Andrographis for colds and sinus infection - Phytotherapy Review & Commentary

Townsend Letter for Doctors and Patients,  Jan, 2003  by Kerry Bone

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One of the best-proven herbs for fighting winter infections is Andrographis. In fact, this herb is my preferred treatment for colds, influenza and acute bacterial sinusitis. I usually combine it with Echinacea root and have found that this combination works particularly well. From an evidence-based perspective, clinical trials have consistently demonstrated the value of Andrographis for the treatment of acute winter illnesses. This evidence and other relevant information for this important herb are reviewed below.

General Information

Andrographis paniculata, commonly known as Kalmegh (meaning 'King of bitters' in Bengal), is grown in hedgerows and gardens in India where it is highly valued by the local people as a medicine. It has often been used as a substitute for the bitter herb Swertia chirayita and as such also has the Indian common name of Chirayta. At one point, Andrographis was advertised in England as a substitute for quinine (possibly due to its bitterness). However, this was discontinued due to lack of antimalarial activity. The whole herb, including the root, has been used for therapeutic purposes in India, probably for liver disorders, but modern preparations mainly use the above ground parts. As well as in Ayurveda, Andrographis is found in the materia medica of other traditional medical systems, including those of China and Thailand. In fact, it is the traditional Chinese use which emphasizes its value for fighting infections.

Clinical Summary

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Bitter tonic, choleretic, immunostimulant, hepato-protective, antipyretic, anti-inflammatory, antiplatelet, abortifacient.

Therapeutic Indications

* Bacterial and viral respiratory infections including common cold, pharyngotonsillitis and acute sinusitis; prophylaxis of common cold; to boost immune function in bacterial and viral infections; relief of fever.

* Treatment of enteric infections and prevention of urinary tract infections.

* Protection against hepatotoxicity and for the treatment of hepatitis.

* Traditionally used to treat digestive disorders (loss of appetite, dyspepsia, flatulence, diarrhea).

Dosage & Administration

Being very bitter, some people may find Andrographis difficult to take in liquid preparations. Whichever way it is taken, the daily preventative dose for an adult is about 2 to 3 g or its equivalent (4 to 6 mL per day of 1:2 fluid extract). During acute infection, the effective dose is nearer to 6 g per day (up to 12 mL per day of 1:2 fluid extract). Standardization for andrographolides is preferable.

Since Andrographis is energetically 'cold,' it is preferably taken in combination with 'warm' herbs when used during winter as a preventative treatment, especially if the user has a 'cold' constitution. Warming herbs include Echinacea spp., Zingiber officinalis (ginger), Astragalus membranaceus and Ocimum sanctum (holy basil).

Adverse Reactions

High doses may cause gastric discomfort, anorexia and emesis (vomiting), but generally there are few side effects associated with its use and it is not toxic. Generally Andrographis has been well tolerated in clinical trials. Two cases (8% of patients) of urticaria were reported in one trial investigating respiratory infections (1) and in another trial one patient in a treatment group of 90 reported adverse effects (unpleasant sensations in the chest and intensified headache). (2) A high incidence of adverse effects was reported in a trial involving HIV patients (3) but the dosage of pure andrographolide which was administered was very high compared to the normal therapeutic dosages of Andrographis extract.

Contraindications & Cautions

The antifertility effect in female mice (albeit at high doses) suggests that Andrographis should not be used during human pregnancy, especially in the first trimester. However it has been suggested that the risks associated with its use during pregnancy are low. (4)

Traditional Uses

In Ayurvedic medicine, the herb is used for its bitter tonic, stomachic, antipyretic and laxative properties. It is said to increase appetite, strengthen digestion and diminish flatulence, hyperacidity and biliousness. (5)

It is also utilized for treatment of many conditions, including diabetes, debility and hepatitis. (6) The roots and leaves have a reputation for being alterative and anthelmintic. (7) In traditional Chinese herbal medicine, Andrographis is bitter and cold, and is used to clear Heat from the Blood (especially in the lungs, throat and urinary tract) and to detoxify Fire Poison (manifesting as skin sores and carbuncles). In addition to gastrointestinal complaints, it is prescribed for throat infections, cough with thick sputum and snake bites. (8,9) As Andrographis is regarded as a 'cold' herb, it is ideally suited to treating acute infections, which are 'hot' conditions.

Scientific Studies

Constituents

The main active constituent is the bitter diterpenoid lactone, andrographolide. Other constituents include other diterpene lactones, diterpene glucosides (which are also lactones, such as neoandrographolide (nonbitter)), (10) diterpene dimers, (11) and flavonoids. (12)