Pelargonium sidoides

Risk of bias included studies

AMSTAR 2 score

• Acute, uncomplicated respiratory tract infection (in general):: Critically low i
• Acute bronchitis: Critically low i
• Acute rhinosinusitis: Critically low i
• Acute tonsillopharyngitis: Critically low i
• Cough: Critically low i

Quality of the included studies in a systematic review

Mechanism of action

• Reducing bacterial adhesion to epithelial cells
• Increased bacterial adhesion to buccal cells
• Increased production of antibmicrobial peptides
• Antiviral effects
• Upregulation of vitamin D receptor on human epithelial cells
• Reduced inflammatory damage
• Increased macrophage functioning
• Increased inflammatory cytokines
• Expectorant
• Antitussive
  [1-19]

Adults

…when used orally or appropriately, short-term. A specific extract of umckaloabo (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals), in doses of 4.5-9 mL daily when administered as a solution, or 90 mg daily when administered as a tablet, has been safely used for up to 24 weeks.

There is insufficient reliable information available about the safety of umckaloabo when used orally, long-term.

Children

…when used orally and appropriately, short-term. A specific extract of umckaloabo (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) in doses of 3 mL daily has been used with apparent safety in children aged 6-10 years for up to 7 days.

Pregnancy

Lactation

Included in national guidelines

Cough (Germany): https://register.awmf.org/assets/guidelines/053-013l_S3_akuter-und-chronischer-Husten_2022-01.pdf
Rhinosinusitis (Germany): https://register.awmf.org/assets/guidelines/017-049_und_053-012l_S2k_Rhinosinusitis_2022-12-abgelaufen.pdf

Mechanism of action

[1] Conrad, A.; Jung, I.; Tioua, D.; Lallemand, C.; Carrapatoso, F.; Engels, I.; Daschner, F.D.; Frank, U. Extract of Pelargonium Sidoides (EPs ® 7630) Inhibits the Interactions of Group A-Streptococci and Host Epithelia in Vitro. Phytomedicine 2007, 14, 52–59.
[2] Janecki, A.; Conrad, A.; Engels, I.; Frank, U.; Kolodziej, H. Evaluation of an Aqueous-Ethanolic Extract from Pelargonium Sidoides (EPs ® 7630) for its Activity against Group A-Streptococci Adhesion to Human HEp-2 Epithelial Cells. J. Ethnopharmacol. 2011, 133, 147–152.
[3] Walther, C.; Döring, K.; Schmidtke, M. Comparative in Vitro Analysis of Inhibition of Rhinovirus and Influenza Virus Replication by Mucoactive Secretolytic Agents and Plant Extracts. BMC Complement. Altern. Med. 2020, 20, 380.
[4] Brendler, T.; Al-Harrasi, A.; Bauer, R.; Gafner, S.; Hardy, M.L.; Heinrich, M.; Hosseinzadeh, H.; Izzo, A.A.; Michaelis, M.; Nassiri-Asl, M.; et al. Botanical Drugs and Supplements Affecting the Immune Response in the Time of COVID-19: Implications for Research and Clinical Practice. Phytother. Res. 2021, 35, 3013–3031.
[5] Roth, M.; Fang, L.; Stolz, D.; Tamm, M. Pelargonium Sidoides Radix Extract EPs 7630 Reduces Rhinovirus Infection through Modulation of Viral Binding Proteins on Human Bronchial Epithelial Cells. PLoS ONE 2019, 14, e0210702.
[6] Roth, M.; Sun, Q.; Tamm, M. Up-Regulated Vitamin D Receptor by Pelargonium Sidoides Extract EPs® 7630 Contributes to Rhinovirus Defense in Bronchial Epithelial Cells. Pharmaceuticals 2021, 14, 172.
[7] Bao, Y.; Gao, Y.; Koch, E.; Pan, X.; Jin, Y.; Cui, X. Evaluation of Pharmacodynamic Activities of EPs® 7630, a Special Extract from Roots of Pelargonium Sidoides, in Animals Models of Cough, Secretolytic Activity and Acute Bronchitis. Phytomedicine 2015, 22, 504–509.
[8] Nöldner, M.; Koch, E. Inhibition of Endotoxin-induced Sickness Behaviour in Mice by an Extract from Roots of Pelargonium Sidoides (Umckaloabo). Focus Altern. Complement. Ther. 2004, 9, 20.
[9] Noldner, M.; Schotz, K. Inhibition of Lipopolysaccharid-Induced Sickness Behavior by a Dry Extract from the Roots of Pelargonium Sidoides (EPs ® 7630) in Mice. Phytomedicine 2007, 14, 27–31.
[10] Neugebauer, P.; Mickenhagen, A.; Siefer, O.; Walger, M. A New Approach to Pharmacological Effects on Ciliary Beat Frequency in Cell Cultures—Exemplary Measurements under Pelargonium Sidoides Extract (EPs 7630). Phytomedicine 2005, 12, 46–51.
[11] Conrad, A.; Hansmann, C.; Engels, I.; Daschner, F.D.; Frank, U. Extract of Pelargonium Sidoides (EPs ® 7630) Improves Phagocytosis, Oxidative Burst, and Intracellular Killing of Human Peripheral Blood Phagocytes in Vitro. Phytomedicine 2007, 14, 46–51.
[12] Kayser, O.; Kolodziej, H.; Kiderlen, A.F. Immunomodulatory Principles of Pelargonium Sidoides. Phytother. Res. 2001, 15, 122–126.
[13] Thale, C.; Kiderlen, A.; Kolodziej, H. Anti-Infective Mode of Action of EPs 7630 at the Molecular Level. Planta Med. 2008, 74, 675–681.
[14] Witte, K.; Koch, E.; Volk, H.; Wolk, K.; Sabat, R. The Herbal Extract EPs® 7630 Increases the Antimicrobial Airway Defense through Monocyte-Dependent Induction of IL-22 in T Cells. J. Mol. Med. 2020, 98, 1493–1503.
[15] Koch, E.; Wohn, C. Pelargonium Sidoides Root Extract EPs® 7630 Stimulates Release of Antimicrobial Peptides from Neutrophil Granulocytes in Human Whole Blood. Planta Med. 2007, 73, P_072.
[16] Witte, K.; Koch, E.; Volk, H.; Wolk, K.; Sabat, R. The Pelargonium Sidoides Extract EPs 7630 Drives the Innate Immune Defense by Activating Selected MAP Kinase Pathways in Human Monocytes. PLoS ONE 2015, 10, e0138075.
[17] Trun, W.; Kiderlen, A.F.; Kolodziej, H. Nitric Oxide Synthase and Cytokines Gene Expression Analyses in Leishmania-Infected RAW 264.7 Cells Treated with an Extract of Pelargonium Sidoides (Eps ® 7630). Phytomedicine 2006, 13, 570–575.
[18] Perić, A.; Vezmar Kovačević, S.; Barać, A.; Perić, A.V.; Vojvodić, D. Effects of Pelargonium Sidoides Extract vs. Roxithromycin on Chemokine Levels in Nasal Secretions of Patients with Uncomplicated Acute Rhinosinusitis. Laryngoscope Investig. Otolaryngol. 2021, 6, 25–33.
[19] Perić, A.; Vezmar Kovačević, S.; Barać, A.; Gaćeša, D.; Perić, A.V.; Vojvodić, D. Effects of Pelargonium Sidoides Extract on Chemokine Levels in Nasal Secretions of Patients with Non-Purulent Acute Rhinosinusitis. J. Drug Assess. 2020, 9, 145–150.