Scientific name Andrographis paniculata is a bitter tasting medicinal plant from Asia which also may be known as king of bitters, green chirayta, Kirayat, Kalmegh, India echinacea, Chuan Xin Lian and many others. The active compound in the herb is andrographolide which should be standardized to 10% in the product. The herb has been used as an agent in upper respiratory infection, as an immunstimulant, fever reducer, antibiotic, for protection from liver toxicity, in ulcerative colitis, and has shown promise in cancer treatment. The indication for andrographis with the greatest amount of quality research backing its effectiveness in treatment of the common cold.
Andrographis paniculata and upper respiratory infection treatment:
Andrographis and the common cold in adults:
A double-blind, placebo-controlled study of 158 adults with colds found that treatment with Andrographis paniculata SHA-10 extract for 4 days significantly reduced cold symptoms. Participants were given either placebo or 1200 mg daily of A. paniculata extract. The results showed that by day 2 of treatment individuals who were given the actual treatment experienced significant improvements in symptoms (tiredness, sleepiness, sore throat, and nasal secretion) compared to participants in the placebo group. These benefits were even better at day 4. The greatest response was seen in earache (odds ratio [OR] = 3.11), sore throat (OR=3.59), and nasal drainage (OR=3.27). (1)
Extract andrographis paniculata (kan jang) was shown to significantly improve treatment of uncomplicated upper-respiratory tract infections in two randomized double-blind, placebo-controlled parallel group clinical trials (a pilot study [n=46] and a phase III study [n=179]). A standardized extract (SHA-10) of A. paniculata was given 3 times a day for 3 to 8 days in the pilot study and for 3 days in the phase III study. In both studies measures such as pain in the muscle, cough, throat symptoms, lymph glands-tonsils, headache, nasal symptoms and eye symptoms were significantly improved in the treatment group compared to placebo group. Throat symptoms showed the most improvement in both studies. (2)
Taking 1200 mg/d of dried extract Andrographis paniculata (kan jang) significantly reduced the length of a common cold in this placebo-controlled double-blind study. Sixty-one participants were assigned to either 1200 mg A. paniculata (n=33) or placebo (n=28). On day 4 of treatment, the A. paniculata group showed significiant reductions in clinical symptoms compared to placebo. (3)
Andrographis paniculata SHA-10 extract (Kan Jang) was found to decrease severity and duration of upper respiratory tract infections in a 5-day double blind, placebo-controlled, parallel-group clinical study. Headache, nose and throat symptoms, and body weakness or discomfort improved significantly in the A. paniculata group. Cough and eye symptoms however were not significantly different between the groups. (4)
A meta-analysis found 7 double-blind, controlled efficacy trials, enrolling a total of 896 participants, evaluating the use of a proprietary oral andrographis extract (AP) for the treatment upper respiratory tract infection (URTI). The combined results indicate that AP is more effective than placebo for reducing symptoms. The studies included in this review used standardized AP alone or in combination with Eleutherococcus senticosus, except for one study. Herbal supplements were compared to either placebo or paracetamol (also known as acetaminophen or Tylenol). The daily dose of AP ranged from 48 to 360 mg/day in the efficacy review and from 11 mg/day to 10 mg/kg per day for 14 studies (n=1,235) included in the safety review. Significant differences in outcomes suggested that A. paniculata is superior to placebo in alleviating subjective symptoms of URTI. One study in HIV-positive patients and healthy volunteers, which used a high dose of AP (5 mg/kg and 10 mg/kg increasing every 3 weeks) was terminated early because of a large number of adverse events such as allergic reaction, fatigue, headache, pruritis/rash, diarrhoea, nausea, metallic taste, bitter taste, decreased/no taste, dry tongue, decreased sex drive, eyes sensitive to light, decreased short term memory, dizziness, heartburn, tender lymph nodes, lymphadenopathy. Side effects reported in other studies include unpleasant sensations in the chest, headache, urticarial, nausea, vomiting, abdominal discomfort, dizziness, drowsiness and malaise, increased nasal discharge and epigastric pain, blocked nose. However, AP was well tolerated among most participants. (5)
Andrographis paniculata and prevention of upper respiratory infection:
Andrographis paniculata may be effective in cold prevention. According to one double-blind, placebo-controlled study, andrographis paniculata (kan jang) may increase resistance to colds. In a 3-month-long trial 54 of the participants took two 100-mg tablets standardized A. paniculata daily. The other 53 students were given placebo tablets. Then, once a week throughout the study, a clinician evaluated all the participants for cold symptoms. No significant differences between the groups were observed after 1 month. By the end of the trial however, only 16 people or 30% in the group using A. paniculata had experienced colds, compared to 33 of the placebo-group participants or 62%. This difference was statistically significant, indicating that A. paniculata reduces the risk of catching a cold by a factor of two as compared to placebo. (6)
Andrographis paniculata and prevention of upper respiratory infection in children:
Andrographis paniculata is effective for symptoms of the common cold in children. Researchers conducted a three-group study in 130 children age 4 to 11 years old comparing echinacea purpurea (L.), Andrographis paniculata (kan jang), and standard treatment. A. paniculata is a herb believed to reduce symptoms of common colds. Children were assigned to either standard treatment (n=39), standard treatment plus A. paniculata (n=53), or standard treatment plus Echinacea (Immunal was used) (n=41) treatment. The A. paniculata was administered as two tablets three times daily for 10 days (30 mg of andrographolide and deoxyandrographolide per day). An equivalent would be Andrographis capsule, 50 mg standardized to 10% andrographolides with 2 capsules taken 3 times per day or a 100 mg capsule standardized to 10% andrographolides taken 3 times daily. The echinacea group received 10 drops three times daily for 10 days. Standard treatment for the control group (n=39) consisted of warm drinks, throat gargles with matricaria (chamomile) infusion, antiseptic nose drops of silver nitrate colloid p.r.n., and acetaminophen (pain-killer) 500 mg three times daily if fever or severe headache was present. An improvement in upper respiratory tract infection symptoms by days 2−3 was reported in all groups but authors reported a faster improvement in symptoms in the A. paniculata group and a decrease in nasal secretions in the AP and echinacea groups. AP treatment was well tolerated with not reported side-effects. (7)
Andrographis paniculata and diabetes mellitus:
The herb Andrographis paniculata (AP) has been demonstrated to lower blood sugar and fasting insulin levels in a small trial involving 20 patients (age of 35 and 70 years) with type 2 diabetes. The study consisted of 12-weeks of daily administered capsules of powered AP at an initial dose of 600 mg (one capsule contained 300mg of dry herb), increasing to 1.8 g. AP was increased by 1 capsule (300 mg) each time an individuals had a fasting blood sugar level above 7 mmol/L (or 126 mg/dl). At the end of the study, researchers report no significant changes in mean body mass index, systolic and diastolic blood pressure, pulse rate, liver or lung function, mean hemoglobin, total white blood cell count, or platelet counts during treatment. There were minimal changes in electrolyte levels (serum sodium 139.5 to 139.85 mmol/L, serum potassium 4.15 to 4.34 mmol/L, serum calcium 2.23 to 2.39 ± 0.03 mmol/L, serum phosphorus 1.77 to 1.23 mmol/L), mean fasting blood sugar level (10.19 to 9.71 mmol/L), cholesterol (5.7 to 5.85 mmol/L), triglycerides (1.59 to 1.56 mmol/L), thyroid hormone (FT4 14.03 to 13.6 nmol/L, TSH 0.98 to 1.06 mU/L) and fasting cortisol levels (319.63 to 342.16 nmol/L). The only significant results reported were a decrease in mean HbA1 concentration, a measure of blood sugar, from 8.61% to 8.13% (a 5.46% decline). Fasting insulin levels were also significantly reduced by 20.93% (from 11.18 to 8.84 IU/L). (8)
Andrographis paniculata and ulcerative colitis:
Andrographis paniculata extract, HPML-004 at a dose of 1200 mg/day may be an effective alternative treatment to the drug mesalazine (4500 mg/day) for mild-to-moderate active ulcerative colitis (UC), a form of inflammatory bowel dieses that causes ulcers in the lining of the rectum and colon. At the end of this 8-week study, 21% of HPML-004 treated participants had clinical remission of UC and 76% had clinical response. Corresponding values in the mesalazine group were 16% and 82%, respectively. Colonoscopy results showed a 28% remission and 74% response rate for HMPL-004, compared to 24% and 71% for mesalazine. No significant difference was apparent between the HPML-004 and the mezalazine groups. (15)
Andrographis paniculata (AP adverse reactions and interactions:
Andrographis paniculata (AP) is well tolerated, but has been found to produce several adverse reactions and interactions.
AP caused gastric irritation and nausea in one patient during a trial for diabetes. (8)
Hypoglycemia (low blood sugar) occurred when using AP as a favorable effect for treatment of diabetes as mentioned above (8). Hypoglycemia also occurred in another study that used much higher doses. A water solution of the plant extract Andrographis paniculata (AP) weas examined for blood sugar lowering effect in rats with normal and high blood sugar levels. Researchers found AP at a dose of 50 mg/kg significantly reduced blood sugar by 52.9%. When a sample of freeze-dried (instead of water solution) extract was used at a dose of 6.25 mg/kg, blood sugar was lowered by 61.81%. (9)
Andrographis paniculata has been shown to relax uterine smooth muscle and therefore should not be taken in pregnancy. (11)
In males, sperm count, motility, and morphology was improved with AP. Testosterone levels were increased with doses of 50 to 200 mg per kilogram in male rats. (10)
Andrographolide has been found to reduce platelet aggregation by inhibiting platelet activating factor, an effect which increased as higher doses were given. This mechanism differed from the mechanism by non-steroidal anti-inflammatory drugs. (12)
A phase I study of AP among 18 individuals (13 confirmed HIV-positive) was stopped after 6 weeks because of multiple cases of reported side-effects such as allergic reactions, fatigue, headache, painful lymphadenopathy, nausea, and diarrhea in doses of 20 mg per kg per day. One major side effect experienced by users of AP as an herbal remedy for minor disorders includes stomach irritation. Other side effects associated with the digestive system include bloating, nausea, vomiting and diarrhea. (13)
Coon JT et al reported a list of adverse effects from a trial review which incuded allergic reaction, fatigue, headache, pruritis/rash, diarrhea, nausea, metallic taste, bitter taste, decreased/no taste, dry tongue, decreased sex drive, eyes sensitive to light, decreased short term memory, dizziness, heartburn, tender lymph nodes, lymphadenopathy. Side effects reported in other studies include unpleasant sensations in the chest, headache, urticarial, nausea, vomiting, abdominal discomfort, dizziness, drowsiness and malaise, increased nasal discharge and epigastric pain, blocked nose. However, AP was well tolerated among most participants. (14)
Assessment and Plan: Andrographis paniculata
- Andrographis paniculata (AP) is beneficial for the common cold in adults by reducing most cold symptoms and the duration of the cold. 1200 mg of the herb standardized to 10% andrographolides divided three times per day for a duration of 3–8 days has been studied and tolerated well.
- For prevention of the common cold, AP at a dose of 200 mg daily for 3 months has been studied and tolerated well but more studies are needed to confirm this benefit.
- AP was effective for symptoms of the common cold in children 4 – 11 years old in the study mentioned with improvement in upper respiratory tract infection symptoms by days 2−3 and reported no side effects. 100 mg capsule standardized to 10% andrographolides taken 3 times daily or equivalent was taken for 10 days and was somewhat more effective than a leading echinacea product.
- Using AP for diabetes mellitus has not had enough studies performed to prove effectiveness and safety but may be a promising therapy once more trials are done.
- Andrographis paniculata extract, HPML-004 at a dose of 1200 mg/day may be an effective alternative treatment to the drug mesalazine (4500 mg/day) for mild-to-moderate active ulcerative colitis. Confirmatory studies are needed.
- Obtain approval from a primary care physician prior to taking and provide careful attention to monitoring for adverse effects of AP mentioned above in section F.
- AP should be avoided in pregnancy or planning to be pregnant, if taking diabetes drugs or insulin, if allergic to AP, or if taking anticoagulants such as aspirin, warfarin, non-steroidal anti-inflammatory drugs, or ticlopidine because of the potential increased risk of bleeding.
References:
1.Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine. 1999;6:217-223. http://www.ncbi.nlm.nih.gov/pubmed/10589439
2.Melchior J, Spasov AA, Ostrovskij OV, Bulanov AE, Wikman G. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine. 2000 Oct;7(5):341-50. http://www.ncbi.nlm.nih.gov/pubmed/11081985
3.Hancke J, Burgos R, Caceres D, et al. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytother Res 1995;9:559–62. http://onlinelibrary.wiley.com/doi/10.1002/ptr.2650090804/abstract
4.Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine 2002;9(7):589-597 http://www.ncbi.nlm.nih.gov/pubmed/12487322
5.Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med. 2004 Apr;70(4):293-8. https://www.thieme-connect.com/ejournals/html/10.1055/s-2004-818938.
6,Caceres DD, Hancke JL, Burgos RA, et al. Prevention of common colds with Andrographis paniculata dried extract: a pilot double blind trial. Phytomedicine 1997;4:101-104.http://ac.els-cdn.com/S0944711397800517/1-s2.0-S0944711397800517-main.pdf?_tid=68e66788-5726-11e2-b89b-00000aab0f6b&acdnat=1357383505_f809c814b95ccf20be69d760625ab274
7.Spasov AA, Ostrovskij OV, Chernikov MV, et al. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang(R) and an echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004;18:47-53. http://www.ncbi.nlm.nih.gov/pubmed/14750201
8.Agarwal R, Sulaiman SA, Mohamed M. Open label clinical trial to study adverse effects and tolerance to dry powder of the aerial part of Andrographis paniculata in patients with type 2 diabetes mellitus. Malay J Med Sci. 2005 Jan;12(1):13-19. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3349408
9.Husen R, Pihie AH, Nallappan M. Screening for antihyperglycemic activity in several local herbs of Malaysia. J Ethnopharmacol. 2004 Dec;95(2-3):205-8. http://www.ncbi.nlm.nih.gov/pubmed?term=15507337
10.Chan KL, Low BS, Teh CH, Das PK. The effect of Eurycoma longifolia on sperm quality of male rats. Nat Prod Commun. 2009 Oct;4(10):1331-6. http://www.ncbi.nlm.nih.gov/pubmed/19911566
11.Burgos RA, Aguila MJ, Santiesteban ET, Sánchez NS, Hancke JL. Andrographis paniculata (Ness) induces relaxation of uterus by blocking voltage operated calcium channels and inhibits Ca(+2) influx. Phytother Res. 2001 May;15(3):235-9. http://www.ncbi.nlm.nih.gov/pubmed/11351359
12.Amroyan E, Gabrielian E, Panossian A, Wikman G, Wagner H. Inhibitory effect of andrographolide from Andrographis paniculata on PAF-induced platelet aggregation. Phytomedicine. 1999 Mar;6(1):27-31. http://www.ncbi.nlm.nih.gov/pubmed/10228608
13.Akbar S. Andrographis paniculata: a review of pharmacological activities and clinical effects. Altern Med Rev. 2011 Mar;16(1):66-77. http://www.altmedrev.com/publications/16/1/66.pdf.
14.Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med. 2004 Apr;70(4):293-8. https://www.thieme-connect.com/ejournals/html/10.1055/s-2004-818938.
15.Tang T., Targan S.R., Li Z.-S., Xu C., Byers V.S., Sandborn W.J, Randomised clinical trial: Herbal extract HMPL-004 in active ulcerative colitis – A double-blind comparison with sustained release mesalazine. Alimentary Pharmacology and Therapeutics 2011 33:2(194-202). http://www.ncbi.nlm.nih.gov/pubmed/21114791