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Principal Proposed Natural Uses
• Colds (Both Treatment and Prevention)
Other Proposed Natural Uses
• Heart Disease Prevention; Familial Mediterranean Fever; Immune Support; Liver Protection; Stimulating Gallbladder Contraction; Ulcerative Colitis
Andrographis is a shrub found throughout India and other Asian countries that is sometimes called "Indian echinacea." It has been used historically in epidemics, including the Indian flu epidemic in 1919 during which andrographis was credited with stopping the spread of the disease.1
What Is Andrographis Used for Today?
Over the last decade, a proprietary extract of andrographis (currently sold in combination with eleutherococcus) has become popular in Scandinavia as a treatment for colds. It is beginning to become available in the United States as well. Reasonably good evidence tells us that either form of this extract can reduce the severity of cold symptoms. It may also help prevent colds.
Researchers have also studied andrographis as a potential treatment for ulcerative colitis, a type of inflammatory bowel disease. In one trial, 120 people with ulcerative colitis were randomized to andrographis extract (400 mg, 3 times daily) or the standard drug mesalazine (1,500 mg, 3 times daily).30 After 8 weeks of treatment, the two groups had similar results.
In a randomized trial of 224 patients with ulcerative colitis, patients were randomized to 1,200 mg or 1,800 mg of andrographis a day, divided into three doses, compared to placebo. Significantly more patients taking the higher dose showed a clinical response, but not a clinical remission, compared to patients taking the placebo. Patients on the lower dose of andrographis showed no significant benefit.31
Preliminary studies in animals weakly suggest that andrographis may offer benefits for preventing heart disease.3,4,5 In addition, highly preliminary studies suggest that andrographis may help protect the liver from toxic injury, perhaps more successfully than the more famous liver-protective herb milk thistle.6,7,8 It also appears to stimulate gallbladder contraction.9
Preliminary lab tests suggest that andrographis may be effective against bacteria.32 This is an exciting possibility. As more and more antibiotics become less effective, it is important to find other ways to treat bacterial infections. However, this first study is in a lab setting. Results from use in human body are important. A number have been carried out. Unfortunately, there are a number of problems with trials. There are wide differences in potency and quality of supplements. Still studies results are trending toward a positive effect against upper respiraoty infections, like a cold.11-15, 22, 26-28, 33-35
What Is the Scientific Evidence for Andrographis?
Reducing Upper Respiratoy Infection Symptoms
A meta-analysis (statistically rigorous review of studies) published in 2004 found seven reasonable quality double-blind, controlled trials, enrolling a total of 896 participants, evaluating the use of a proprietary andrographis extract for the treatment of acute respiratory infections.11,12,13,26 The combined results indicate that this andrographis extract is more effective than placebo for reducing symptoms.
For example, a 4-day, double-blind, placebo-controlled study of 158 adults with colds found that treatment with this andrographis significantly reduced cold symptoms.14 Participants were given either placebo or 1,200 mg daily of an andrographis extract standardized to contain 5% andrographolide. The results showed that by day 2 of treatment, and even more by day 4, individuals who were given the actual treatment experienced significant improvements in symptoms compared to participants in the placebo group. The greatest response was seen in earache, sleeplessness, nasal drainage, and sore throat, but other cold symptoms improved as well.
Three other double-blind, placebo-controlled studies, enrolling a total of about 400 people, evaluated a related proprietary herbal combination treatment containing both andrographis and Eleutherococcus senticosus.15,22 (This proprietary combination is sold under the name, “Kan Jang." The manufacturer regards this combination as more effective than andrographis alone.) Another study found this combination more effective than echinacea for colds in children.27
A different formulation of andrographis has been compared to acetaminophen (Tylenol). In a double-blind study of 152 adults with sore throat and fever, participants received andrographis (in doses of 3 g per day or 6 g per day, for 7 days) or acetaminophen.16 The higher dose of andrographis (6 g) decreased symptoms of fever and throat pain to about the same extent as acetaminophen, but the lower dose of andrographis (3 g) was not as effective. There were no significant side effects in either group.
A Russian study of questionable quality apparently found andrographis extract approximately as effective as the drug amanditine for influenza infections.28
A systematic review assessed 33 randomized trials that compared andrographis to placebo in the management of an upper respiratory tract infection. It was not clear if these infections were caused by viruses or bacteria. The comparisons also varied from placebo, to usual care, or other herbal medicine. Andrographis supplements did shwo a trend to faster improvement in symptoms and a shorter duration of illness. Unfortunately, there were a number of quality issues with the included trials. One of the main issues was the lack of consistency in products used and difference in the quality and quantity of andrographis.33-35 Higher quality studies may help confirm benefits and find optimal dosing. If effective, a supplement like this could play an important role in infection care.
According to one double-blind, placebo-controlled study, andrographis may increase resistance to colds.17 A total of 107 students, all 18 years old, participated in this 3-month-long trial that used the same proprietary extract of andrographis mentioned above. Fifty-four of the participants took two 100-mg tablets standardized to 5.6% andrographolide daily—considerably less than the 1,200 to 6,000 mg per day that has been used in studies on treatment of colds. The other 53 students were given placebo tablets with a coating identical to the treatment. Then, once a week throughout the study, a clinician evaluated all the participants for cold symptoms.
By the end of the trial, only 16 people in the group using andrographis had experienced colds, compared to 33 of the placebo-group participants. This difference was statistically significant, indicating that andrographis reduces the risk of catching a cold by a factor of two as compared to placebo.
A typical dosage of andrographis is 400 mg 3 times a day. Doses as high as 1,000 to 2,000 mg 3 times daily have been used in some studies. Andrographis is usually standardized to its content of andrographolide, typically 4% to 6%. Note that virtually all published studies of andrographis have involved a single proprietary product. It is not clear that the results of these studies apply to products using different andrographis sources, or different methods of extraction.
Andrographis has not been associated with any side effects in human studies. In one study, participants were monitored for changes in liver function, blood counts, kidney function, and other laboratory measures of toxicity.18 No problems were found.
However, some animal studies have raised concerns that andrographis may impair fertility. One study found that male rats became infertile when fed 20 mg of andrographis powder daily.19 In this case, the rats stopped producing sperm and showed physical changes in some of the testicular cells involved in sperm production. Researchers also detected evidence of degeneration of other anatomical structures in the testicles. However, another study showed no evidence of testicular toxicity in male rats that were given up to 1 g per kilogram body weight daily for 60 days, so this issue remains unclear.20 Furthermore, a human trial using the widely tested andrographis-eleutherococcus combination found no adverse effect on male fertility measurements such as sperm quality and number.29
One group of female mice also did not fare well on high dosages of andrographis.21 When fed 2 g per kilogram body weight daily for 6 weeks (thousands of times higher than the usual human dose), all female mice failed to get pregnant when mated with males of proven fertility. Meanwhile, of the control females, 95.2% got pregnant when mated with a similar group of male mice. Another study found a potential explanation for this in evidence that androphraphis relaxes the uterus.23 While andrographis is probably not a useful form of birth control, these results are worrisome regarding the use of androphraphis by pregnant women.
Finally, if androphraphis does indeed stimulate the immune system, this would lead to a whole host of potential risks. The immune system is balanced on a knife edge. An immune system that is too relaxed fails to defend us from infections, but an immune system that is too active attacks healthy tissues, causing autoimmune diseases. A universal immune booster might cause or exacerbate lupus, Crohn’s disease, asthma, Graves’ disease, Hashimoto’s thyroiditis, multiple sclerosis, and rheumatoid arthritis, among other illnesses.
Safety in young children, nursing women, or those with severe liver or kidney disease has also not been established.
Also, because andrographis may stimulate gallbladder contraction, it should not be used by individuals with gallbladder disease except under physician supervision.
References [ + ]
1. 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;9:559-562.
2. Puri A, Saxena R, Saxena RP, et al. Immunostimulant agents from Andrographis paniculata. J Nat Prod. 1993;56:995-999.
3. Zhao HY, Fang WY. Antithrombotic effects of Andrographis paniculata nees in preventing myocardial infarction. Chin Med J (Engl). 1991,104:770-775.
4. Zhang CY, Tan BK. Mechanisms of cardiovascular activity of Andrographis paniculata in the anaesthetized rat. J Ethnopharmacol. 1997;56:97-101.
5. Wang DW, Zhao HY. Prevention of atherosclerotic arterial stenosis and restenosis after angioplasty with Andrographis paniculata nees and fish oil. Chin Med J (Engl). 1994;107:464-470.
6. Visen PKS, Shukla B, Patnaik GK, et al. Andrographolide protects rat hepatocytes against paracetamol-induced damage. J Ethnopharmacol. 1993;40:131-136.
7. Kapil A, Koul IB, Banerjee SK, et al. Antihepatotoxic effects of major diterpenoid constituents of Andrographis paniculata.Biochem Pharmacol. 1993;46:182-185.
8. Handa SS, Sharma A. Hepatoprotective activity of andrographolide from Andrographis paniculata against carbontetrachloride. Indian J Med Res. 1990;92:276-283.
9. Shukla B, Visen PKS, Patnaik GK, et al. Choleretic effect of andrographolide in rats and guinea pigs. Planta Med. 1992;58:146-149.
11. 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.
12. Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold—a pilot trial. Phytomedicine. 1996/1997;34:315-318.
13. 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;9:559-562.
14. 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.
15. Melchior J, Spasov AA, Ostrovskij OV, et al. 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;7:341-350.
16. Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata (Nees) for pharyngotonsillitis in adults. J Med Assoc Thai.1991;74:437-442.
17. 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.
18. 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;9:559-562.
19. Akbarsha MA, Manivannan B, Shahul Hamid K, et al. Antifertility effect of Andrographis paniculata (Nees) in male albino rat. Indian J Exp Biol. 1990;28:421-426.
20. Burgos RA, Caballero EE, Sanchez NS, et al. Testicular toxicity assessment of Andrographis paniculata dried extract in rats. J Ethnopharmacol. 1997;58:219-224.
21. Zoha MS, Hussain AHM, Choudhury SAR. Antifertility effect of Andrographis paniculata in mice. Bangladesh Med Res Counc Bull. 1989;15:34-37.
22. 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;9:589-597.
23. Burgos RA, Aguila MJ, Santiesteban ET. Andrographis paniculata (Nees) induces relaxation of uterus by blocking voltage operated calcium channels and inhibits Ca(+2) influx. Phytother Res. 2001;15:235-239.
24. Panossian A, Hambartsumyan M, Panosyan L, et al. Plasma nitric oxide level in familial Mediterranean fever and its modulations by Immuno-Guard. Nitric Oxide. 2003;9:103-110.
25. Amaryan G, Astvatsatryan V, Gabrielyan E, et al. Double-blind, placebo-controlled, randomized, pilot clinical trial of ImmunoGuard—a standardized fixed combination of Andrographis paniculata Nees, with Eleutherococcus senticosus Maxim, Schizandra chinensis Bail, and Glycyrrhiza glabra L. extracts in patients with familial Mediterranean fever. Phytomedicine. 2003;10:271-285.
26. Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med. 2004;70:293-298.
27. 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.
28. Kulichenko LL, Kireyeva LV, Malyshkina EN, et al. A randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd. J Herb Pharmcother. 2003;3:77-92.
29. Mkrtchyan A, Panosyan V, Panossian A, et al. A phase I clinical study of Andrographis paniculata fixed combination Kan Jang versus ginseng and valerian on the semen quality of healthy male subjects. Phytomedicine. 2005;12:403-409
30. Tang T, Targan SR, Li ZS, Xu C, Byers VS, Sandborn WJ. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis—a double-blind comparison with sustained release mesalazine. Aliment Pharmacol Ther. 2011;33(2):194-202.
31. Sandborn WJ, Targan SR, Byers VS, et al. Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. Am J Gastroenterol. 2013;108(1):90-98.
32. Malahubban M, Alimon AR, Sazili AQ, Fakurazi S, Zakry FA.Phytochemical analysis of Andrographis paniculata and Orthosiphon stamineus leaf extracts for their antibacterial and antioxidant potential. Trop Biomed. 2013;30(3):467-480.
33. Hossain MS, Urbi Z, Sule A, Hafizur Rahman KM. Andrographis paniculata (Burm. f.) Wall. ex Nees: a review of ethnobotany, phytochemistry, and pharmacology. ScientificWorldJournal. 2014;2014:274905.
34. Banerjee M, Parai D, Chattopadhyay S, Mukherjee SK. Andrographolide: antibacterial activity against common bacteria of human health concern and possible mechanism of action. Folia Microbiol (Praha). 2017;62(3):237-244.
35. Hu XY, Wu RH, Loque M, et al. Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One. 2017 Aug 4;12(8)
Last reviewed December 2017 by EBSCO CAM Review Board
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