Avoid in individuals with a known allergy or hypersensitivity to gotu kola or any of its constituents, including asiaticoside, asiatic acid, or madecassic acid. There are numerous reports of allergic contact dermatitis after topical gotu kola use. Allergic contact dermatitis has been reported after the use of topical Blasteostimulina® cream, containing Centella asiatic extract, and after the application of topical Madecassol® ointment.

Studies suggest that gotu kola has few side effects when taken by mouth. Reported symptoms include stomach upset and nausea. In animal research, large doses of gotu kola cause drowsiness, increase cholesterol levels, and raise blood sugar levels. Individuals with diabetes or high cholesterol should avoid gotu kola. Use caution if driving or operating heavy machinery while taking gotu kola as it may cause drowsiness. Asiaticoside, an ingredient of gotu kola, may have weak cancer-causing effects when applied to the skin. There is also a report of night eating syndrome associated with gotu kola.

Gotu kola is not related to the kola nut (Cola nitida, Cola acuminata). Gotu kola is not a stimulant and does not contain caffeine.

In animal studies, gotu kola reduces the ability of a female to become pregnant, but it is not known if this effect occurs in humans. Gotu kola is not recommended during pregnancy or breast-feeding because there is little safety and efficacy information available.

There is no proven effective dose for gotu kola in adults. For chronic venous insufficiency, varicose veins, or venous hypertension, various dosing regimens have been studied, including 60-120 milligrams daily Centellase® (TTFCA); 30 milligrams twice daily Centellase®; 30 milligrams three times daily TTFCA; 60mg twice daily TTFCA; 60 milligrams TTFCA three times daily. Preliminary studies suggest a dose-dependent response, with better results using 60 milligrams three times daily TTFCA. TECA (titrated extract from Centella asiatica) has also been studied, at a dose of 60-120 milligrams daily. For diabetic microangiopathy, 60 milligrams twice daily of TTFCA (total triterpenic fraction of Centella asiatica) has been studied.

There is no proven effective dose for gotu kola in children.

In theory, gotu kola may increase the amount of drowsiness caused by sedating drugs. Examples include benzodiazepines such as lorazepam (Ativan®); barbiturates such as phenobarbital; narcotics such as codeine; and alcohol. Caution is advised while driving or operating heavy machinery.

In animals, gotu kola can raise blood sugar levels. Patients taking medications for diabetes or using insulin should be monitored closely by a qualified health care professional while using gotu kola. Dosing adjustments may be necessary.

In theory, gotu kola may increase cholesterol levels and may work against the activity of cholesterol-lowering drugs.

In theory, gotu kola may increase the amount of drowsiness caused by some herbs or supplements. Caution is advised while driving or operating heavy machinery.

Although not well studied in humans, gotu kola may raise blood sugar and may therefore counteract the effects of products that lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Studies in animals suggest that gotu kola may increase cholesterol levels. It may therefore interfere with the effectiveness of lipid-lowering agents such as fish oil, garlic, or niacin.