Andrographis paniculata

Risk of bias included studies

• Acute, uncomplicated respiratory tract infection (in general): High risk of bias

AMSTAR 2 score

• Acute, uncomplicated respiratory tract infection (in general): Low i
• Cough: Critically low i, Low i
• Sore throat: Critically low i, Low i

Quality of the included studies in a systematic review

• Acute, uncomplicated respiratory tract infection: Critically low quality i
• Cough: Low quality i
• Sore throat: Low quality i

Mechanism of action

• Antibacterial effects
• Restoring antibiotic sensitivity and reducing biofilm
• Reducing bacterial adhesion
• Antiviral effects
• Immunomodulatory effects
• Regulation of macrophage functioning
• Antipyretic effects [5-16]

Adults

…when used orally and appropriately, short-term. Andrographis has been used with apparent safety in doses of up to 6 grams daily for up to 7 days. Andrographis extract has been used with apparent safety at doses of up to 340 mg daily for up to 12 months, 600 mg daily for up to 3 months, or 1200 mg daily for up to 8 weeks. Andrographolide, a constituent of andrographis, has been used with apparent safety at a dose of 280 mg daily for 24 months. A specific combination product containing andrographis extract 178-206 mg and eleuthero (Kan Jang, Swedish Herbal Institute) has been taken three times daily with apparent safety for up to 4-7 days.

Children

…when used orally and appropriately, short-term. Andrographis, in combination with other herbs, has been used with apparent safety in clinical trials at doses up to 48 mg daily in children 3-15 years of age for up to one month.

Pregnancy

….when used orally. Andrographis is thought to have abortifacient effects; avoid using.

Lactation

Adverse effects

Vomiting, epistaxis, urticaria, diarrhoea (with nausea and lethargy), loss of appetite, rash, headache, runny nose, and fatigue. When used in high doses or long-term, andrographis might cause swollen lymph glands, serious allergic reactions, elevations of liver enzymes, and other side effects.

Interactions

• “Might affect hepatic Cytoschrome 450 enzymes. Aerial parts may contribute to herb-drug interactions if they are administered concomitantly with drugs metabolised by CYP2C9, CYP2D6 and CYP3A4 (Hanapi 2010). Ethanol and methanol extracts of whole plants inhibit CYP activities more potently than aqueous and hexane extracts (Pan 2011).
• WebMD: Andrographis interacts with medication for high blood pressure, with medications that suppress the immune system and medication that slows blood clotting.”

Overdose

There is insufficient reliable information available about the presentation or treatment of overdose with andrographis.

National registration

Not registered in EU countries.

Included in national guidelines

UK: cough, acute (NICE guideline)

Warnings

A. paniculata products should be free of toxic pollution and contain a standardized percentage of andrographolides.

Mechanism of action

[1] Abubacker, M.N.; Vasantha, S. Antibacterial Activity of Ethanolic Leaf Extract of Andrographis Paniculata Nees (Acanthaceae) and its Bioactive Compound Andrographolide. Drug Invention Today 2010, 2, 440-442.
[2] Ajaya Kumar, R.; Sridevi, K.; Vijaya Kumar, N.; Nanduri, S.; Rajagopal, S. Anticancer and Immunostimulatory Compounds from Andrographis Paniculata. Journal of ethnopharmacology 2004, 92, 291-295.
[3] Chandrasekaran, C.V.; Gupta, A.; Agarwal, A. Effect of an Extract of Andrographis Paniculata Leaves on Inflammatory and Allergic Mediators in Vitro. Journal of ethnopharmacology 2010, 129, 203-207.
[4] Chandrasekaran, C.V.; Thiyagarajan, P.; Deepak, H.B.; Agarwal, A. In Vitro Modulation of LPS/Calcimycin Induced Inflammatory and Allergic Mediators by Pure Compounds of Andrographis Paniculata (King of Bitters) Extract. International immunopharmacology 2011, 11, 79-84.
[5] Chen, J.; Xue, H.; Ye, W.; Fang, B.; Liu, Y.; Yuan, S.; Yu, P.; Wang, Y. Activity of Andrographolide and its Derivatives Against Influenza Virus in Vivo and in Vitro. Biological & pharmaceutical bulletin 2009, 32, 1385-1391.
[6] Hossain, S.; Urbi, Z.; Karuniawati, H.; Mohiuddin, R.B.; Moh Qrimida, A.; Allzrag, A.M.M.; Ming, L.C.; Pagano, E.; Capasso, R. Andrographis Paniculata (Burm. F.) Wall. Ex Nees: An Updated Review of Phytochemistry, Antimicrobial Pharmacology, and Clinical Safety and Efficacy. Life (Basel, Switzerland) 2021, 11, 348.
[7] Jiang, M.; Sheng, F.; Zhang, Z.; Ma, X.; Gao, T.; Fu, C.; Li, P. Andrographis Paniculata (Burm.F.) Nees and its Major Constituent Andrographolide as Potential Antiviral Agents. Journal of ethnopharmacology 2021, 272, 113954.
[8] Kumar, S.; Singh, B.; Bajpai, V. Andrographis Paniculata (Burm.F.) Nees: Traditional Uses, Phytochemistry, Pharmacological Properties and Quality Control/Quality Assurance. Journal of ethnopharmacology 2021, 275, 114054.
[9] Liu, J.; Wang, Z.; Ge, B. Andrograpanin, Isolated from Andrographis Paniculata, Exhibits Anti-Inflammatory Property in Lipopolysaccharide-Induced Macrophage Cells through Down-Regulating the p38 MAPKs Signaling Pathways. International immunopharmacology 2008, 8, 951-958.
[10] Mishra, P.K.; Singh, R.K.; Gupta, A.; Chaturvedi, A.; Pandey, R.; Tiwari, S.P.; Mohapatra, T.M. Antibacterial Activity of Andrographis Paniculata (Burm. F.) Wall Ex Nees Leaves Against Clinical Pathogens. Journal of pharmacy research 2013, 7, 459-462.
[11] Okhuarobo, A.; Ehizogie Falodun, J.; Erharuyi, O.; Imieje, V.; Falodun, A.; Langer, P. Harnessing the Medicinal Properties of Andrographis Paniculata for Diseases and Beyond: A Review of its Phytochemistry and Pharmacology. Asian Pacific Journal of Tropical Disease 2014, 4, 213-222.
[12] Parichatikanond, W.; Suthisisang, C.; Dhepakson, P.; Herunsalee, A. Study of Anti-Inflammatory Activities of the Pure Compounds from Andrographis Paniculata (Burm.F.) Nees and their Effects on Gene Expression. International immunopharmacology 2010, 10, 1361-1373.
[13] Rajalakshmi, V.; Cathrine, L. Phytochemical Screening and Antimicrobial Activity of Ethanolic Extract of Andrographis Paniculata. Journal of Pharmacognosy and Phytochemistry 2016, 5, 175-177.
[14] Sheeja, K.; Shihab, P.K.; Kuttan, G. Antioxidant and Anti-Inflammatory Activities of the Plant Andrographis Paniculata Nees. Immunopharmacology and immunotoxicology 2006, 28, 129-140.
[15] Wang, W.; Wang, J.; Dong, S.; Liu, C.; Italiani, P.; Sun, S.; Xu, J.; Boraschi, D.; Ma, S.; Qu, D. Immunomodulatory Activity of Andrographolide on Macrophage Activation and Specific Antibody Response. Acta pharmacologica Sinica 2010, 31, 191-201.
[16] Xu, C.; Chou, G.; Wang, C.; Wang, Z. Rare Noriridoids from the Roots of Andrographis Paniculata. Phytochemistry (Oxford) 2012, 77, 275-279.