BOTTOMLINE: Andrographis has been studied for the treatment of colds, flu, and upper respiratory infections. Its anticancer effects have not been studied in humans.
Andrographis paniculata is used in traditional medicine to treat infectious diseases and fevers. Andrographis possesses antibacterial, antioxidant, antiinflammatory, anticancer, and immunostimulating properties. Either alone, or in combination with other herbs, andrographis has been shown to reduce the duration and severity of upper respiratory infections such as those associated with the common cold or flu. Kan Jang, an extract made of Andrographis paniculata and Eleutherococcus senticosus has been used in some clinical trials of respiratory symptoms from cold and flu. Patients should use caution before using this herb as this may interact with many drugs.
Colds and Flu Either alone or in combination with other herbs, andrographis may reduce the duration and severity of cold and flu symptoms in humans.
HIV In a trial of patients infected with HIV, andrographolides, the active ingredients in andrographis, were shown to increase the number of lymphocytes, suggestive of an improvement in immune function.
Cancer Studies done in cancer-bearing mice have shown that andrographis has antioxidant activities. It is unclear if this herb has beneficial effects in human as cancer treatment.
Most of the clinical studies have been sponsored by the manufacturer of Kan Jang, a standardized formula with extracts of Andrographis paniculata and Eleutherococcus senticosus.
Andrographis paniculata is a bitter tasting annual plant prevalent in much of Asia. It is often used in combination with other herbs in traditional medicine to treat infectious diseases and associated fevers. This herb and its fractionated extracts have been studied for their antioxidant, antiviral, antibacterial, antiinflammatory, antihypertensive, antineoplastic, anti-ulcerogenic, and analgesic properties with some positive results. Formulations containing standardized extracts of andrographis are marketed in Western countries as dietary supplements for cold and flu. Kan Jang, a standardized extract of Andrographis paniculata and Eleutherococcus senticosus, has been studied in manufacturer-sponsored clinical trials for relief of respiratory symptoms from cold and flu (1)(2)(3)(4). It has also been studied in an early phase trial for male fertility (5). Dietary supplements containing Andrographis have been promoted for cancer prevention, cancer treatment, and to counter the toxicity of chemotherapy in humans but clinical evidence is lacking. Theoretically, Andrographis can cause multiple interactions including with many drugs used in cancer care. This herb should be used with caution.
The active constituents of Andrographis paniculata are diterpenoid lactones known as Andrographolides (6)(7). These compounds were shown to cause apoptosis through the induction of c-Jun N-terminal kinase (13) and through the activation of capases in vitro (14). They also inhibited E-selection expression resulting in the decreased adhesion of gastric cancer cells to endothelial tissues (15). Andrographolides can also suppress IFN-gamma and IL2 production (18) and inhibit production of reactive oxygen species (17). In addition, they were shown to inhibit HIV-induced dysregulation of cell cycle and to increase CD4+ lymphocyte levels in HIV-1 patients (6). Andrographolides also demonstrated anti inflammatory activity by inhibiting nitric oxide production and cyclooxygenase-2 expression (16).
Andrographis paniculata extract exhibited selective antiviral (23), antimicrobial (24), and antimalarial (25) activities. It also inhibited tumor cell growth by stimulating cytotoxic T-lymphocyte production through IL-2 and IFN-ã secretion (8). In animal models, Andrographis demonstrated antioxidant (12) and anti-angiogenic (11) properties, and reduced cyclophosphamide induced toxicity by inhibiting proinflammatory cytokines (9)(10). In other studies, the extract demonstrated calcium channel inhibition effect that can cause relaxation of smooth muscle resulting in decrease in blood pressure and heart rate (19), and relaxation of uterus (20). It also showed antiplatelet effects by inhibiting thrombin (21) and platelet activating factor (22). When given orally, the extract was shown to neutralize snake venom (26).
Andrographolide is readily absorbed when admininstered orally. A single dose of 20mg resulted in maximum plasma levels in 2 hours and has a half-life of 6.6 hours. It is 55% protein bound in the plasma (27).
Common adverse effects include headache, fatigue, allergic reactions, lymphadenopathy, pain in the lymph nodes, nausea, diarrhea and altered taste (6)(7). A case of anaphylactic reaction has been reported (6).
Drugs metabolized by Cytochrome P450 1A2, 2C9, 3A4 Andrographis extract can inhibit these enzymes and potentially interact with drugs they metabolize (28).
Anticoagulants and antiplatelet drugs Data from animal studies indicate possible inhibition of platelet aggregation (21)(22). But an animal study showed that andrographis extract does not interact with warfarin when used concomitantly (30). Patients taking anticoagulant or antiplatelet medications should use andrographis products with caution.
Chemotherapy drugs Andrographolide may have antioxidant effects (17). This may interfere with the actions of some chemotherapy drugs.
Blood pressure lowering drugs Andrographis may has additive hypotensive effect (19).
Many of the studies published on andrographis are manufacturer-sponsored in which Kan Jang, a standardized combination of Andrographis paniculata and Elutherococcus senticoscus, was used. While some of these studies are well designed, it is unclear if andrographis exerts the beneficial effects alone or in combination with other herbs.
A three arm study was conducted comparing Kan Jang preparation with Immunal, an Echinacea-based preparation, as adjuvants to a standard regimen of warm drinks, mouth gargles and paracetamol prn in children aged 4 to 11 suffering from the common cold over 10 days. 130 children were randomized to receive either standard treatment, or standard treatment with either Kan Jang or Immunal. Adjuvant treatment with Kan Jang was more effective than Immunal. Cold symptoms were less severe in the Kan Jang group, particularly in the amount of nasal secretion and congestion reported. Kan Jang accelerated recovery time compared to Immunal which did not demonstrate the same efficacy. There was less use of standard medication in the Kan Jang group, and treatment was well tolerated.
This study compared the combination formula Kan Jang to amantadine in patients diagnosed with influenza. 540 patients were enrolled. 71 received either 2 tablets andrographis extract (88.8mg) and 3 tablets of Eleutherococcus (10.0mg) 3 times daily for 3 to 5 days. The 469 patients in the control group received amantadine or another physician-preferred anti-viral medicine. The primary outcome measures were disease severity as measured by complication development and disease duration as measured by length of sick leave. In the Kan Jang group 30.1% of patients progressed to complicated influenza compared to 67.8% in the control group. The Kan Jang group experienced a shorter duration of symptoms of approximately 6 to 7 days as compared to the control group's 9 to 10 days. In a second phase of the study 66 patients, the Kan Jang group's days of sick leave were fewer (7.2 days) as compared to the control group (9.8 days). Additionally, 31.4% of the Kan Jang group developed post-influenza complications as compared to 71.0% in the control group. The authors suggest that Kan Jang may represent an effective treatment for reducing the duration and severity of influenza infections.
