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Viral Upper Respiratory Infections (Colds and Influenza) and Andrographis

Read more about Andrographis.

Overview

Andrographis is a shrub found throughout India and other Asian countries, sometimes called "Indian echinacea" because it is believed to provide much the same benefits for treating cold and flu. It has been used historically in epidemics, including the Indian flu epidemic in 1919, during which andrographis was credited with stopping the spread of the disease.36 Recently, it has become popular in Scandinavia as a treatment for colds.

According to a few, well-designed studies (almost all of which used the proprietary extract produced by a single company), andrographis can reduce the symptoms of colds. It may offer the additional useful benefit of helping to prevent colds. The same may also be true for the flu.

Effect of Andrographis on Viral Upper Respiratory Infections (Colds and Influenza)

Although we don't know how andrographis might work for colds and flu, some evidence suggests that it might stimulate immunity.37 Interestingly, the ingredient of andrographis used for standardization purposes, andrographolide, does not appear to affect the immune system as much as the whole plant extract.

Research Evidence on Andrographis

According to a few, well-designed studies (almost all of which used the proprietary extract produced by a single company), andrographis can reduce the symptoms of colds and flu. It may offer the additional useful benefit of helping to prevent colds.

##Reducing Cold and Flu Symptoms

A total of seven double-blind, placebo-controlled studies enrolling, all together, almost a 1,000 people have found that andrographis (or a combination containing it as the presumed primary ingredient) significantly reduces the duration and severity of cold symptoms.^38-41,120 ^

For example, a 4-day, double-blind, placebo-controlled trial of 158 adults with colds found that treatment with a proprietary andrographis extract significantly reduced cold symptoms.41 Participants were given either placebo or 1,200 mg daily of an andrographis extract standardized to contain 5% andrographolide. The results showed that by day 2 of treatment, and even more by day 4, individuals given the actual treatment experienced significant improvements in symptoms as compared to participants in the placebo group. The greatest response was seen in earache, sleeplessness, nasal drainage, and sore throat, but other cold symptoms improved as well.

Three other double-blind, placebo-controlled studies, enrolling a total of about 400 people, evaluated a proprietary herbal combination treatment containing both andrographis and Eleutherococcus senticosus (so-called Russian Ginseng) and found benefit.42,108 Another study suggests that this combination may be more effective than echinacea.121 (Somewhat confusingly, this proprietary combination is sold under the same name, “Kan Jang,” as the pure andrographis product noted above; the manufacturer regards this combination as more effective than andrographis alone, and the combination version of the product has now superseded the previous single-herb version.)

The same combination has also shown promise in two double-blind studies for reducing the duration, severity, and rate of complications of influenza (flu).122

Andrographis has also been compared to acetaminophen (Tylenol). In a double-blind study of 152 adults with sore throat and fever, participants received andrographis (in doses of 3 g or 6 g per day for 7 days) or acetaminophen.43 The higher dose of andrographis (6 g) decreased symptoms of fever and throat pain to about the same extent as acetaminophen, but the lower dose of andrographis (3 g) was not as effective. There were no significant side effects in either group. This study used a different form of andrographis than the proprietary product noted above.

##Preventing Colds

According to one double-blind, placebo-controlled study, andrographis may increase resistance to colds.44 A total of 107 students, all 18 years old, participated in this 3-month trial that used the same proprietary extract of andrographis noted earlier. Fifty-four of the participants took two 100 mg tablets standardized to 5.6% andrographolide daily—considerably less than the 1,200 mg to 6,000 mg per day that has been used in studies on treatment of colds. The other 53 students were given placebo tablets with a coating identical to the treatment. Then, once a week throughout the study, a clinician evaluated all the participants for cold symptoms.

By the end of the trial, only 16 people in the group using andrographis had experienced colds, compared to 33 of the placebo-group participants. This difference was statistically significant, indicating that andrographis reduces the risk of catching a cold by a factor of two as compared to placebo.

How to Use Andrographis

A typical dosage of andrographis is 400 mg 3 times a day. Doses as high as 1,000 to 2,000 mg 3 times daily have been used in some studies. Andrographis is usually standardized to its content of andrographolide, typically 4% to 6%. Note that virtually all published studies of andrographis have involved a single proprietary product. It is not clear that the results of these studies apply to products using different andrographis sources, or different methods of extraction.

Side Effects and Warnings

#Safety Issues

Andrographis has not been associated with any side effects in human studies. In one study, participants were monitored for changes in liver function, blood counts, kidney function, and other laboratory measures of toxicity. ^[1] No problems were found.

However, some animal studies have raised concerns that andrographis may impair fertility. One study found that male rats became infertile when fed 20 mg of andrographis powder daily. ^[2] In this case, the rats stopped producing sperm and showed physical changes in some of the testicular cells involved in sperm production. Researchers also detected evidence of degeneration of other anatomical structures in the testicles. However, another study showed no evidence of testicular toxicity in male rats that were given up to 1 g per kilogram body weight daily for 60 days, so this issue remains unclear. ^[3] Furthermore, a human trial using the widely tested andrographis-eleutherococcus combination found no adverse effect on male fertility measurements such as sperm quality and number. ^[4] One group of female mice also did not fare well on high dosages of andrographis. ^[5] When fed 2 g per kilogram body weight daily for 6 weeks (thousands of times higher than the usual human dose), all female mice failed to get pregnant when mated with males of proven fertility. Meanwhile, of the control females, 95.2% got pregnant when mated with a similar group of male mice. Another study found a potential explanation for this in evidence that androphraphis relaxes the uterus. ^[6] While andrographis is probably not a useful form of birth control, these results are worrisome regarding the use of androphraphis by pregnant women.

Finally, if androphraphis does indeed stimulate the immune system, this would lead to a whole host of potential risks. The immune system is balanced on a knife edge. An immune system that is too relaxed fails to defend us from infections, but an immune system that is too active attacks healthy tissues, causing autoimmune diseases. A universal immune booster might cause or exacerbate lupus , Crohn’s disease , asthma , Graves’ disease, Hashimoto’s thyroiditis , multiple sclerosis , and rheumatoid arthritis , among other illnesses.

Safety in young children, nursing women, or those with severe liver or kidney disease has also not been established.

Also, because andrographis may stimulate gallbladder contraction, it should not be used by individuals with gallbladder disease except under physician supervision.

References

  1. Hancke J, Burgos R, Caceres D, et al. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytother Res. 1995;9:559-562.
  2. Puri A, Saxena R, Saxena RP, et al. Immunostimulant agents from Andrographis paniculata.J Nat Prod. 1993;56:995-999.
  3. Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine. 1999;6:217-223.
  4. Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold-a pilot trial. Phytomedicine. 1996-1997;3:315-318.
  5. Hancke JJ, Burgos RA, Caceres DD, et al. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytother Res. 1995;9:559-562.
  6. Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine. 1999;6:217-223.
  7. Melchior J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine. 2000;7:341-350.
  8. Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai. 1991;74:437-442.
  9. Caceres DD, Hancke JL, Burgos RA, et al. Prevention of common colds with Andrographis paniculata dried extract. A pilot double blind trial. Phytomedicine. 1997;4:101-104.
  10. Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographispaniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine. 2002;9:589-597.
  11. Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med. 2004;70:293-298.
  12. Spasov AA, Ostrovskij OV, Chernikov MV, et al. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang(R) and an echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res. 2004;18:47-53.
  13. Kulichenko LL, Kireyeva LV, Malyshkina EN, et al. A randomized, controlled study of Kan Jang versus amantadine in the treatment of influenza in Volgograd. J Herb Pharmcother. 2003;3:77-92.

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