Ginseng

Aka: Ginseng, Panax ginseng, Panax

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II. Mechanism

  1. Panax is a genus of slow growing perennials of the northern hemisphere (family Araliaceae)
    1. Panax is the source of Ginseng, as well as other pharmacologically active agents
    2. Used in traditional medicine (esp. chinese medicine), including as an "adaptogen" in times of stress
  2. Different effects seen with each species of Ginseng
    1. Panax ginseng is most studied
    2. Marketed as fresh, red or white depending on processing
  3. Commercial products are often a mix of species
    1. Asian Ginseng or Korean Ginseng (Panax ginseng)
    2. Siberian Ginseng (Eleutherococcus)
    3. American Ginseng (Panax quinquefolius)
  4. Active ingredient: Ginsenosides (triterpene saponins)
    1. Active at Hypothalamus-Pituitary-Adrenal Axis
    2. Immune activity (Phagocytosis, Natural Killer Cell)
    3. Vasodilation
    4. Hypoglycemic activity

III. Efficacy

  1. May improve immune function
    1. Scaglione (1996) Drugs Exp Clin Res 22:65-72 [PubMed]
  2. May reduce the risk of acute respiratory infection when taken for 3 months
    1. Lee (2012) J Korean Med Sci 27(12):1472-8 +PMID: 23255845 [PubMed]
  3. Mixed results on cognitive function and memory
    1. Geng (2010) Cochrane Database Syst Rev (12):CD007769 +PMID: 21154383 [PubMed]
    2. Zeng (2024) Phytother Res 38(12):6023-34 +PMID: 39474788 [PubMed]
  4. Appears effective in improving psychologic functioning
    1. Variable effects in studies
    2. Wiklund (1999) Int J Clin Pharmacol Res 19:89-99 [PubMed]
  5. Minimal improvement in sexual function and Erectile Dysfunction compared with Placebo
    1. Lee (2021) Cochrane Database Syst Rev 4(4):CD012654 +PMID: 33871063 [PubMed]
  6. No benefit for physical performance (e.g. Running times)
    1. Bahrke (2000) Sports Med 29:113-33 [PubMed]
  7. Highly valued in Chinese culture
  8. No standardization of products commercially available
  9. Folk uses (Described as tonic or adaptogen)
    1. Strengthen normal body functions
    2. Assist with resisting stress
    3. Weight loss or weight gain

IV. Contraindications

  1. Hypertension
  2. Asthma
  3. Bleeding Disorder

V. Adverse Effects

  1. Lowers Blood Glucose levels (Hypoglycemic effect)
    1. Occurs in both those with and without Diabetes Mellitus
    2. Effect may be additive with Oral Hypoglycemics and Insulin
  2. Possible Platelet inhibitory effect
  3. Hypertension
  4. Nausea
  5. Diarrhea
  6. Insomnia
  7. Headaches

VI. Dosing: Doses used in studies

  1. Panax ginseng extract 200 mg orally daily
  2. Longterm, continuous use (>6 months) is not recommended due to adverse effect risk (see above)

VII. Drug Interactions

  1. CYP3A4 Inducer (Asian Ginseng)
    1. May lower affected drug levels and related drug efficacy
  2. Warfarin (American Ginseng)
    1. May lower INR
  3. Diabetes Mellitus agents
    1. See adverse effects above
    2. Risk of Hypoglycemia
  4. Digoxin
    1. Risk of Digoxin Toxicity by raising Digoxin serum levels
    2. McRae (1996) CMAJ 155:293-5 [PubMed]

VIII. Safety

  1. Discontinue at least 7 days before surgery
  2. Avoid in pregnancy
    1. Teratogenic in animal studies
  3. Avoid in Lactation
    1. Unknown safety

IX. References

  1. (2025) Presc Lett 32(4): 24
  2. Ang-Lee (2001) JAMA 286:208-16 [PubMed]
  3. Cupp (1999) Am Fam Physician 59(5):1239-44 [PubMed]
  4. Kiefer (2003) Am Fam Physician 68:1539-42 [PubMed]
  5. Shaughnessy (1997) Fam Practice Recert 19(10):53-6 [PubMed]

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