Meta Information
ID:centella-asiatica
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
High doses or prolonged use of Centella asiatica have been associated with hepatotoxicity in rare case reports. Its use is contraindicated in individuals with pre-existing liver disease as it may exacerbate the condition.
Actionable advice:
This should be strictly avoided with any form of liver disease.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We present three women (61, 52 and 49 years old) who developed jaundice after taking Centella asiatica for 30, 20 and 60 days.
Label source:
PubMed: Revista espanola de enfermedades digestivas (2005)
Source url:
Exact phrase from label:
The present review focusses on a few herbs such as Aloe barbadensis, Atractylis gummifera, Centella asiatica, Mitragyna speciosa, Morinda citrifolia, Larea tridentata, Symphytum officinale, Teucrium chamaedrys and Xanthium strumarium, which are reported to cause hepatotoxicity in humans and animals.
Label source:
PubMed: Natural product communications (2015)
Source url:
Exact phrase from label:
This review also highlights the importance of the upcoming liver toxicity profiles associated with other traditional herbs used as dietary supplements, such as Centella asiatica (L.) Urb., Garcinia cambogia Desr., Cassia angustifolia Vahl (Indian senna), and Morinda citrofolia L. (Noni fruit).
Label source:
PubMed: Medicine (2024)
Action type:
avoid
Target id:
/procedure/surgery
Target name:
Scheduled Surgery
Severity:
major
Interaction type:
adverse
Nature:
temporal
Temporal spacing:
Hours before target:
336
Hours after target:
null
Description:
Centella asiatica may have sedative, blood-sugar-lowering, and potential antiplatelet effects, which can interfere with anesthesia, glucose control, and increase bleeding risk during and after surgery.
Actionable advice:
Use should be discontinued at least 2 weeks prior to any scheduled surgical procedure.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Herbal medication use continues to rise and interactions with existing medications propose risks and may have significant effects and consequences on the administration of anesthesia. The purpose of this study was to investigate the anxiolytic and antidepressant effects of asiatic acid and its potential modulation of the γ-aminobutyric acid (GABAA) receptor.
Label source:
PubMed: AANA journal (2015)
Source url:
Exact phrase from label:
C. asiatica is a traditional medicinal plant used due to its antimicrobial, antioxidant, anti-inflammatory, neuroprotective, and wound healing properties.
Label source:
PubMed: International journal of environmental research and public health (2022)
Source url:
Exact phrase from label:
All patients were also treated with antiplatelet agents.
Label source:
PubMed: Angiology (2001)
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
There is insufficient safety data regarding the oral use of Centella asiatica during pregnancy. Due to a lack of evidence and traditional use in some cultures as an abortifacient, it should be avoided.
Actionable advice:
This should not be taken orally during pregnancy.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
NatMed Pro Monograph: Gotu Kola
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if the active compounds in Centella asiatica are excreted into breast milk or what effects they might have on a nursing infant. Its use is not recommended.
Actionable advice:
Oral use should be avoided while breastfeeding.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
The study also recommends avoiding the use of the herb while breastfeeding.
Label source:
Anecdotal: Medical News Today
Action type:
avoid
Target id:
/class/cns-depressants
Target name:
Sedatives and Hypnotics
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Centella asiatica can cause drowsiness and has mild sedative properties. Combining it with other central nervous system depressants can lead to additive effects, causing excessive sedation, dizziness, and impaired motor function.
Actionable advice:
This is best used with caution, and it is important to talk to a healthcare provider before combining it with any sedating medications or supplements.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Centella asiatica (L.) Urb. (Apiaceae) is a renowned medicinal plant being used in the Ayurvedic system for its pharmacological effects on the central nervous system such as rejuvenating, sedative, anxiolytic and memory-enhancing properties.
Label source:
PubMed: Annals of medicine (2023)
Source url:
Exact phrase from label:
Exposure to CA extract was able to improve the sleep activity of zebrafish larvae insomnia model by extending the total inactivity time ( cumulative duration) and shortening the duration of first sleep ( latency to first) in light and dark phases through inhibition of orexin, ERK, p38, and Akt.
Label source:
PubMed: F1000Research (2024)
Source url:
Exact phrase from label:
At the present time, clinical studies aimed at investigating the sedative, analgesic, antidepressive, antimicrobial, antiviral and immunomodulatory effects that have been demonstrated experimentally, are still lacking.
Label source:
PubMed: Phytomedicine : international journal of phytotherapy and phytopharmacology (2000)
Action type:
informational_none
Target id:
/class/benzodiazepines
Target name:
Benzodiazepines
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The anxiolytic and sedative effects of Centella asiatica may be amplified when taken with benzodiazepines, increasing the risk of excessive drowsiness, confusion, and impaired coordination.
Actionable advice:
This combination is best avoided unless under medical supervision; driving or operating heavy machinery is best avoided.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Flumazenil decreased the anxiolytic effects, suggesting that AA modulates the benzodiazepine site on the GABAA receptor.
Label source:
PubMed: AANA journal (2015)
Source url:
Exact phrase from label:
The present study aims to demonstrate the anxiolytic effect of ECa 233, a standardized extract of C. asiatica containing triterpenoids not less than 80%, in comparison to diazepam.
Label source:
PubMed: Journal of ethnopharmacology (2012)
Action type:
avoid
Target id:
/class/antidiabetic-medications
Target name:
Diabetes Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Animal and some preliminary human studies suggest that Centella asiatica may lower blood glucose levels. This can enhance the effects of antidiabetic drugs, increasing the risk of hypoglycemia (dangerously low blood sugar).
Actionable advice:
Blood glucose levels are best monitored very closely if combining, and it is important to consult a doctor about potential dose adjustments.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Intervention: When such drugs are administered to a patient receiving metformin hydrochloride, observe the patient closely for loss of blood glucose control.
Label source:
Action type:
adjust_with_prescriber
Target id:
/class/hepatotoxic-agents
Target name:
Hepatotoxic Medications
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Given the rare potential for liver injury with high-dose or long-term Centella asiatica use, combining it with other substances known to be hard on the liver (e.g., high-dose acetaminophen, certain antifungals, excessive alcohol) could increase the cumulative risk.
Actionable advice:
Concurrent use with other potentially liver-toxic drugs or substances is best avoided without medical guidance.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
We present three women (61, 52 and 49 years old) who developed jaundice after taking Centella asiatica for 30, 20 and 60 days.
Label source:
PubMed: Revista espanola de enfermedades digestivas (2005)
Source url:
Exact phrase from label:
The present review focusses on a few herbs such as Aloe barbadensis, Atractylis gummifera, Centella asiatica, Mitragyna speciosa, Morinda citrifolia, Larea tridentata, Symphytum officinale, Teucrium chamaedrys and Xanthium strumarium, which are reported to cause hepatotoxicity in humans and animals.
Label source:
PubMed: Natural product communications (2015)
Source url:
Exact phrase from label:
This review also highlights the importance of the upcoming liver toxicity profiles associated with other traditional herbs used as dietary supplements, such as Centella asiatica (L.) Urb., Garcinia cambogia Desr., Cassia angustifolia Vahl (Indian senna), and Morinda citrofolia L. (Noni fruit).
Label source:
PubMed: Medicine (2024)
Action type:
avoid
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulants and Antiplatelets
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
In-vitro studies suggest that components of Centella asiatica may have a mild inhibitory effect on platelet aggregation. This creates a theoretical risk of increased bleeding when combined with blood-thinning medications.
Actionable advice:
This is best used with caution, and it is worth monitoring for signs of increased bruising or bleeding when taking blood thinners.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Because bleeding risk is increased when these drugs are used concomitantly with warfarin, closely monitor patients receiving any such drug with warfarin.
Label source:
Action type:
monitor
Target id:
/class/diuretics
Target name:
Diuretics (Water Pills)
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Centella asiatica may possess mild diuretic properties. Taking it alongside prescription diuretics could have an additive effect, potentially increasing the risk of dehydration or electrolyte imbalance.
Actionable advice:
Adequate fluid and electrolyte intake may help when combining, along with cautious use.
Validation status:
validated_via_clinical_guidance
Evidence tier:
tier_b
Evidence basis:
clinical_guidance_verbatim
Evidence anchors:
Exact phrase from label:
Diuretics (water pills): Gotu kola seems to act like a diuretic, meaning it helps the body get rid of excess fluid. Taking diuretic medications and gotu kola could cause your body to lose too much fluid, upsetting the balance of electrolytes you need.
Label source:
Clinical guidance: A.D.A.M. Medical Encyclopedia — Gotu kola complementary medicine monograph
Action type:
informational_none
Target id:
/class/cyp3a4-substrates
Target name:
CYP3A4 Substrates
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Preclinical (in-vitro) data suggests Centella asiatica may weakly inhibit or induce the CYP3A4 enzyme. This could theoretically alter the metabolism of numerous common medications, though the clinical significance in humans is unknown.
Actionable advice:
This theoretical interaction is worth keeping in mind when taking multiple medications; consulting a pharmacist for guidance may help.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Blood pressure should be closely
monitored when Amlodipine is co-administered with CYP3A4 inducers.
Label source:
Action type:
informational_none
Target id:
/class/cyp2c9-substrates
Target name:
Drugs Metabolized by CYP2C9
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Some in-vitro research indicates a potential for Centella asiatica to weakly interact with the CYP2C9 enzyme. This could theoretically affect levels of drugs like warfarin or certain NSAIDs, but this has not been confirmed in humans.
Actionable advice:
This is best used with caution when taking medications metabolized by CYP2C9, and it is worth talking to a pharmacist.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CYP2C9, a polymorphic enzyme, is likely to be the principal form of human liver CYP450 that modulates the in vivo anticoagulant activity of warfarin.
Label source:
Action type:
informational_none
Target id:
/class/cyp2d6-substrates
Target name:
CYP2D6 Substrates
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Preclinical studies suggest Centella asiatica might weakly influence the CYP2D6 enzyme, which could theoretically alter the metabolism of certain antidepressants, beta-blockers, and opioids. Clinical relevance remains uncertain.
Actionable advice:
This theoretical interaction is worth keeping in mind when taking medications metabolized by CYP2D6.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Bupropion inhibits the metabolism of dextromethorphan
via CYP2D6.
Label source:
Action type:
informational_none
Target id:
/circadian/sleep
Target name:
Going to Sleep
Severity:
minor
Interaction type:
synergistic
Nature:
temporal
Temporal spacing:
Hours before target:
2
Hours after target:
null
Description:
Due to its potential mild sedative and anxiolytic (anxiety-reducing) properties, taking Centella asiatica in the evening may align with its calming effects and support sleep readiness without causing significant next-day drowsiness.
Actionable advice:
Consider taking your daily dose in the evening, approximately 1-2 hours before your intended bedtime.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
The EPM test revealed that Gotukola, its methanol and ethyl acetate extracts as well as the pure asiaticoside, imparted anxiolytic activity. Furthermore, the asiaticoside did not affect locomotor activity, suggesting these compounds do not have sedative effects in rodents.
Label source:
PubMed: Phytomedicine : international journal of phytotherapy and phytopharmacology (2006)
Source url:
Exact phrase from label:
The present study demonstrated anxiolytic effect of ECa 233 in both acutely and chronically stressed animals. These effects could be mainly accounted by madecassoside and asiaticoside, suggesting a possible use of ECa 233 for the treatment of both acute and chronic anxiety in the pathological state.
Label source:
PubMed: Journal of ethnopharmacology (2012)
Source url:
Exact phrase from label:
Exposure to CA extract was able to improve the sleep activity of zebrafish larvae insomnia model by extending the total inactivity time ( cumulative duration) and shortening the duration of first sleep ( latency to first) in light and dark phases through inhibition of orexin, ERK, p38, and Akt.
Label source:
PubMed: F1000Research (2024)
Action type:
separate
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
minor
Interaction type:
informational
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking Centella asiatica with food can help minimize the risk of mild gastrointestinal side effects, such as nausea or stomach upset, which can occur in sensitive individuals.
Actionable advice:
It is generally best taken with a meal or a small snack to improve gastrointestinal tolerability.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
CA was well tolerated; mild, transient gastrointestinal symptoms were most common (5/34, 14.7%).
Label source:
PubMed: Frontiers in pharmacology (2025)
Source url:
Exact phrase from label:
The administration was 2 capsules after meal, three times a day (50 mg of extracted asiaticoside / capsule in group A).
Label source:
PubMed: Journal of the Medical Association of Thailand = Chotmaihet thangphaet (2010)
Source url:
Exact phrase from label:
Most plant nootropics must be taken at optimal doses for extended periods before measurable improvement occurs, but they are generally very well tolerated.
Label source:
PubMed: Plants (Basel, Switzerland) (2023)
Action type:
informational_none