What are the health benefits of andrographis? Can it treat colds, help with joint pain, or other conditions, and is it safe?

Answer:

What is andrographis?

Andrographis (Andrographis paniculata), sometimes referred to as "Indian echinacea," or "chiretta," is a plant native to India and Sri Lanka traditionally used to help prevent and treat colds and other respiratory infections, as well as to sooth digestive ailments and reduce joint aches and pains. It is most commonly taken as an extract, although occasionally, crushed whole leaves have been used.

The leaves and stems of andrographis contain compounds, collectively known as andrographolides (including andrographolide, neoandrographolide, and others), that have been shown in laboratory studies to have antitumor, antiviral, antibacterial, and anti-inflammatory effects. Andrographolide appears to inhibit cyclooxygenase-2 (COX-2), a pro-inflammatory enzyme that is the target of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Coon, Planta Med 2004; Hidalgo, Br J Pharmacol 2005).

Health benefits of andrographis?

As discussed below, andrographis has shown possible benefit for some conditions and no benefit for others.

Possible benefit:

Colds and respiratory infections

Several small clinical trials suggest that andrographis extract may help to relieve the severity of symptoms during colds and other respiratory infections, although it has not been proven to shorten the duration of colds.

A review of seven double-blind, controlled trials in people concluded that andrographis "may be a safe and efficacious treatment for the relief of symptoms of uncomplicated upper respiratory infections," but noted that further research is needed. The studies showed that andrographis extract providing between 48 to 60 mg of andrographolides per day, taken within 36 to 72 hours from the time of first symptoms reduced the severity of symptoms such as cough, headache and sore throat compared to placebo (Coon, Planta Med 2004).

In three of these trials, andrographis extract was taken alone, and in three others, it was given in combination with Siberian ginseng (which, although often promoted for treating colds, has little evidence of benefit for colds when taken alone). This formulation, sold as Kan Jang from Swedish Herbal Institute, does not appear to be sold in the U.S. A single, seven-day trial among people with pharyngitis, using capsules containing crushed whole andrographis leaves, found that taking either 6 grams of andrographis (providing 360 mg of andrographolides per day) or paracetamol (also known as acetaminophen or Tylenol) provided greater relief of sore throat and a reduction of fever on day three than a lower dose of andrographis (3 grams per day), but by the seventh day, there were no significant differences in symptoms between the three treatments (Thamlikitkul, J Med Assoc Thai 1991).

A later study in India among 220 men and women with upper respiratory infections found that 100 mg of a branded andrographis extract (KalmCold, by Natural Remedies Pvt. Ltd) taken twice daily within three days of symptom onset (a total daily dose of 200 mg of extract providing 76 mg of total andrographolides) for five days modestly reduced self-reported symptoms including cough, nasal discharge, headache, sore throat and fatigue, but not earache, on day five compared to placebo (Saxena, Phytomedicine 2010).

Osteoarthritis

A study in India among 103 men and women with mild to moderate early-stage knee osteoarthritis found that 150 mg of an andrographis extract standardized to 50% andrographolides (ParActin, by HP Ingredients, which funded the study) taken twice daily providing 150 mg total andrographolides) for three months modestly reduced knee pain and stiffness and improved physical function, compared to placebo. Participants began to experience significant improvements after one month of supplementation, and continued to improve during the second and third month of the trial, suggesting it may take a month or more to experience a benefit. A higher daily dosage of 600 mg of extract resulted in similar, but no greater improvements compared to the lower dosage (Hancke, Phytother Res 2019).

Ulcerative colitis

In a study among 223 men and women being treated for mild to moderate ulcerative colitis at clinics in the U.S., Canada, and Ukraine (most of whom were also taking the NSAID mesalamine or similar drug), 600 mg of andrographis extract taken three times daily (total daily dose of 1,800 mg – amount of andrographolides not provided) for two months, 60% of those who took andrographis achieved clinical response (a decrease of at least 30% on the Mayo Score for Ulcerative Colitis Activity including a decrease in rectal bleeding) at two months compared to 40% of those who took a placebo. Supplementation did not increase rates of mucosal healing or clinical remission. A lower daily dose of 1,200 did not result in significantly higher rates of clinical response, or improve other measures, compared to placebo (Sandborn, Am J Gastroenterol 2013).

Unproven benefit:

Rheumatoid arthritis

ParActin has also been studied in people with rheumatoid arthritis, using, apparently, an earlier formulation standardized to 30% andrographolides (the current version is standardized to 50%). In one such study, 60 men and women (average age 46 ) with active rheumatoid arthritis who took 100 mg of ParActin three times daily (a total daily dose of 300 mg providing 90 mg total andrographolides) had reductions in certain blood markers of inflammation and disease activity (rheumatoid factor, IgA, and C4) and modest reductions in joint tenderness and the number of tender joints, but these improvements were not compared to placebo, making it impossible to determine actual efficacy (Burgos, Clin Rheumatol 2009).

In a separately published case series, taking 300 mg of ParActin (providing 90 mg of andrographolides) three times daily for up to four years was reported to be well-tolerated and to significantly decrease pain and fatigue in six people with a long history (3 to 15 years) of active rheumatoid arthritis, rheumatoid spondylitis or psoriatic arthritis, compared to before supplementation. Again, however, this was not a controlled trial, more research is needed to prove a benefit (Hidalgo, Innovative Rheumatology 2012).

No benefit:

COVID-19

Due to its immune stimulating properties and potential benefit in colds, there has been some interest in the effects on andrographis supplementation to help prevent or treat COVID-19. However, clinical research does not support the use of andrographis for COVID-19. For example, a small study in Thailand among 57 patients (average age 39) with mild COVID-19 found that taking andrographis extract for 5 days did not significantly reduce the risk of pneumonia or reduce the risk of still testing positive for COVID-19 on day 5 compared to placebo (Wanaratna, Arch Intern Med Res 2022). Similarly, a slightly larger study in Thailand among 146 patients (average age 38) with mild to moderate COVID showed that taking andrographis extract along with the antiviral drug favipiravir did not reduce the risk of disease progression, need for oxygen therapy, or death, nor did it improve symptoms, compared to taking favipiravir plus placebo (Siripongboonsitti, Phytomedicine 2023). In both studies, andrographis extract was standardized to 60 mg of andrographolide and taken three times daily for 5 days.

A retrospective observational study in Thailand among 605 people (average age 35) hospitalized with mild COVID-19 from March 2020 to April 2021 found that those who received 1.5 grams of crude andrographis extract (standardized to 60 mg of andrographolide) three times daily (total daily dose of andrographolide: 180 mg) for 5 days beginning within 5 days of admission did not have a lower risk of developing pneumonia compared to the control group, which received only standard care. In fact, slightly more people in the andrographis group developed pneumonia (10.5% vs. 8.7%) or experienced worsening of symptoms (16.8% vs. 15.4%) compared to the control group. Although these differences were not statistically significant, the researchers suggested that physicians in Thailand suspend using andrographis for COVID-19 treatment due to the lack of confirmed benefit and the potential harmful effects (Tanwettiyanont, Front Med 2022).

Be aware the Therapeutic Goods Administration of Australia's Department of Health issued an alert in May 2020 that taste disturbances have been reported in people using andrographis products, with the number of cases increasing since mid-2019 (prior to the pandemic). In some cases, complete loss of taste was reported, and it took several weeks after discontinuing andrographis for taste to return to normal. This could be a serious concern in the context of COVID-19, as loss of taste can also be a symptom of SARS-CoV-2 infection (TGA Alert, 5-20-20).

Multiple sclerosis

A preliminary clinical study among 29 people (average age 59) with progressive multiple sclerosis showed that taking 140 mg of the andrographis constituent andrographolide twice daily for 24 months did not slow the loss of brain volume or the rate of disability progression (i.e., the percentage of participants who had a confirmed 12-week disability progression) compared to placebo, although the average change in disability progression was slightly lower for those in the andrographolide group (-0.03 vs. +0.35 on a scale of 0 to 10) (Ciampi, BMC Neurol 2020).

Cancer

Laboratory studies suggest that andrographis may suppress the growth of cancerous cells in cancers such multiple myeloma and colorectal cancer; it has also been shown to inhibit colorectal growth in mice (Gunn, Leuk Lymphoma 2011; Shimura, Sci Rep 2021). However, there does not appear to be any reliable clinical research on the effects of andrographis supplementation in people with cancer. One preliminary study in China among 30 patients with advanced or metastatic esophageal squamous cell carcinoma who were unfit for surgery and had exhausted other treatment options, all of whom took andrographis granules (130 mg/kg) dissolved in hot water and consumed after lunch daily, found that those who completed all 4 months of treatment had longer average survival time compared to those who did not complete 4 months of treatment (8.64 vs. 3.33 months). However, it is impossible to determine a benefit from this study, which lacked a placebo control (Chiu, Phytother Res 2023).

Andrographis safety, side effects and drug interactions

In clinical trials, andrographis extract taken at up to 600 mg per day have generally been safe when taken short-term (3 months or less), although elevated levels of alanine aminotransferase (ALT), a liver enzyme, have been reported in some individuals when taking 300 to 600 mg of extract daily for three months (Hancke, Phytother Res 2019). Studies are needed to determine safety when taken for longer periods of time. Side effects are generally mild and include, most commonly, gastrointestinal symptoms such as heartburn, diarrhea, constipation, nausea and vomiting. Headache and skin reactions such as itching and rash, and metallic taste in the mouth and loss of taste have also been reported.

Rarely, lymph node pain and swelling have been reported with very high doses (3 to 6 grams per day of whole crushed leaves (Rahman, Curr Treat Options Gastroenterol 2017).

Theoretically, the immune-stimulating properties of andrographis might interfere with the effects of immunosuppressive medications such as azathioprine, 6-mercaptopurine and prednisone, although this hasn’t been reported to date. Similarly, andrographis might worsen certain autoimmune diseases, although, again, cases of this do not appear to have been reported and, as noted above, andrographis has actually been used with benefit for specific autoimmune disease (e.g., rheumatoid arthritis, ulcerative colitis). Until more is known, people with autoimmune disease or taking immunosuppressive drugs should consult with their physician before using (Rahman, Curr Treat Options Gastroenterol 2017).

Based on laboratory studies, andrographis may have blood-thinning and blood-sugar lowering effects (Kligler, Explore (NY) 2006). It should be used with caution in people taking blood thinners or blood-sugar lowering medications.

Some studies in animals suggest andrographis may have contraceptive and/or anti-fertility effects; until more is known, andrographis should not be taken by men or women who wish to conceive, or by women who are pregnant or breastfeeding.

Three cases of anaphylactic (severe allergic) reactions, including one case of anaphylactic shock, associated with andrographis supplementation were reported in Sweden in 1996; however, it has not been established if andrographis was the cause of these reactions. One other anaphylactic reaction was reported in a person with HIV who was taking 5 mg/kg of bodyweight of andrographolide orally for about four weeks (Coon, Planta Med 2004; Calabrese, Phytother Res 2000).

Cost

Most brands of andrographis extract supplements cost about $12 to $20 for 60 capsules (2 to 33 cents per recommended 2-capsule serving). Be aware that many extracts on the market are standardized to just 10% andrographolides and provide fewer total andrographolides than used in studies that have shown benefit. The branded andrographis extract ParActin, which is standardized to 50% andrographolides, costs about $35 to $37 for 90 capsules ($1.17 to $1.23 per recommended 3-capsule serving).

Bottom Line

Taken within about three days of onset of symptoms, evidence from small clinical trials suggests that andrographis extract may reduce the severity of cold symptoms, although there doesn’t appear to be evidence that it can reduce the duration of colds or prevent colds. Andrographis extract may reduce the pain and stiffness of knee osteoarthritis and improve symptoms of ulcerative colitis, but there is currently little or no evidence that it helps with rheumatoid arthritis, multiple sclerosis, COVID-19, or cancer. Short-term use of andrographis extract has been generally safe and well-tolerated, although side effects such as stomach upset, diarrhea, constipation, rash and headache have been reported, and rarely, elevated liver enzymes and severe allergic reactions have been reported. Further research is needed to determine the safety and efficacy of andrographis extract taken long-term.