Side effects from Tongkat Ali range from mild to severe. Gain more awareness of the side effects and how you can avoid those risks.
Side effects of Tongkat Ali affect less than 1% of Tongkat Ali users around the world. According to public records, there are no severe side effects that lead to hospitalization, or death caused by taking pure 100% Tongkat Ali extract in the last 20 years.
However, users taking Tongkat Ali supplements by Huberman Lab or Nootropics Depot reported irritability, insomnia, nausea, headaches, swollen testes and others; a clear signal of the side effects of Tongkat Ali.
Most of the reported side effects of Tongkat Ali are from users who have bought US-made Tongkat Ali supplements, which may contain adulterants, contaminants, impurities, binder and allergens. Indonesian Tongkat Ali extracts sold in the US add to the rising concerns amongst users who experience constant headaches, nausea and vomitting.
This article shares the common side effects of Tongkat Ali, its severity and their likelihood of occurrence, and ways to mitigate those risks.
Here is the list of possible side effects that users may experience from Tongkat Ali. The list of Tongkat Ali side effects in the article is categorized based on the likelihood of occurrence and the severity of the side effects.
Tongkat Ali Side Effects | Risk Level
| Severity (Mild, Moderate, Severe) |
Loss
| High Unlikely (Extremely Rare)
| Mild |
Nausea
| Unlikely (Frequent)
| Mild |
Heart
| Highly Unlikely (Extremely Rare)
| Moderate |
Restlessness
| Likely (Rare)
| Mild |
Insomnia
| Likely (Rare)
| Mild |
Anxiety & Panic Attacks | Unlikely (Rare)
| Moderate
|
Fatigue | Unlikely (Rare)
| Mild
|
Skin Rash | Highly Unlikely (Extremely Rare)
| Mild |
Diarrhea | Highly Unlikely (Extremely Rare)
| Mild
|
High / low blood sugar | Highly Unlikely (Extremely Rare)
| Mild |
Liver | Highly Unlikely (Extremely rare)
| Mild
|
Heart Palpitations | Unlikely (Extremely
| Mild |
Tongkat Ali reported side effects range from mild to severe headaches, irritability, insomnia, elevated heart rate, anxiety, and gastrointestinal issues such as nausea and diarrhea that are caused by adulterants, impurities, allergens or preservatives. The addition of excessive maltodextrin in Tongkat Ali extract or capsules may cause side effects such as gastrointestinal symptoms, such as gas and diarrhea, vomiting and others. Other rare but severe side effects may include changes in blood pressure, changes in blood sugar levels, and liver toxicity.
“Those taking standardized Tongkat Ali supplements that are clinically tested usually reported almost minimal to no side effects due to higher purity, lower toxicity and zero contaminations from mercury, arsenic and lead.” said Dr. Annie George from Biotropics.
Herbal experts believe that common Tongkat Ali side effects such as headaches, diarrhea, feeling jittery or heart palpitation could be caused by impurities when using ethanol as a solvent during the extraction process.
If you experience side effects such as headaches, diarrhea, cramps, bloating, or nausea, chances are you may have bought a Tongkat Ali supplement that contains excessive amounts of maltodextrin, or worst, higher mercury levels and other toxic chemicals from ethanol-based extract.
Despite the use of maltodextrin in Tongkat Ali is regarded as safe by USFDA, many manufacturers have abused the use of maltodextrin as a binder/filler in addition to sourcing low-quality Tongkat Ali extract from Indonesia which contributed to the growing list of side effects of Tongkat Ali.
You may feel “full”, less hungry and eat less as a result of taking Tongkat Ali. This happens after a few weeks and the sudden “loss of appetite” can sometimes be misconstrued as a negative side effect. The thermogenic properties of Tongkat Ali enable you to burn fat more efficiently and this could be the cause of you feeling less hungry. In addition, Tongkat Ali reduces your cortisol (i.e stress hormone), thus preventing emotional eating or overeating habits.
Loss of appetite may lead to gradual weight loss and should not be categorized as a side effect that you should be worried about. The likelihood of it occurring is high amongst active adults, elite athletes and those who are exercising / training regularly.
Likelihood: Common
You may experience dizziness and nausea which may be caused by impurities, adulterants and addition of high amount of fillers (eg: maltodextrin) in Tongkat Ali capsules – a filler that is commonly found in lower-quality Tongkat Ali supplements. This side effect usually reduces and goes away after a few days. However, if the symptoms persist, or if you experience an allergic or toxic reaction to Tongkat Ali, please consult your doctor or medical professionals for further advice.
Likelihood : Rare
Heart palpitations are uncommon when taking Tongkat Ali. It happens to those taking high doses of Tongkat Ali (i.e > more than 800mg) for the first time, more so or if the Tongkat Ali extract is filled with excessive maltodextrin or other adulterants.
Tongkat Ali is known to relax the blood vessels in your aortic rings, causing increased blood flow while its thermogenic properties are known to increase metabolism in your body.
Consumers with chronic high blood pressure or those with pre-existing heart conditions are advised to consult with their doctors before consuming Tongkat Ali.
Likelihood: Rare
Tongkat Ali may cause restlessness if you have chronic ADHD or undiagnosed anxiety although it is very uncommon to most people. Tthe feeling of being jittery or restless is commonly associated as a side effect of taking Tongkat Ali. The level of restlessness may vary according to individuals and users are cautioned against taking a high dose of Tongkat Ali (i.e more than 600mg) in the first few weeks – even if you consider yourself as an active healthy adult.
Sports athletes who are exercising or training regularly may not experience restlessness even when taking Tongkat Ali at high doses (below 1,000mg).
Likelihood: Common among people who are sensitive to the effect of alkaloids (caffeine), or psychoactive substances.
Despite studies showing that Tongkat Ali improves sleep quality, Tongkat Ali may cause mild insomnia for those who are intolerant to alkaloids or caffeine/tea or sensitive to psychoactive substances or stimulants.
Tongkat Ali contains a family of alkaloids that contribute to mental alertness (and focus) and this may cause insomnia-like experience to users if taken in high dosages (i.e typically above 200mg). A strong indication of insomnia is the inability to sleep, feeling restless despite being extremely exhausted after a long day. If you are mentally fresh and alert in the evening after taking Tongkat Ali, then this may not be related to insomnia – but more of having that spare “battery” / energy to fuel up your evening or late night.
If you have mild, undiagnosed insomnia or worried about sleeping late after midnight, you should avoid taking Tongkat Ali 5 hours before bedtime, and reduce your consumption of coffee or tea when taking Tongkat Ali.
Likelihood: Common among people who are sensitive to the effect of alkaloids (caffeine), or psychoactive substances.
Related article: Does Tongkat Ali improve sleep quality?
Tongkat Ali has calming effects to those who has anxiety due to its effect of reducing stress hormone (cortisol), so therefore it rarely causes anxiety.
However, Tongkat Ali contains alkaloids that may trigger feelings of anxiety and panic if it is consumed in extremely high dose (eg: 600mg or 1,000mg) in a single intake.
Because Tongkat Ali raises dopamine (happy hormones) too, you may feel depressed – a sign of withdrawal side effect if stop taking Tongkat Ali.
If you are easily anxious or diagnosed with chronic anxiety, you may experience “a panic attack” for the first time after taking Tongkat Ali – and it may fade away after few hours.
For first-time users, it is advisable to take Tongkat Ali in low doses (200mg or less) for the first few days before increasing your dose to allow your body to adjust to this minor setback (if required).
Likelihood: Rare
It is reported that Tongkat Ali that produces more fatigue on those experiencing chronic fatigue syndrome. However, this reported side-effect is extremely rare as multiple clinical studies in the last 20 years showed that Tongkat Ali raises testosterone, energy and stamina.
There are no reported cases of extreme fatigue from taking Tongkat Ali in public records, medical reports, or other published studies. Therefore the risk of experiencing fatigue or feeling weak after taking Tongkat Ali is very low.
Likelihood: Extremely Rare
Some people experience skin rashes after using Tongkat Ali although the likelihood is extremely rare. This side effect could be potentially due to allergy and other hormone imbalance.
If you develop a rash or other unexplained skin symptoms, discontinue use of Tongkat Ali and speak with your doctor.
Likelihood: Extremely Rare
Tongkat Ali may cause diarrhea or abdominal pain if you have a sensitive stomach, or when consumed in high doses. However, it is very uncommon if you are taking a standardized hot water Tongkat Ali extract, with 0.1% cases reported in the last 10 years.
As reported by EFSA study on animals, high Tongkat Ali doses may lead to localized DNA damage on stomach and duodenum tissue. It is advisable to stop taking Tongkat Ali if you have frequent diarrhea to ensure the extract is not contaminated with impurities and other contaminants. However, there are no reported adverse side effects from clinical studies showing DNA damage on humans.
Likelihood: Extremely Rare
In extremely rare occasions, some users may experience urinary problems and/or edema (water retention) after taking Tongkat Ali. For 99.9% of the users who took Tongkat Ali, there have been no reported cases of water retention or urinary infections or problems.
The issue of water retention may be caused by drug interactions when taking non-standardized Tongkat Ali extract or when the supplement is not 3rd party lab tested for toxicity, allergen or other safety standards.
Taking generic 200:1 Tongkat Ali extract (notably from Black Tongkat Ali) or those from unreputable brands or suppliers may cause swelling in the hands, feet, and legs.
Likelihood: Extremely Rare
Tongkat Ali lowers your blood sugar levels in diabetic patients or those who are pre-diabetic by improving insulin resistance. However, it will not cause your blood sugar levels to drop below the normal range (i.e hypoglycemia) for most healthy adults.
Low blood sugar level is not a side effect of Tongkat Ali that one should be worried about, but if you are insulin resistant or diagnosed with type 2 diabetes, then please take extra precautions and refrain from taking higher than 200mg of Tongkat Ali daily.
It is important to monitor your blood glucose while taking Tongkat Ali with other vitamins or herbs if you are diagnosed with hypoglycemia, or symptoms associated with low blood sugar levels.
Likelihood: Extremely Rare
Present studies from human clinical trials showed taking Tongkat Ali root extract did not affect the liver and kidneys. However, Tongkat Ali containing adulterants, impurities and steroids or taking Tongkat Ali with other herbs may cause acute liver injuries, increasing the risks of jaundice and liver cirrhosis. The risks of Tongkat Ali-induced liver injuries are extremely low. For example, there is a rare case reported in 2024 by a 47-year-old healthy adult who was diagnosed with elevated liver enzymes and jaundice after consuming Tongkat Ali which is not 3rd party lab-tested. Against the backdrop of millions of Tongkat Ali users, the probability of it causing liver or kidney injury is very low.
In addition, a randomized clinical study on Tongkat Ali root extract based on 400 mg per day did not produce toxic effects on the kidneys and liver.
However, if you have pre-existing medical conditions such as kidney disease, Acute Kidney Injury (AKI) or liver disease, it is recommended to avoid taking Tongkat Ali supplements to avoid any long term side effects on liver and kidneys.
Likelihood: Extremely Rare
Related article: Analysis of the effects of Tongkat Ali on liver and kidneys.
There have been reports on Reddit that Tongkat Ali produces heart palpitations. Health experts warned that heart palpitations from Tongkat Ali is a side effect that may be caused by adulterants, steroids, magnesium or zinc in excessive quantity.
Although this side effect is rare and never been officially reported to health authorities, the feeling of your heart beating rigorously may to do with the blood being pumped and circulated in your body faster than usual.
It will usually fade away after a few hours. This side effect is often mixed with a feeling of jittery or restlessness, especially if you are taking it for the first time.
If you are experiencing this side effect, the best way to reduce heart palpitations is to reduce the dosage to a minimum.
Likelihood: Rare
Majority of the side effects of Tongkat Ali affects a small number of users who may be diagnosed with underlying medical conditions or those who are sensitive to alkaloids, quassionoids, terpenoids. Generally, most side effects such as feeling jittery, mild nausea, headaches or frequent urination may go away after few days and are non-toxic or harmful to health.
However, if you are buying low quality Tongkat Ali extracts that are filled with impurities, allergens or adulterants (eg: maltodextrin or fillers), you may experience frequent headaches, recurring nausea, frequent diarrhea or occasional vomiting.
If severe side effects occur, please stop taking Tongkat Ali as it may contain impurities or excessive heavy metals due to the extraction technique or poor quality sourcing issues.
Users must take precautions to reduce the risk of side effects when taking Tongkat Ali. There are factors that you can avoid that contribute to the side effects such as:
Dr. Annie George, a lead scientist with 20 papers published on Tongkat Ali said “Adulterants, contaminants, and impurities are major contributors that cause mild to severe side effects when taking Tongkat Ali”.
Users are cautioned against buying lab-tested Tongkat Ali extracts that are not clinically tested. Clinically tested Tongkat Ali products are considered superior with fewer side effects compared to generic lab-tested Tongkat Ali products due to their purity without being contaminated by allergens or heavy metals.
Find out more about the root cause of these side effects and how you can avoid those risks.
Based on the genotoxicity and toxicology studies on Tongkat Ali based on average consumption of 200mg to 400mg daily showed no negative side effects on liver function, kidneys and may not be toxic to your DNA. It means, Tongkat Ali is relatively safe and non-toxic when consumed in low dosages. In addition, other acute side effects such as headaches or nausea may not be toxic or cause any harm.
Whilst the genotoxicity animal study showed that the recommend human dose (500mg per 60kg of human body weight) may not damage your DNA, taking high dose of Tongkat Ali at 1,940mg per single serving (based on 60kg of human weight) may be toxic. Users are recommended to take Tongkat Ali in low dosage of less than 1,000mg per day to prevent any risks associated with long-term DNA damage. This warrants further research on the long-term safety of Tongkat Ali when taken at high dosages.
You may choose to buy hot-water Tongkat Ali extract that adheres to the Tongkat Ali standards, known as the Malaysian Tongkat Ali standards, which is reported to have few side effects based on our customer survey carried out on 1,300 customers.
To further minimize the risk of side effects from Tongkat Ali, it is recommended to consult with a healthcare provider before taking the supplement and to monitor for any adverse reactions if you are already taking Tongkat Ali.
Here is what you should do if you suffer any adverse side effects from Tongkat Ali:
There are 26 drug interaction studies on Tongkat Ali. Tongkat Ali may also interact with certain medications, such as blood thinners, hypertension and diabetes medications.
Medicinal drugs such as propranolol may cause side effects when taken with Tongkat Ali.
Tongkat Ali interacts with propranolol; medicine to treat heart problems, hypertension, help with anxiety and prevent migraines. It may cause mild side effects or any side-effect symptoms indicated in this article.
A placebo-controlled randomized study published in the Journal of Clinical Pharmacy and Therapeutics found that using propranolol with Tongkat Ali did not affect changes in heart rate or blood pressure.
Propranolol is also known as other names (brands) such as Hemangeol, Inderal, Inderal LA, Inderal XL, InnoPran XL, Propranolol HCl Intensol.
Reference: Salman et.al, Journal of Clinical Pharmacy and Therapeutics (2010)
What should I do?
The side effects of Tongkat Ali may occur such as insomnia if you are taking higher than recommended dosage, more so if the Tongkat Ali extract contains impurities or adulterants such as excessive maltodextrin or synthetic steroids.
According to a study in Molecules and Healthline, the recommended dosage for Tongkat Ali is between 200 to 400 milligrams per day. Although this may not guarantee users from any negative side effects, users are cautioned against consuming Tongkat Ali supplements that are not 3rd party lab-tested or brands that use ethanol extract to reduce the chances of nausea, vomitting or frequent headaches.
Assuming you are taking standardized hot water pure Tongkat Ali extract without mixing it with other medications or herbs, you will be likely to experience zero side effects, even at a higher dose of 400mg daily.
The long-term side effects of taking Tongkat Ali have not been well established or documented. However, users are warned not to take Tongkat Ali in high doses, or exceed the safety limits of 30,000mg/kg bodyweight to avoid kidney damage or liver damage. The consensus on the safety dosage limit is 1,000mg per day which is relatively safe for long-term use.
Please consult your doctor if you are taking Tongkat Ali long term, or before you consume any Tongkat Ali products or supplements.
Warnings
Users should be aware that not all Tongkat Ali supplements are created equal, and the quality and purity of Tongkat Ali extract are determining factors that contribute to the list of side effects.
To reduce the likelihood of side effects of Tongkat Ali, it is recommended to use quality Tongkat Ali products that have been extensively clinically tested on humans (both men and women) and lab-tested for toxicity. Please consult your physician or healthcare professionals if you are using other medications with Tongkat Ali.
Ask us if you have any questions, or if you are reporting on adverse side-effects related to Tongkat Ali.
Our experts do not provide any medical advice. Please consult your nearest doctor, physician, or healthcare professional for advice on side effects related to Tongkat Ali consumption, usage and supplementation.
The side effects of Tongkat Ali can range from mild to severe, but in most cases, users will experience mild headaches or nausea that will go away due to the impurities that are widely found in major Tongkat Ali brands sold in the US. This is due to the practice of sourcing low-quality extracts from Indonesia that are filled with impurities and adulterants.
Other severe side effects of Tongkat Ali such as cramping, bloating, vomiting, and diarrhea are rare but may happen if you are taking Tongkat Ali supplements that are filled with excessive amounts of maltodextrin and rice fillers.
You may experience fewer or virtually no side effects from premium Tongkat Ali extracts that are sourced from pure root extract using hot water technology. Always look out for clinically tested Tongkat Ali supplements to reduce the chances of side effects as they conform to high-quality manufacturing and safety standards.
Naressa Khan contributes regularly on AKARALI. As a writer and journalist, Naressa is all about creating, deconstructing, and reassembling meanings through words. With this approach always in mind, she eagerly explores the nuances in life via the aspects of lifestyle, culture, travel, health, and wellness.
Our articles are third party reviewed by our panel of experts and medical advisors to ensure the facts are accurate and credible. These are validated against multiple source references which include but not limited to research studies, peer-reviewed journals, pre-clinical studies, clinical tests and other credible publications.
Our panel of medical advisors and experts are highly experienced in their individual fields. However, they do not provide any medical advice or recommendations arising from content published in this article.
