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Panax ginseng has real stimulant properties and can cause nervousness, insomnia, and headaches, especially combined with caffeine or other stimulants. It may decrease the effectiveness of warfarin and has a theoretical bleeding-risk interaction with other blood thinners. Combined with MAOI antidepressants (like phenelzine), it has caused manic-like symptoms in case reports — do not combine the two. It can lower blood sugar and cause additive hypoglycemia with diabetes medications, including insulin. Traditional contraindications include high blood pressure, acute asthma, acute infections, and nosebleeds or heavy menstrual bleeding. Reported hormone-related effects (breast tenderness, vaginal bleeding) mean caution is warranted alongside hormone therapy. Avoid taking late in the day if it disrupts sleep.
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