your neurologist set, because that selectivity belongs to the licensed dose rather than to the drug at any dose.
Evidence: Supported by human study data.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive sympathomimetic activity
Amber Does interact with Dexamfetamine sulfate?
Panax ginseng has a mild stimulant-like effect on the nervous system, so taking it alongside dexamfetamine could add to that stimulation. In practice that might mean more trouble sleeping, jitteriness or a faster heartbeat. This has not been tested directly, so it is a cautious flag rather than a strong warning. If you take dexamfetamine, it is worth telling the doctor who manages it before you start ginseng, and keeping an eye on your sleep, restlessness and heart rate.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Lisdexamfetamine dimesylate?
Panax ginseng has a mild stimulant-like effect on the nervous system, so taking it alongside lisdexamfetamine could add to that stimulation. In practice that might mean more trouble sleeping, jitteriness or a faster heartbeat. This has not been tested directly, so it is a cautious flag rather than a strong warning. If you take lisdexamfetamine, it is worth telling the doctor who manages it before you start ginseng, and keeping an eye on your sleep, restlessness and heart rate.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Methylphenidate hydrochloride?
Panax ginseng has a mild stimulant-like effect on the nervous system, so taking it alongside an ADHD stimulant like methylphenidate could add to that stimulation. In practice that might mean more trouble sleeping, jitteriness or a faster heartbeat. This has not been tested directly, so it is a cautious flag rather than a strong warning. If you take methylphenidate, it is worth telling the doctor who manages it before you start ginseng, and keeping an eye on your sleep, restlessness and heart rate.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
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