Tongkat Ali (Eurycoma longifolia) is a traditional Southeast Asian herb commonly used in men’s health supplements. As its popularity grows, many people are asking the same questions: What are the side effects of Tongkat Ali? Is it safe to take every day? Can it affect the liver or blood pressure?
Short-term human studies using certain standardized Tongkat Ali extracts have generally reported good tolerability. However, this does not mean that every extract, dose or long-term use pattern has been proven safe.
Research on long-term use, medication interactions and use in people with existing health conditions remains limited. There have also been isolated reports of possible liver injury associated with Tongkat Ali supplementation, although a direct causal relationship has not been firmly established in every case.
Quick Answer
Tongkat Ali appears to be generally well tolerated in short-term human studies using specific standardized extracts, but side effects can still occur.
Possible side effects reported or recognised include:
- Nausea
- Abdominal or digestive discomfort
- Diarrhoea
- Headache
- Skin rash or itching in some people
- Increased alertness or difficulty sleeping in some users
Long-term safety data are still limited.
If you take prescription medication, have liver, kidney, cardiovascular or hormone-related health conditions, or plan to use Tongkat Ali for an extended period, speak with a doctor or pharmacist before use.
What Are the Possible Side Effects of Tongkat Ali?
Tongkat Ali has generally been well tolerated in short-term clinical studies, but individual responses can vary.
Possible side effects discussed in medical literature include:
1. Digestive Discomfort
Some people may experience symptoms such as:
- Nausea
- Abdominal discomfort
- Diarrhoea
These effects may vary depending on the dose, extract concentration and individual sensitivity.
2. Headache
Headache is another possible adverse effect associated with Tongkat Ali use.
If headaches repeatedly occur after starting a supplement, consider stopping use and speaking with a healthcare professional.
3. Skin Reactions
Skin rash or itching may occur in some individuals.
Stop taking the supplement and seek medical advice if you experience a significant or persistent skin reaction.
4. Difficulty Sleeping
Some users report increased alertness, restlessness or difficulty sleeping after taking Tongkat Ali.
However, strong human clinical evidence showing that Tongkat Ali directly causes insomnia remains limited.
If you notice that it interferes with your sleep, consider taking it earlier in the day or discontinuing use.
The U.S. NIH LiverTox resource lists possible adverse effects at conventional doses including nausea, abdominal discomfort, diarrhoea, headache and rash.
Are Tongkat Ali Side Effects Common?
Available short-term clinical studies suggest that significant adverse effects are not commonly reported when specific standardized Tongkat Ali extracts are used at studied doses.
One randomized, double-blind, placebo-controlled trial studied 109 men aged 30 to 55 years for 12 weeks. Participants received either 300 mg per day of a standardized water extract of Eurycoma longifolia or placebo.
The researchers reported that safety parameters were comparable between the Tongkat Ali and placebo groups.
However, this finding has important limitations.
A study involving one particular standardized extract over 12 weeks cannot prove that:
- Every Tongkat Ali extract has the same safety profile
- Higher doses are equally safe
- Long-term continuous use is safe
- The supplement is suitable for everyone
The strength and composition of Tongkat Ali products can vary considerably between manufacturers.
Does Tongkat Ali Cause Insomnia?
Difficulty sleeping is frequently discussed by Tongkat Ali users, particularly when the supplement is taken later in the day.
However, strong clinical evidence demonstrating that Tongkat Ali directly causes insomnia in humans is currently limited.
Individual responses may differ depending on:
- Dose
- Extract strength
- Timing of use
- Caffeine consumption
- Other supplements
- Individual sensitivity
If Tongkat Ali appears to affect your sleep, consider taking it earlier in the day rather than close to bedtime.
If sleep disturbance continues, stop using the supplement and speak with a healthcare professional.
Does Tongkat Ali Raise Blood Pressure?
There is currently not enough high-quality human evidence to conclude that Tongkat Ali consistently raises or lowers blood pressure.
Some short-term clinical studies of standardized Tongkat Ali extracts did not identify major safety changes during the study period, but these trials were not specifically designed to determine whether Tongkat Ali is safe for everyone with hypertension or cardiovascular disease.
If you have:
- High blood pressure
- Low blood pressure
- Cardiovascular disease
- A history of heart problems
- Blood pressure that requires regular monitoring
speak with your doctor or pharmacist before using Tongkat Ali.
Do not stop, reduce or change prescribed blood pressure medication because of a supplement.
Can You Take Tongkat Ali With Blood Pressure Medication?
Research specifically investigating interactions between Tongkat Ali and blood pressure medicines remains limited.
Because of this, it is not possible to provide a complete list of blood pressure medications that can or cannot safely be combined with Tongkat Ali.
If you currently take medication for hypertension, speak with your doctor or pharmacist before starting Tongkat Ali.
This is particularly important if your blood pressure medication requires regular monitoring or dose adjustments.
Does Tongkat Ali Affect the Liver?
This is one of the most important safety questions surrounding Tongkat Ali.
Short-term human studies of certain standardized Tongkat Ali extracts have generally not reported clinically significant changes in routine liver safety measures.
However, long-term liver safety has not been firmly established.
The U.S. National Institutes of Health LiverTox database classifies Tongkat Ali as a:
“Possible rare cause of clinically apparent liver injury.”
LiverTox gives Tongkat Ali a Likelihood Score D, meaning that liver injury appears possible but rare and the available evidence is limited.
There have also been isolated reports of suspected liver injury.
A 2024 medical case report described a 47-year-old man who developed acute liver injury after beginning Tongkat Ali supplementation. His condition improved after discontinuing the supplement.
A case report alone does not prove that Tongkat Ali will cause liver damage in most users, and LiverTox notes that possible confounding factors exist in reported cases.
Nevertheless, people with existing liver conditions should be particularly cautious.
Speak with a healthcare professional before using Tongkat Ali if you:
- Have liver disease
- Have previously abnormal liver test results
- Take medicines that can affect liver function
- Take multiple herbal supplements
- Have previously experienced supplement-related liver problems
What Does Research Say About Long-Term Tongkat Ali Safety?
Most human Tongkat Ali studies have lasted weeks or a few months rather than years.
This means there is currently not enough high-quality human research to confirm that continuous long-term supplementation is safe for every individual.
Another important issue is that Tongkat Ali supplements are not all identical.
Products may differ in:
- Extraction method
- Extract concentration
- Eurycomanone content
- Serving size
- Purity
- Manufacturing standards
- Additional ingredients
Therefore, research involving one standardized extract cannot automatically be applied to every Tongkat Ali product.
What Did EFSA Find?
In 2021, the European Food Safety Authority (EFSA) assessed a specific standardized water extract of Tongkat Ali root proposed for use as a novel food supplement.
EFSA reported concerns about potential DNA damage based on laboratory and animal testing and concluded that the safety of that particular novel food extract had not been established under the proposed conditions of use.
This finding should be interpreted carefully.
It does not automatically prove that every Tongkat Ali product is harmful, because the EFSA assessment related to a specific extract with a defined composition.
However, it highlights why broad claims such as “Tongkat Ali is completely safe for long-term use” are not supported by the available evidence.
Does Tongkat Ali Interact With Medications?
Well-designed human studies examining Tongkat Ali drug interactions are limited.
As a result, a comprehensive list of possible drug interactions has not been established.
Speak with a doctor or pharmacist before taking Tongkat Ali if you regularly use prescription medication.
This is especially important if you take medicines that:
- Require regular blood tests
- Require regular blood pressure monitoring
- Have a narrow dosing range
- Affect liver function
- Are used to manage a chronic medical condition
Always tell your healthcare professional about all supplements and herbal products you use.
What Should You Not Take With Tongkat Ali?
There is currently insufficient evidence to create a universal list of supplements or medicines that must never be combined with Tongkat Ali.
However, combining multiple products marketed for:
- Testosterone
- Energy
- Pre-workout performance
- Male sexual performance
- Hormonal support
can make it more difficult to identify which ingredient is responsible if side effects occur.
Combination supplements may also contain stimulants or other active ingredients unrelated to Tongkat Ali.
Check the entire ingredient list rather than looking only at the Tongkat Ali content.
Who Should Be Cautious With Tongkat Ali?
Speak with a healthcare professional before using Tongkat Ali if you:
- Take prescription medication
- Have an existing liver condition
- Have kidney disease
- Have high or low blood pressure
- Have cardiovascular disease
- Have a hormone-sensitive medical condition
- Take several supplements at the same time
- Have previously reacted badly to herbal supplements
- Are pregnant or breastfeeding
- Are under 18
Pregnant and breastfeeding women are generally advised to avoid Tongkat Ali because adequate safety data are not available. The EFSA evaluation of the specific extract it assessed also excluded pregnant and lactating women from the proposed target population.
Is Tongkat Ali Safe to Take Every Day?
Some human studies have evaluated daily Tongkat Ali use for limited periods.
For example, one randomized controlled study used 300 mg daily of a standardized water extract for 12 weeks, with safety parameters reported as comparable with placebo.
However, this does not mean that taking every Tongkat Ali supplement every day indefinitely has been proven safe.
Daily-use safety depends on factors including:
- Type of extract
- Extract concentration
- Serving size
- Duration of use
- Individual health
- Medications
- Other supplements
Follow the directions on the specific product label rather than assuming all Tongkat Ali supplements have the same dose.
What Happens If You Take Too Much Tongkat Ali?
There is limited human research on very high doses of Tongkat Ali.
Taking more than the recommended amount has not been proven to provide greater benefits and may increase the risk of unwanted effects.
More is not necessarily better.
If you accidentally take substantially more than the recommended amount and develop concerning symptoms, seek medical advice.
How to Use Tongkat Ali More Responsibly
If you decide to use a Tongkat Ali supplement, a few practical steps can help you make a more informed choice:
-
Check the serving size.
Look at the actual amount per serving rather than relying only on front-label marketing. -
Check whether it is an extract or raw root powder.
Different products may have very different concentrations. -
Do not exceed the recommended serving.
Higher doses have not necessarily been shown to work better. -
Pay attention to how you feel.
Stop use if you experience persistent or concerning symptoms. -
Consider timing if it affects sleep.
If you feel unusually alert after taking it, earlier daytime use may be more suitable. -
Check all ingredients in combination products.
Other ingredients may contribute to side effects. -
Tell your healthcare professional about your supplements.
This is particularly important if you take prescription medication. -
Choose products from reputable manufacturers.
Product quality, extract concentration and ingredient transparency matter when evaluating herbal supplements.
Frequently Asked Questions
What are the possible side effects of Tongkat Ali?
Possible adverse effects discussed in medical literature include nausea, abdominal discomfort, diarrhoea, headache and skin rash. Some users also report increased alertness or difficulty sleeping. Individual responses can vary.
Are Tongkat Ali side effects common?
Short-term studies using certain standardized extracts have generally reported good tolerability. In one 12-week randomized controlled trial involving 109 men, safety parameters were comparable with placebo. However, this does not establish long-term safety for every product or dose.
Does Tongkat Ali cause insomnia?
Some people report difficulty sleeping or increased alertness, but strong human evidence demonstrating that Tongkat Ali directly causes insomnia remains limited. If it appears to interfere with your sleep, consider earlier daytime use or discontinuing it.
Does Tongkat Ali raise blood pressure?
There is currently insufficient high-quality evidence to say that Tongkat Ali consistently raises blood pressure. Anyone taking blood pressure medication or managing cardiovascular disease should speak with a healthcare professional before use.
Can I take Tongkat Ali with blood pressure medication?
Specific interaction data are limited. If you take medication for high or low blood pressure, check with your doctor or pharmacist before combining it with Tongkat Ali.
Does Tongkat Ali affect the liver?
Short-term studies of certain extracts have not generally reported major liver abnormalities, but rare suspected cases of liver injury have been reported. NIH LiverTox classifies Tongkat Ali as a possible rare cause of clinically apparent liver injury.
Is Tongkat Ali safe to take every day?
Some clinical trials have studied daily use for approximately 12 weeks, but this does not establish the safety of continuous long-term use for every extract, dose or individual.
What happens if you take too much Tongkat Ali?
Human evidence on very high doses is limited. Taking more than recommended has not been shown to provide greater benefits and may increase the likelihood of unwanted effects.
Who should not take Tongkat Ali?
People who are pregnant or breastfeeding, under 18, taking prescription medication, or managing liver, kidney, cardiovascular or hormone-related conditions should seek professional advice before use.
Should Tongkat Ali be taken in the morning or at night?
There is no universal timing requirement. However, people who notice increased alertness or difficulty sleeping may prefer to take it earlier in the day.
Scientific References
1. National Institutes of Health — LiverTox: Tongkat Ali
National Institute of Diabetes and Digestive and Kidney Diseases. Updated October 18, 2024.
A clinical reference covering reported adverse effects and suspected Tongkat Ali-related liver injury.
2. Ismail SB, et al. Randomized Clinical Trial on the Use of PHYSTA Freeze-Dried Water Extract of Eurycoma longifolia for the Improvement of Quality of Life and Sexual Well-Being in Men.
Evidence-Based Complementary and Alternative Medicine. 2012. PMID: 23243445.
Randomized, double-blind, placebo-controlled 12-week study involving 109 men.
3. EFSA Panel on Nutrition, Novel Foods and Food Allergens. Safety of Eurycoma longifolia (Tongkat Ali) Root Extract as a Novel Food.
EFSA Journal. 2021;19(12):6937. DOI: 10.2903/j.efsa.2021.6937.
Safety evaluation of a specific standardized Tongkat Ali water extract.
4. Kaliounji A, Shadid G, Saba H, Ahlawat S. A Rare Case of Tongkat Ali-Induced Liver Injury: A Case Report.
Cureus. 2024;16(3):e56639. PMID: 38646387.
Published case report describing acute liver injury following Tongkat Ali supplementation.
Tongkat Ali Benefits Guide — How to Choose a Quality Supplement in Singapore
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This article is for general educational purposes and is not medical advice. Please consult a healthcare professional before starting any new supplement, especially if you have a pre-existing condition, are pregnant or breastfeeding, or are taking medication.