Abstract
Ashwagandha (Withania somnifera) is a widely used adaptogenic supplement promoted for stress reduction and general wellness. Although generally well tolerated, rare but clinically significant adverse events have been documented. We report a case of acute neurotoxicity in a 40-year-old man temporally associated with ashwagandha ingestion. The patient presented with prolonged sleep, abnormal sleep behaviours, acute confusion, and retrograde amnesia. Comprehensive diagnostic evaluation excluded alternative causes. Discontinuation of ashwagandha, along with supportive management, resulted in complete symptom resolution. The underlying pathophysiology may involve GABAergic modulation mediated by withanolides, with interindividual variability in drug metabolism contributing to susceptibility. This case highlights the importance of clinician awareness regarding potential neuropsychiatric complications of herbal supplements and underscores the need for careful patient counselling about their use and possible drug interactions.