Andrographis: benefits, dosage, contraindications

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Andrographis paniculata, or green chiretta, is a small plant from the Acanthaceae family, native to Asia. It grows 50 to 80 cm tall. Its flowers are purple and white. Andrographis has been long used in traditional medicines to reduce fever, fight acute infections, eliminate body toxins, or stimulate digestion. Therapeutically, the used parts of andrographis are the leaf and rhizome. The main group of active components is the bitter diterpenoid lactones known as andrographolides (4 to 6%). More recently, green chiretta is used for its immunomodulatory and anti-inflammatory effects, particularly for the treatment and prevention of upper respiratory tract infections. Its use in non-infectious inflammatory diseases such as ulcerative colitis and rheumatoid arthritis has also been studied.

Other name(s) 

Andrographis paniculata, Green chiretta

Scientific name(s)

Andrographis paniculata

Family or group: 

Plants

Active ingredients:

Andrographolides


Indications

Rating methodology

EFSA approval.

Several clinical trials (> 2) randomized controlled with double blind, including a significant number of patients (>100) with consistently positive outcomes for the indication.
Several clinical trials (> 2) randomized controlled with double blind, and including a significant number of patients (>100) with positive outcomes for the indication.
One or more randomized studies or multiple cohorts or epidemiological studies with positive outcomes for the indication.
Clinical studies exist but are uncontrolled, with conclusions that may be positive or contradictory.
Lack of clinical studies to date that can demonstrate the indication.


ENT infections
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Andrographis paniculata has become popular as a treatment for upper respiratory infections. It is most often used in combination with other medicinal plants, particularly Siberian ginseng (Eleuthero) and sometimes echinacea. Clinical studies confirm that treatment with andrographis, alone or in combination with Siberian ginseng, is beneficial and provides some relief of symptoms within a few days; however, maximum effects appear by the fifth day. Clinical evidence indicates that treatment with andrographis reduces cough, expectoration, nasal discharge, headaches, fever, sore throat, fatigue, sinus pain, and sleep disturbances. Other research shows that the combination of andrographis and eleuthero relieves cold symptoms better than echinacea or placebo in children.

Posologie

posologieOral: leaf

posologie200 mg

formulationstandardized andrographolide extract, Kan Jang®, standardized extract, dry extract


Synergies


Cold
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Andrographis can reduce the incidence of colds according to available evidence. Indeed, a randomized double-blind clinical study on 107 healthy schoolchildren revealed that a specific treatment combining green chiretta and eleuthero (100 mg standardized to 5.6 mg andrographolide/tablet) taken twice daily for 5 days one week for a period of 3 months reduced the risk of developing a cold by about 50% after 2 months compared to placebo.

Posologie

posologieOral: leaf

posologie200 mg

formulationstandardized andrographolide extract, Kan Jang®, standardized extract, dry extract


Synergies


Ulcerative colitis
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Some clinical research has found that treatment with andrographis reduces the symptoms of mild to moderate ulcerative colitis, but does not affect remission rates, compared to placebo. Two different concentrations of andrographis (1200 mg, or 1800 mg per day) were compared to a placebo over 8 weeks. At the end of the treatment period, the clinical response was observed in 60% of patients receiving 1800 mg/day of green chiretta, compared to 45% for the 1200 mg dose and 40% for the placebo. Consequently, only the 1800 mg/day dose was significantly superior to placebo.

Posologie

posologieOral: leaf

posologie1200 - 1800 mg

formulationstandardized andrographolide extract, standardized extract, dry extract


Rheumatoid Arthritis
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Treatment with andrographis in tablets (standardized to 30 mg andrographolide/tablet) three times a day for 14 weeks significantly reduced joint pain and the number of tender joints compared to placebo, in a double-blind, randomized clinical trial involving 60 patients with active rheumatoid arthritis. A reduction in IgA and C4 rheumatoid factors was also observed.

Posologie

posologieOral route: leaf

posologie90 mg

formulationStandardized extract in Andrographolide, standardized extract, dry extract


Pharyngitis
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A clinical benefit of andrographis in the treatment of pharyngitis was reported in an early randomized clinical trial involving 152 volunteers. Symptoms of sore throat and fever were reduced at a dose of 6 g/day of a non-standardized chirette preparation after 3 days.

Posologie

posologieOral route: leaf

posologie3 - 6 g

formulationStandardized extract, dry extract


Osteoarthritis
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In patients with mild to moderate knee osteoarthritis, clinical research shows that taking andrographis extract 300 mg and 600 mg per day for 12 weeks reduces pain and stiffness by approximately 40% and 46%, respectively, compared to changes of less than 10% with a placebo.

Posologie

posologieOral route: leaf

posologie300 - 600 mg

formulationStandardized extract in Andrographolide, standardized extract, dry extract


Properties


Immunomodulatory

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A number of immunomodulatory actions have been identified with andrographis and its derivatives. One of the major constituents responsible for the immunostimulant activity is andrographolide, which affects the stimulation and proliferation of immunocompetent cells and the production of cytokines and key immune markers in vitro.

Usages associés

ENT infections, Cold, Ulcerative colitis, Rheumatoid arthritis

Antimicrobial

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An aqueous extract of Andrographis paniculata has shown antibacterial and antifungal activity in vitro. In various laboratory studies, activity was demonstrated against Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida albicans. An ethanolic extract of Andrographis paniculata showed powerful inhibitory activity against Gram-positive and Gram-negative bacteria according to an in vitro study.


Antiviral

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Andrographolides from andrographis have shown antiviral activity against herpes simplex virus type 1 and dengue serotype virus, in vitro. Andrographis has in vitro activity against avian influenza A viruses and human influenza A H1N1 viruses, possibly by preventing the binding of viral hemagglutinin to cells.

Usages associés

ENT infections, Cold

Anti-inflammatory

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The antipyretic activity of andrographis has been demonstrated in animal models. Anti-inflammatory activity has also been observed in vitro and in vivo with andrographis, primarily associated with andrographolide. It has been shown that andrographolide reduces the production of cytokines, chemokines, adhesion molecules, nitric oxide, and lipid mediators, as well as IL-1 beta, IL-6, prostaglandin E2, and thromboxane B2, and the allergic mediator leukotriene B4. Some in vitro data have shown that antioxidant mechanisms may contribute to the plant's anti-inflammatory effect.

Usages associés

Arthritis, Rheumatoid arthritis, Pharyngitis

Anticancer

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There is an interest in using andrographis as an anticancer agent. Andrographis extracts inhibit the proliferation of colon cancer cells in vitro. This activity has been attributed to the diterpene constituents andrographolide, deoxyandrographolide, and 14-deoxy-11,12-didehydroandrographolide. The andrographolide constituent also inhibits the proliferation of breast, brain, lung, skin, ovarian, prostate, and kidney cancer cells in vitro.


Cardiovascular

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Research has shown that andrographis inhibits human platelet aggregation induced by platelet-activating factor and also appears to confer additional antiplatelet activity, for which several mechanisms may be involved. A number of compounds seem to be involved in these actions, such as andrographolide and 14-deoxy-11,12-didehydroandrographolide.


Hypoglycemic

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Andrographis is traditionally used for diabetes. Early data suggest that andrographis has hypoglycemic effects, possibly by slowing the absorption of glucose by the intestine or stimulating insulin release.


Antiplatelet/Anticoagulant

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Research has shown that andrographis inhibits human platelet aggregation induced by platelet-activating factor and also appears to confer additional antiplatelet activity, for which several mechanisms may be involved. A number of compounds seem to be involved in these actions, such as andrographolide and 14-deoxy-11,12-didehydroandrographolide.


Safety dosage

Adult from 15 years: 200 mg - 1800 mg

A dose of 100 mg twice a day of a standardized andrographis extract providing 60 mg of andrographolide per day is used for symptomatic treatment. Equivalent or higher doses of 5 mg/kg/day of the andrographolide component should be avoided due to the risk of significant adverse effects.

Child from 6 to 15 years: 48 mg

Andrographis, in combination with other plants, has been used with apparent safety in clinical trials at doses up to 48 mg per day in children aged 3 to 15 years for a period of up to one month.


Interactions

Médicaments

Antiplatelet/Anticoagulant drugs: moderate interaction

Theoretically, andrographis may increase bleeding risk when used with anticoagulant or antiplatelet medications.

Immunosuppressant: moderate interaction

Theoretically, andrographis could increase the risk of hypotension when used with antihypertensive medications.

Immunosuppressant: moderate interaction

Laboratory research suggests andrographolide has immunostimulant activity. Theoretically, andrographis could interfere with the effects of immunosuppressant drugs.


Precautions

Breastfeeding women: avoid

Avoid use due to lack of information.

Autoimmune diseases: use with caution

Andrographis could have immunostimulant effects. Theoretically, andrographis could worsen autoimmune diseases by stimulating immune activity. Advise patients with autoimmune diseases like multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis to use andrographis cautiously.

Bleeding disorders: use with caution

In vitro and in vivo evidence suggests that andrographis may inhibit platelet aggregation. Although not seen in humans, theoretically, andrographis may increase bleeding risk in patients with bleeding disorders. Use cautiously.

Hypotension: use with caution

Animal research suggests andrographis might reduce blood pressure. Although this has not been observed in clinical research, andrographis should be used with caution.


Contraindications

Pregnant women: prohibited

Andrographis is believed to have abortifacient effects.