Artemisia annua

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Artemisia annua

Common Names

  • Qing Hao
  • Sweet sagewort
  • Sweet wormwood
  • Annual wormwood

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


What is it?

Artemisia annua is an herb used in traditional Chinese medicine. It also comes as capsules, teas, powders, and extracts.

What is it used for?

 Artemisia is used to:

  • Treat malaria
  • Reduce fever
  • Reduce swelling

 Artemisia has other uses, but doctors haven’t studied them to see if they work.

It’s generally safe to use artemisia in tea. Talk with your healthcare providers before taking artemisia supplements. Herbal supplements are stronger than the herbs you’d use in cooking. They can also interact with some medications and affect how they work. For more information, read the “What else do I need to know?” section below.

What are the side effects?

Side effects of artemisia supplements may include:

  • Dizziness
  • Hearing problems
What else do I need to know?
  • Don’t take artemisia if you have ulcers or stomach disorders. It may not be safe for you.
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For Healthcare Professionals

Scientific Name
Artemisia annua
Clinical Summary

Commonly known as wormwood or sweet sagewort, Artemisia annua has been used in traditional Chinese medicine for fevers, inflammation, headaches, bleeding, and malaria. In vitro studies indicate that artemisinin, the active principle of A. annua, may be effective for protozoal infections including leishmaniasis (8), Chagas’ disease, and African sleeping sickness (9). Cytotoxic effects of A. annua compounds have also been evaluated in tumor cell lines (1) (18) (19) (20) (25) (26).

Artemisinin-based combination therapies are part of the standard treatment arsenal for malaria. Systematic reviews suggest it is as effective as quinine (4) (5), but increased risk of relapse may limit its uses (6) (7). It is also unclear whether it is effective against quinine-resistant malaria strains. Other reports of artemisinin-based therapy resistance are also emerging, prompting additional drug development (28).

Studies of artemisia for other conditions are limited. In one RCT, a low-dose artemisia formulation produced clinically relevant pain reductions in patients with hip or knee osteoarthritis (3). A subsesquent open-label continuation study demonstrated long-term safety with improvements maintained at 6 months (10). A few safety studies in advanced cancer patients suggest oral add-on artesunate, a semisynthetic artemisinin derivative, is well tolerated, although monitoring for ototoxicity is needed (13) (21). In other studies, oral or intravenous artesunate did not produce a response (29) (30), although modest clinical activity was observed with intravenous administration (30). More studies are needed to determine the conditions under which compounds derived from artemisia may be safe and effective.

Purported Uses
  • Malaria
  • Fever
  • Inflammation
Mechanism of Action

Artemisinin, the active constituent of A. annua, exerts antimalarial effects by free radicals formed via cleavage of the endoperoxide bond in its structure, which are responsible for eradicating the Plasmodium species (23).

Artemisinin induces apoptosis and cell cycle arrest of Leishmani donovani promastigotes (8). It has antiproliferative effects on medullary thyroid carcinoma cells (2), and induces apoptosis in a lung cancer cell line by modulating p38 and calcium signaling (14). In another study, it significantly inhibited cell growth and proliferation, and caused G1 cell-cycle arrest in neuroblastoma cell lines (25). Dihydroartemisinin, a semi-synthetic derivative of artemisinin, demonstrates anti-inflammatory activity by attenuating COX-2 production via downregulation of serine/threonine kinase and MAPK pathways  (24). Recent findings suggest that dihydroartemisinin-triggered apoptosis in colorectal cells occurs through the ROS-mediated mitochondria-dependent pathway (26).

Contraindications

Patients with ulcers or GI disorders should not take artemisia (11).

Adverse Reactions

Case reports

  • Hepatitis: In a 52-year-old man following consumption of an herbal supplement containing artemisinin (17).
  • Acute cholestatic hepatitis: In a patient due to ingestion of artemisia tea as prophylaxis against malaria (31).
  • Delayed hemolytic anemia: Two cases after either oral or intravenous therapy with artemisinin-based treatment for malaria (32) (33). It is thought this reaction may be related to higher parasite loads (32).
  • Ototoxicity and vertigo: Possibly related to oral artesunate, an active artemisia compound, among several advanced breast cancer patients in a safety trial (13) (21). The study drug was otherwise largely well tolerated among patients.
  • Dermatitis: With topical use of artemisia (11).
Herb-Drug Interactions
  • CYP450 substrates: In laboratory studies, artemisia extracts induced CYP2B6 and CYP3A4 (27) and may affect the serum concentration of drugs metabolized by these enzymes. Clinical relevance has yet to be determined.
Dosage (OneMSK Only)
References
  1. Singh NP, Lai HC. Artemisinin induces apoptosis in human cancer cells. Anticancer Res. 2004 Jul-Aug;24(4):2277-80.
  2. Zheng GQ. Cytotoxic terpenoids and flavonoids from Artemisia annua. Planta Med. 1994 Feb;60(1):54-7.
  3. Stebbings S, Beattie E, McNamara D, et al. A pilot randomized, placebo-controlled clinical trial to investigate the efficacy and safety of an extract of Artemisia annua administered over 12 weeks, for managing pain, stiffness, and functional limitation associated with osteoarthritis of the hip and knee. Clin Rheumatol. Jul 2016;35(7):1829-1836.
  4. McIntosh HM, Olliaro P. Artemisinin derivatives for treating severe malaria. Cochrane.Database.Syst.Rev. 2000;CD000527.
  5. McIntosh HM, Olliaro P. Artemisinin derivatives for treating uncomplicated malaria. Cochrane.Database.Syst.Rev. 2000;CD000256.
  6. Mueller MS, et al. Randomized controlled trial of a traditional preparation of Artemisia annua L. (Annual Wormwood) in the treatment of malaria. Trans R Soc Trop Med Hyg. 2004;98:318-21.
  7. Blanke CH, Naisabha GB, Balema MB, et al. Herba Artemisiae annuae tea preparation compared to sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in adults: a randomized double-blind clinical trial. Trop Doct. Apr 2008;38(2):113-116.
  8. Sen R, Bandyopadhyay S, Dutta A, et al. Artemisinin triggers induction of cell-cycle arrest and apoptosis in Leishmania donovani promastigotes. J Med Microbiol. Sep 2007;56(Pt 9):1213-1218.
  9. Mishina YV, Krishna S, Haynes RK, Meade JC. Artemisinins inhibit Trypanosoma cruzi and Trypanosoma brucei rhodesiense in vitro growth. Antimicrob Agents Chemother. May 2007;51(5):1852-1854.
  10. Hunt S, Stebbings S, McNamara D. An open-label six-month extension study to investigate the safety and efficacy of an extract of Artemisia annua for managing pain, stiffness and functional limitation associated with osteoarthritis of the hip and knee. N Z Med J. Oct 28 2016;129(1444):97-102.
  11. Skyles AJ, Sweet BV. Alternative therapies. Wormwood. Am J Health Syst.Pharm. 2004;61:239-42.
  12. Rinner B, et al. Activity of novel plant extracts against medullary thyroid carcinoma cells. Anticancer Res 2004;24:495-500.
  13. Konig M, von Hagens C, Hoth S, et al. Investigation of ototoxicity of artesunate as add-on therapy in patients with metastatic or locally advanced breast cancer: new audiological results from a prospective, open, uncontrolled, monocentric phase I study. Cancer Chemother Pharmacol. Feb 2016;77(2):413-427.
  14. Mu D, Zhang W, Chu D, et al. The role of calcium, P38 MAPK in dihydroartemisinin-induced apoptosis of lung cancer PC-14 cells. Cancer Chemother Pharmacol. Apr 2008;61(4):639-645.
  15. Rath K, et al. Pharmacokinetic study of artemisinin after oral intake of a traditional preparation of Artemisia annua L. (annual wormwood). Am J Trop Med Hyg. 2004;70:128-32.
  16. Payne AG. Exploiting intracellular iron and iron-rich compounds to effect tumor cell lysis. Med Hypotheses 2003;61:206-9.
  17. Centers for Disease Control and Prevention. Hepatitis Temporally Associated with an Herbal Supplement Containing Artemisinin —- Washington, 2008. Accessed December 10, 2021.
  18. Lai H, Nakase I, Lacoste E, Singh NP, Sasaki T. Artemisinin-transferrin conjugate retards growth of breast tumors in the rat. Anticancer Res. 2009 Oct;29(10):3807-10.
  19. Willoughby JA Sr, Sundar SN, Cheung M, et al. Artemisinin blocks prostate cancer growth and cell cycle progression by disrupting Sp1 interactions with the cyclin-dependent kinase-4 (CDK4) promoter and inhibiting CDK4 gene expression. J Biol Chem. 2009 Jan 23;284(4):2203-13.
  20. Zhai DD, Supaibulwatana K, Zhong JJ. Inhibition of tumor cell proliferation and induction of apoptosis in human lung carcinoma 95-D cells by a new sesquiterpene from hairy root cultures of Artemisia annua. Phytomedicine. 2010 Sep;17(11):856-61.
  21. Konig M, von Hagens C, Hoth S, et al. Erratum to: Investigation of ototoxicity of artesunate as add-on therapy in patients with metastatic or locally advanced breast cancer: new audiological results from a prospective, open, uncontrolled, monocentric phase I study. Cancer Chemother Pharmacol. Jun 2016;77(6):1321.
  22. van der Kooy F, Sullivan SE. The complexity of medicinal plants: the traditional Artemisia annua formulation, current status and future perspectives.J Ethnopharmacol. 2013 Oct 28;150(1):1-13.
  23. Ho WE, Peh HY, Chan TK, Wong WS. Artemisinins: pharmacological actions beyond anti-malarial. Pharmacol Ther. 2014 Apr;142(1):126-39.
  24. Kim HG, Yang JH, Han EH, et al. Inhibitory effect of dihydroartemisinin against phorbol ester-induced cyclooxygenase-2 expression in macrophages.  Food Chem Toxicol. 2013 Jun;56:93-9.
  25. Zhu S, Liu W, Ke X, et al. Artemisinin reduces cell proliferation and induces apoptosis in neuroblastoma. Oncol Rep. 2014 Sep;32(3):1094-100.
  26. Lu M, Sun L, Zhou J, Yang J.Dihydroartemisinin induces apoptosis in colorectal cancer cells through the mitochondria-dependent pathway. Tumour Biol. 2014 Jun;35(6):5307-14.
  27. Xing J, Kirby BJ, Whittington D, et al. Evaluation of P450 inhibition and induction by artemisinin antimalarials in human liver microsomes and primary human hepatocytes. Drug Metab Dispos. 2012 Sep;40(9):1757-64.
  28. van der Pluijm RW, Tripura R, Hoglund RM, et al. Triple artemisinin-based combination therapies versus artemisinin-based combination therapies for uncomplicated Plasmodium falciparum malaria: a multicentre, open-label, randomised clinical trial. Lancet. Apr 25 2020;395(10233):1345-1360.
  29. von Hagens C, Walter-Sack I, Goeckenjan M, et al. Long-term add-on therapy (compassionate use) with oral artesunate in patients with metastatic breast cancer after participating in a phase I study (ARTIC M33/2). Phytomedicine. Feb 15 2019;54:140-148.
  30. Deeken JF, Wang H, Hartley M, et al. A phase I study of intravenous artesunate in patients with advanced solid tumor malignancies. Cancer Chemother Pharmacol. Mar 2018;81(3):587-596.
  31. Ruperti-Repilado FJ, Haefliger S, Rehm S, et al. Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea. Front Med (Lausanne). 2019;6:221.
  32. Conlon CC, Stein A, Colombo RE, et al. Post-artemisinin delayed hemolysis after oral therapy for P. falciparum infection. IDCases. 2020;20:e00741.
  33. Hasegawa C, Kudo M, Maruyama H, et al. Severe delayed haemolytic anaemia associated with artemether-lumefantrine treatment of malaria in a Japanese traveller. J Infect Chemother. Mar 2018;24(3):216-219.
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