- Qing Hao
- Sweet sagewort
- Sweet wormwood
- Annual wormwood
For Patients & Caregivers
How It Works
A compound from artemisia is used as part of combination therapy to treat malaria, but studies of its use for other conditions are limited.
Artemisia annua is an herb traditionally used in Chinese medicine to treat fever, inflammation, and malaria. A compound from artemisia is used in combination with other drugs to treat malaria.
There are limited studies on the use of artemisia or it compounds for other conditions. A few initial studies suggest it may help treat osteoarthritis. Other preliminary studies in advanced cancer patients have not shown any clinical response, and patients need to be monitored for potential side effects. More studies are needed to determine whether compounds from artemisia are safe and effective for these conditions.
To treat malaria
A compound from artemisia is used in combination with other drugs to treat malaria. Patients need to be treated by a healthcare provider for this condition, and should not self-treat with artemisia for malaria.
To reduce inflammation
Preliminary studies suggest that artemisia may be helpful for hip or knee osteoarthritis, but more study is needed.
To treat cancer
Only a few safety studies in advanced cancer patients have been conducted, and have not shown a treatment response. In addition, patients need to be monitored for potential side effects. More studies are needed to determine the conditions under which compounds derived from artemisia may be safe and effective.
- Hepatitis: One case was attributed to an herbal supplement containing artemisinin. Another case was linked to drinking artemisia tea to protect against malaria.
- Anemia: Two cases of loss of healthy red blood cells after artemisinin-based treatment for malaria.
- Hearing loss, ringing in the ears, and dizziness: Among several advanced breast cancer patients in a safety trial, and possibly related to oral artesunate, an active artemisia compound. The study drug was otherwise largely well tolerated among patients.
- Skin rash: With topical use of artemisia.
For Healthcare Professionals
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 an effective treatment 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 have shown it to be as effective as quinine for both uncomplicated and severe malaria (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). Large superiority trials of artemisia tea infusions found them equivalent or superior to artesunate-amodiaquine against malaria (29) and effective against schistosomiasis compared with standard praziquantel treatment (30).
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 maintained improvements 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 (31) (32), although modest clinical activity was observed with intravenous administration (32). More studies are needed to determine the conditions under which compounds derived from artemisia may be safe and effective.
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 (AKT) and mitogen activated protein kinase (MAPK) pathways (24). Recent findings suggest that dihydroartemisinin-triggered apoptosis in colorectal cells occurs through the reactive oxygen species (ROS)-mediated mitochondria-dependent pathway (26).
- 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 (33).
- Delayed hemolytic anemia: Two cases after either oral or intravenous therapy with artemisinin-based treatment for malaria (34) (35). It is thought this reaction may be related to higher parasite loads (34).
- 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).
- Cytochrome P450 (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.