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Panchakarma procedures are potent interventions that alter fluid balance, gastrointestinal function and autonomic tone, and they can therefore cause harm when applied inappropriately. Ayurvedic texts devote entire sections to Vyapad (complications) of Vamana, Virechana, Basti, Nasya and Snehana, with detailed management. This article reviews the classical classification of complications, the corresponding modern clinical risks such as dehydration, electrolyte disturbance, aspiration, mucosal injury and burns, and the safety of the accompanying drugs, with attention to heavy-metal contamination. Principles of patient selection, informed consent, monitoring, pharmacovigilance and quality assurance are summarised. A safety-first approach, supported by training, standard operating procedures and adverse-event reporting, is essential for the credibility of Panchakarma.