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Andrographis

Andrographis paniculata
Evidence Level
Moderate
3 Clinical Trials
2 Documented Benefits
3/5 Evidence Score

Andrographis (Andrographis paniculata) is a bitter herb used in traditional Indian and Chinese medicine for cough, colds and flu. Its main active compounds are andrographolides. Most of its human research is on symptoms of acute respiratory infections: a meta-analysis of 33 randomized trials in 7,175 adults and children found it eased cough and sore throat compared with placebo, but rated the trials as poor quality, and many tested herbal mixtures such as Kan Jang rather than andrographis alone. A placebo-controlled trial of the KalmCold extract found lower symptom scores by day 5. The research covers easing symptoms once an infection has started, not preventing or curing it. For joints, one placebo-controlled trial of the ParActin extract, led by an author from the company that sells it, found less knee pain and stiffness in adults with knee osteoarthritis. Rare serious allergic reactions have been reported. Avoid it in pregnancy.

Studied Dose Respiratory trials: 200 mg a day of the KalmCold extract, with symptoms tracked over 5 days; other trials used various extracts and herbal mixtures. Knee trial: 300 or 600 mg a day of ParActin for 84 days. Short-term use only in the respiratory trials.
Active Compound Andrographolides (diterpene lactones), mainly andrographolide. Extract strength varies; the ParActin extract in the rheumatoid arthritis trial was standardized to 30% total andrographolides.

Benefits

Cough and sore throat comfort during upper respiratory infections

A meta-analysis of 33 randomized trials (7,175 people) found andrographis, alone or in herbal mixtures, eased cough and sore throat more than placebo and shortened symptoms versus usual care, but rated the trials as poor quality. In one placebo-controlled trial of the KalmCold extract (200 mg a day, 223 people), symptom scores were lower than placebo by day 5.

Supported by Trial 1, Trial 2

Knee joint comfort and stiffness studied in adults with knee osteoarthritis

In a placebo-controlled trial in 103 adults with mild to moderate knee osteoarthritis, the ParActin extract at 300 or 600 mg a day lowered WOMAC knee pain at days 28, 56 and 84 and improved stiffness, function and fatigue scores. It is the only knee trial, and its lead author worked for HP Ingredients, which sells ParActin. In a 60-person rheumatoid arthritis trial, joint pain did not drop significantly more than with placebo.

Supported by Trial 3

Mechanism of action

1

Blocks NF-kB signaling in laboratory studies

In cell and animal studies, andrographolide binds a cysteine on the p50 part of NF-kB, a switch for inflammation genes, and stops it attaching to DNA. This reduced adhesion molecules and inflammation in lab and animal models. It has not been shown to lower inflammation in people in the studies cited here.

Clinical trials

1
Andrographis for acute respiratory infection symptoms: meta-analysis
PubMed

Systematic review and meta-analysis of 33 randomized controlled trials of oral andrographis, alone or in herbal mixtures, for symptoms of acute respiratory tract infections (Hu et al. 2017, PLoS One)

7,175 adults and children across 33 trials.

Compared with placebo, andrographis improved cough (SMD -0.39) and sore throat (SMD -1.13) and overall symptoms. Compared with usual care, it shortened cough, sore throat and time to resolution. No major adverse events were reported; minor ones were mainly digestive. The authors rated trial quality as poor, found wide variation between trials, and said results should be interpreted cautiously.

2
KalmCold extract for uncomplicated upper respiratory infection
PubMed

Randomized, double-blind, placebo-controlled trial of an Andrographis paniculata extract (KalmCold, 200 mg a day) with symptoms scored on days 1, 3 and 5 (Saxena et al. 2010, Phytomedicine)

223 people with an uncomplicated upper respiratory tract infection.

Symptom scores were the same in both groups on days 1 and 3. By day 5, all symptoms except earache had improved significantly more with KalmCold than placebo, and overall symptom scores were lower. Minor side effects were similar in both groups. The result applies to this extract and dose.

3
ParActin extract in knee osteoarthritis
PubMed

Randomized, double-blind, placebo-controlled trial of ParActin at 300 or 600 mg a day for 84 days (Hancke et al. 2019, Phytother Res)

103 adults with grade I to II knee osteoarthritis.

Both doses lowered WOMAC pain versus placebo at days 28, 56 and 84 and improved stiffness, physical function, quality of life and fatigue scores. The lead author was affiliated with HP Ingredients, which sells ParActin, and this is the only knee trial.

Side effects and drug interactions

Common Potential side effects

In a review of 10 randomized trials and 3 monitoring studies, serious side effects were very rare, but non-serious ones were common (about 10 in 100 people in trials), mostly digestive upset and skin reactions.
Rare serious allergic reactions, including anaphylaxis and angioedema, have been reported to the Thai national safety database; stop and get medical help for rash, hives, swelling or trouble breathing.
Avoid during pregnancy; safety in pregnancy has not been shown in the studies cited here.
Anyone with an autoimmune condition or taking immune-suppressing medication should talk to a doctor first, because andrographis is used for immune-related purposes and has not been tested alongside those treatments.

Important Drug interactions

Prescription medicines processed by liver enzymes: lab studies of andrographis on CYP450 enzymes are inconclusive, and no human interaction studies are cited here, so check with a pharmacist if you take regular medicines.
Immune-suppressing medicines such as cyclosporine or tacrolimus: not tested together; check with your doctor before using andrographis.

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Frequently asked questions about Andrographis

How much andrographis should I take?

The placebo-controlled KalmCold trial used 200 mg of extract a day, with symptoms tracked over 5 days, and the knee trial used 300 or 600 mg of ParActin a day. Other respiratory trials used a range of extracts and herbal mixtures. In the respiratory research it was used short term once symptoms had started, not continuously.

What is andrographis used for?

Andrographis has been studied mainly for easing cough, sore throat and other symptoms of colds and upper respiratory infections once they have started, though the trials were of poor quality overall. One trial by the company that sells ParActin found less knee pain and stiffness than placebo in adults with knee osteoarthritis, and a rheumatoid arthritis trial found no significant pain benefit. It has not been shown to prevent infections.

When should I take andrographis?

In the respiratory trials it was used short term, starting once cold symptoms appeared and continuing through the illness, rather than continuously. Some products, such as Kan Jang, combine andrographis with other herbs; Kan Jang was tested in 130 children as an add-on to standard care for uncomplicated colds and compared with an echinacea product, so those results belong to the combination rather than to andrographis on its own.

Does andrographis have side effects?

It is usually well tolerated short term, but digestive upset and skin reactions are fairly common, and rare serious allergic reactions, including anaphylaxis, have been reported. It should be avoided in pregnancy. If you take regular prescription medicines, have an autoimmune condition or take immune-suppressing medication, check with your doctor or pharmacist first.

What is Andrographis?

Andrographis (Andrographis paniculata) is a bitter herb used in traditional Indian and Chinese medicine for cough, colds and flu. Its main active compounds are andrographolides.

Does Andrographis interact with any medications?

Possible interactions include: Prescription medicines processed by liver enzymes: lab studies of andrographis on CYP450 enzymes are inconclusive, and no human interaction studies are cited here, so check with a pharmacist if you take regular medicines. If you take prescription medication, check with a pharmacist or doctor before using it.

How strong is the scientific evidence for Andrographis?

NutraSmarts rates the evidence for Andrographis as Moderate (3 out of 5). It is backed by 3 study summaries and 10 cited references summarized on this page. A higher rating reflects more, larger, and better-designed human studies.

References(10 citations)

Evidence ratings on NutraSmarts are based on the totality of human clinical research, with emphasis on randomized controlled trials, meta-analyses, and systematic reviews. The references below directly support claims made throughout this page.

  1. Hu XY, Wu RH, Logue M, Blondel C, Lai LYW, Stuart B, Flower A, Fei YT, Moore M, Shepherd J, Liu JP, Lewith G. Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One. 2017;12(8):e0181780. doi: 10.1371/journal.pone.0181780.PubMedUsed to support: Systematic review and meta-analysis of 33 RCTs (7,175 patients) of oral andrographis, alone or in herbal mixtures, for acute respiratory infections. Improved cough (SMD -0.39) and sore throat (SMD -1.13) versus placebo; shortened cough, sore throat and time to resolution versus usual care. Trial quality was overall poor, so results should be interpreted cautiously.
  2. Saxena RC, Singh R, Kumar P, Yadav SC, Negi MP, Saxena VS, Joshua AJ, Vijayabalaji V, Goudar KS, Venkateshwarlu K, Amit A. A randomized double blind placebo controlled clinical evaluation of extract of Andrographis paniculata (KalmCold) in patients with uncomplicated upper respiratory tract infection. Phytomedicine. 2010;17(3-4):178-85. doi: 10.1016/j.phymed.2009.12.001.PubMedUsed to support: Randomized double-blind placebo-controlled trial in 223 people with uncomplicated upper respiratory infection: KalmCold 200 mg a day lowered symptom scores versus placebo by day 5 (not on days 1 or 3), with minor side effects similar to placebo.
  3. 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(4):293-8. doi: 10.1055/s-2004-818938.PubMedUsed to support: Systematic review of 7 double-blind controlled trials (896 people): andrographis was superior to placebo for the subjective symptoms of uncomplicated upper respiratory infection, adverse events were generally mild and infrequent, and the authors called for more research.
  4. Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res. 2004;18(1):47-53. doi: 10.1002/ptr.1359.PubMedUsed to support: Three-arm controlled study in 130 children aged 4 to 11 with uncomplicated colds, all given standard treatment: adding Kan Jang (a fixed combination containing andrographis extract) eased symptoms more than adding an echinacea product and sped recovery, and children in the Kan Jang group used less standard medication than either other group. The active arm is a combination, not andrographis on its own.
  5. Hancke JL, Srivastav S, Cáceres DD, Burgos RA. A double-blind, randomized, placebo-controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. Phytother Res. 2019;33(5):1469-1479. doi: 10.1002/ptr.6339.PubMedUsed to support: Randomized double-blind placebo-controlled trial in 103 adults with grade I to II knee osteoarthritis: ParActin 300 or 600 mg a day reduced WOMAC pain at days 28, 56 and 84 and improved stiffness, function, SF-36 and fatigue scores. The lead author was affiliated with HP Ingredients, which sells ParActin.
  6. Burgos RA, Hancke JL, Bertoglio JC, Aguirre V, Arriagada S, Calvo M, Cáceres DD. Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. Clin Rheumatol. 2009;28(8):931-46. doi: 10.1007/s10067-009-1180-5.PubMedUsed to support: Randomized placebo-controlled trial in 60 people with active rheumatoid arthritis: 14 weeks of an andrographis extract (Paractin, 30% andrographolides) three times a day did not reduce joint pain, the primary outcome, significantly more than placebo. Joint counts and HAQ improved within the active group only.
  7. Xia YF, Ye BQ, Li YD, Wang JG, He XJ, Lin X, Yao X, Ma D, Slungaard A, Hebbel RP, Key NS, Geng JG. Andrographolide attenuates inflammation by inhibition of NF-kappa B activation through covalent modification of reduced cysteine 62 of p50. J Immunol. 2004;173(6):4207-17. doi: 10.4049/jimmunol.173.6.4207.PubMedUsed to support: Cell and animal study showing andrographolide forms a covalent bond with cysteine 62 of the NF-kB p50 subunit, blocking NF-kB binding to DNA, reducing E-selectin and leukocyte adhesion and reducing inflammation in mouse models. Laboratory evidence only.
  8. Worakunphanich W, Thavorncharoensap M, Youngkong S, Thadanipon K, Thakkinstian A. Safety of Andrographis paniculata: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf. 2021;30(6):727-739. doi: 10.1002/pds.5190.PubMedUsed to support: Systematic review and meta-analysis of 10 RCTs and 3 intensive monitoring studies of oral andrographis: serious adverse events were very rare (0.02 per 1,000 in RCTs) but non-serious events were common (102.6 per 1,000 in RCTs), mainly digestive and skin related.
  9. Suwankesawong W, Saokaew S, Permsuwan U, Chaiyakunapruk N. Characterization of hypersensitivity reactions reported among Andrographis paniculata users in Thailand using Health Product Vigilance Center (HPVC) database. BMC Complement Altern Med. 2014;14:515. doi: 10.1186/1472-6882-14-515.PubMedUsed to support: Analysis of the Thai national pharmacovigilance database (2001 to 2012): 106 reports linked hypersensitivity reactions to andrographis alone, including 5 anaphylactic shock, 4 anaphylactic reactions and 4 angioedema cases, at doses of 352 to 1,750 mg.
  10. Tan ML, Lim LE. The effects of Andrographis paniculata (Burm.f.) Nees extract and diterpenoids on the CYP450 isoforms' activities, a review of possible herb-drug interaction risks. Drug Chem Toxicol. 2015;38(3):241-53. doi: 10.3109/01480545.2014.947504.PubMedUsed to support: Review of laboratory studies on andrographis extracts and diterpenoids and CYP450 enzymes: data are insufficient to call them CYP1A2, CYP2C9 or CYP3A4 inhibitors, and none showed CYP450 induction in human cells. Herb-drug interaction risk remains unclear.