Pelargonium, also known as “umckaloabo,””umcka,” South African geranium, kaloba, zucol, & others is an herb native to South Africa. This herbal agent has research based evidence in the treatment of respiratory tract infections which may be reviewed in more detail below. Pelargonium may help in treatment of the common cold, acute bronchitis, and pharyngitis. However, use of pelargonium may trigger mild to moderate adverse effects. The use of pelargonium should be monitored by the healthcare provider.
Pelargonium and Respiratory Health:
Pelargonium sidoides in RCTs (randomized controlled trials) on adults:
A randomized, double-blind, placebo-controlled trial enrolled 124 adults with acute bronchitis present for 48 hours or less, with symptoms greater than 5 points on the Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea). Participants received Pelargonium sidoides (30 drops [1.5 mL]) (n=64) or placebo (n=60) 3 times daily for 7 days. From baseline to day 7, decrease in the BSS in the treatment group was 7.2 points versus 4.9 points for placebo. In the treatment group, at day four onset of treatment effect was reported for 68.8% versus 33.3% for placebo. Patients on pelargonium reported a greater improvement in quality of life status. No serious side effects were reported.(1)
Pelargonium sidoides and acute bronchitis:
A randomized, double-blind, placebo-controlled, multi-center study evaluated 217 adults aged 18 to 66 years with acute bronchitis. Participants in the active arm (n=108) received Pelargonium sidoides, 30 drops (1.5 mL) or placebo 3 times daily, for 7 days. Changes in bronchitis severity score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea) were assessed. At the end of treatment, the BSS decreased by 7.6 points in the active treatment group and by 5.3 points in the placebo group. Only minor side-effects were reported. (3)
Pelargonium sidoides (EPs 7630) was reported to benefit both adults and children with acute bronchitis. A total of 2099 patients aged 0-93 years were included in this study. Participants received EPs 7630 for 14 days at a dose determined by a participant’s age. During treatment, the average Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea) of all patients decreased from 7.1 points at baseline to 1.0 points at last visit. For children, average BSS decreased from 6.3 points to 0.9 points. For children aged 3 years or less, average mean BSS decreased from 5.2 points to 1.2 points. No serious side-effects were reported. (2)
Cold symptoms and pelargonium herbal extract:
A double-blind study of 133 adults who had just come down with the common cold found that use of a standardized pelargonium herbal extract significantly reduced the severity and duration of symptoms as compared to placebo. Patients received either 30 drops (1.5 mL) of pelargonium sidoides or a placebo 3 times daily for 10 days. Ten cold symptoms were evaluated: nasal drainage, sore throat, nasal congestion, sneezing, scratchy throat, hoarseness, cough, headache, muscle aches, and fever. From day one to day five the treatment group had a significant reduction in symptoms compared to placebo group. The average cold intensity score decreased by 10.4 points in the treatment group compared to a 5.6 point improvement for placebo. Average duration of absence from work also improved (6.9 days for treatment vs 8.2 days for placebo). After 10 days, 78.8% of those taking pelargonium were clinically cured compared to 31.4% of placebo. (4)
Pelargonium sidoides and non-group A beta hemolytic strep throat:
Pelargonium sidoides extract was found to reduce the total duration of a non-dangerous form of strep throat (technically, non-group A beta hemolytic strep tonsillopharyngitis) by 2 days (on average) in the treatment group (n=73) as compared to the placebo group (n=70). This double-blind, placebo-controlled study enrolled 143 children aged 6-10 years with a strep throat. Tonsillopharyngitis Severity Score from baseline to day four decrease was 7.1 points in the treatment group versus 2.5 points for placebo. Treatment was considered safe according to the author. (5)
Pelargonium sidoides adverse reactions, and interactions:
Pelargonium sidoides and bleeding risk:
Pelargonium sidoides was studied for increased risk of bleeding. There was no change seen in thromboplastin time (TPT), partial TPT (PTPT) or thrombin time (TT) in rats given extremely large doses of EPs 7630. Also, the supplement added to warfarin treatment did not affect the lab values either. Hemorrhage caused by this agent was felt to be unlikely. (7)
Pelargonium sidoides and hepatotoxicity:
Hepatotoxicity was reported in 13 cases of individuals using Pelargonium sidoides but the patients taking this herb also had been taking other hepatotoxic medications or had other conditions including acute pancreatitis, cholangitis, acute cholecystitis, hepatic contusion, viral hepatitis, and autoimmune hepatitis. (8)
Pelargonium sidoides and coumarin:
It is also possible that the hepatotoxicity was in related to the coumarin content of Pelargonium sidoides (9). Until there is enough safety data determined on the use of the herb and the concentration of coumarin is known, it may be best to avoid the use of Pelargonium sidoides.
Danger of coumarin:
There is no clear definition of how much coumarin is dangerous for any particular individual, but Abraham K, et al determined the tolerable daily intake of coumarin to be 0.1 mg per kg of body weight. For a person weighing 80 kg, or about 176 lbs, a tolerable daily intake would be approximately 8 mg of coumarin. (6) The various studies mentioned have defined few adverse effects of Pelargonium sidoides in both adults and children.
Summary and Conclusion: Pelargonium sidoides:
Acute bronchitis and Pelargonium sidoides:
- A randomized, double-blind, placebo-controlled trial done on 124 adults with acute bronchitis for 48 hours or less received Pelargonium sidoides (30 drops [1.5 mL]) (n=64) or placebo (n=60) 3 times daily for 7 days. At day four onset of treatment effect was reported for 68.8% of the treatment group versus 33.3% for placebo. No serious side effects were reported. (1)
- Matthys H et al did a similar study to the one above with the same dose which also revealed significant response to treatment (3).
- A total of 2099 patients aged 0-93 years received EPs 7630 (a Pelargonium sidoides extract) for 14 days at a dose determined by a participant’s age. During treatment, the average Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnoea) of all patients decreased significantly. No serious side-effects were reported. (2)
Common cold and Pelargonium sidoides:
- A double-blind study of 133 adults with the common cold found that pelargonium herbal extract significantly reduced the severity and duration of symptoms as compared to placebo. From day one to day five the treatment group had a significant reduction in symptoms compared to placebo group. Average duration of absence from work also improved (6.9 days for treatment vs 8.2 days for placebo). After 10 days, 78.8% of those taking pelargonium were clinically cured compared to 31.4% of placebo. (4)
- Pelargonium sidoides extract was studied in a double-blind, placebo-controlled trial which enrolled 143 children 6-10 years old. The extract reduced the total duration of tonsillopharyngitis by 2 days (on average) in the treatment group (n=73) as compared to the placebo group (n=70). Treatment was considered very safe. (5)
- The dose in the studies 3 times per day given before meals. Adults and children over 12 years were given a dose of 30 drops, children over 6 up to 12 years old were provided a dose of 20 drops, and children under 6 years old were given 10 drops per dose for duration of either 7 or 14 days. There were few adverse effects occurring at similar rates in both treatment and placebo groups. It is currently widely available but as a general consensus by most physicians, it is felt more research is needed before it is recommended routinely.
Adverse reactions and interactions:
- Hepatotoxicity was reported in 13 cases of individuals using Pelargonium sidoides but the patients taking this herb also had been taking other hepatotoxic medications or had other conditions including acute pancreatitis, cholangitis, acute cholecystitis, hepatic contusion, viral hepatitis, and autoimmune hepatitis. (8)
- If the cases of hepatotoxicity were in fact related to Pelargonium sidoides, this may have been due to the coumarin content of the herb. Until there is enough safety data determined on the use of the herb and the concentration of coumarin is known, it may be best to avoid the use of Pelargonium sidoides.
- Pelargonium sidoides was studied for increased risk of bleeding. There was no change seen in thromboplastin time (TPT), partial TPT (PTPT) or thrombin time (TT) in rats given extremely large doses of EPs 7630. Also, the supplement added to warfarin treatment did not affect the lab values either. Hemorrhage caused by this agent was felt to be unlikely. (7)
- Research which defines the amount of coumarin present in Pelargonium sidoides is not available. Once coumarin content of Pelargonium sidoides is known some of the fears on the herb’s safety can be alleviated. There is no clear definition of how much coumarin is dangerous for any particular individual, but Abraham K, et al determined the tolerable daily intake of coumarin to be 0.1 mg per kg of body weight. For a person weighing 80 kg, or about 176 lbs, a tolerable daily intake would be approximately 8 mg of coumarin. (6) Nonetheless, the various studies mentioned have defined few adverse effects even in children.
- Patients should not take Pelargonium sidoides if they have an allergy to this herbal preparation or allergy to a similar plant family.
References:
1.Chuchalin AG, Berman B, Lehmacher W. Treatment of acute bronchitis in adults with a Pelargonium sidoides preparation (EPs 7630): a randomized, double-blind, placebo-controlled trial. Explore (NY). 2005 Nov;1(6):437-445. http://www.ncbi.nlm.nih.gov/pubmed/16781588
2.Matthys H, Kamin W, Funk P, Heger M. Pelargonium sidoides preparation (EPs 7630) in the treatment of acute bronchitis in adults and children. Phytomedicine. 2003;14 Suppl 6:69-73. http://www.ncbi.nlm.nih.gov/pubmed/17184981
3.Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Opin . 2007;23:323-331.http://www.ncbi.nlm.nih.gov/pubmed/17288687
4.Lizogub VG, Riley DS, Heger M. Efficacy of a Pelargonium sidoides preparation in patients with the common cold: a randomized, double blind, placebo-controlled clinical trial. Explore (NY). 2007;3:573-584. http://www.ncbi.nlm.nih.gov/pubmed/18005909
5.Bereznoy VV, Riley DS, Wassmer G, Heger M. Efficacy of extract of Pelargonium sidoides in children with acute non-group A beta-hemolytic streptococcus tonsil-lopharyngitis: a randomized, double-blind, placebo-controlled trial. Altern Ther Health Med. 2003 Sep-Oct;9(5):68-79. 7. http://www.ncbi.nlm.nih.gov/pubmed/14526713
6.Abraham K, Wöhrlin F, Lindtner O, Heinemeyer G, Lampen A. Toxicology and risk assessment of coumarin: focus on human data. Mol Nutr Food Res. 2010 Feb;54(2):228-39. http://www.ncbi.nlm.nih.gov/pubmed/20024932
7.Koch E. Biber A.Treatment of rats with the Pelargonium sidoides extract EPs 7630 has no effect on blood coagulation parameters or on the pharmacokinetics of warfarin. Phytomedicine. 2007;14 Suppl 6:40-5. Epub 2006 Dec 22. http://www.ncbi.nlm.nih.gov/pubmed/17188479
8.Teschke R, Frenzel C, Wolff A, Herzog J, Glass X, Schulze J, Eickhoff A. Initially purported hepatotoxicity by Pelargonium sidoides: the dilemma of pharmacovigilance and proposals for improvement.Ann Hepatol. 2012 Jul-Aug;11(4):500-12. http://www.ncbi.nlm.nih.gov/pubmed/22700632