Side effects: none reported for this species of ginseng. 

High-dose prolonged exposure to Panax ginseng  can result in ginseng abuse syndrome, with morning diarrhea, rash, insomnia, nervousness, and hypertension. ⁴

Adverse events: none reported for P.quinquefolius. 

Other species of ginseng have been associated rarely with insomnia, mastalgia, vaginal bleeding, tachycardia, mania, cerebral arteritis, Stevens Johnson syndrome, cholestatic hepatitis (multi-herb product), amenorrhea, decreased appetite, edema, hyperpyrexia, pruritis, hypertension, hypotension, palpitations, headache, vertigo, euphoria and neonatal death. ¹⁵   The FDAÕs adverse event monitoring system recorded 114 events related to products containing P. ginseng (NOT P. quinquefolius): 13 deaths, tonic-clonic seizure and  2 mild strokes; jaundice with itching, nausea, vomiting, and diarrhea; sweating; dermatomyositis; coma; stomach pains; palpitations; atrial fibrillation; thrombocytopenia and bone marrow necrosis; headache; abnormal vaginal bleeding ⁴ . Causal relationships are unclear as pre-existing conditions are unknown

Precautions/contraindications:  Precautions should be used in diabetics on hypoglycemic agents.

Should NOT be used in pregnant women as ginenoside Rb1 was found to cause birth defects in rats. ¹⁶   Safety in nursing mothers is unknown. ¹⁵ American ginseng may lower blood glucose levels in diabetics.