Key Facts for Therapeutic Use

Andrographis paniculata: Key Facts for Therapeutic Use

Stephen Behr

Introduction

Andrographis his paniculata Nees is a slender upright annual varying in height from 30 to 100 cm (1 to 3 feet), with a square stem and “lanceolate” leaves (i.e., shaped like a lance, sharp at the ends and curved in the middle). Andrographis is indigenous to the plains of India where it is called Kalmegh (in the Bengali language) or Kiryat (in the Hindi language). It is cultivated throughout Southeast Asia and in China where it is called Chuan Xin Lian, and has also been introduced to the West Indies.

Andrographis does not contain and has nothing to do with “androgens” (testosterone) or any steroids. The active components of andrographis are “andrographolides,” very bitter compounds known as diterpene lactones found in the aerial parts of the plant (leaves and stems). The andrographolide content of the leaves varies considerably from season to season, such that standardized extracts are much more reliable as means of supplementation than the leaves or the whole plant.

Traditional Uses

The geographical distribution of the plant has led to its traditional use in Ayervedic (Indian), Thai, and Chinese medicine. According to these traditions, andrographis dispels heat (i.e., is antipyretic) and removes toxins, which makes it a good treatment for infectious fevercausing diseases. It has been used in bacterial dysentery, arresting diarrhea and in upper respiratory infections, tonsillitis, pharyngitis, laryngitis, pneumonia, tuberculosis, and pyelonephritis. It has also been used in herpes, skin infections, and in helminthic (parasitic) infections. Finally, it has been used for conditions as diverse and unrelated as snakebites and diabetes, as well as terminating pregnancies. These conditions are so varied and seemingly unconnected that more recent research has sought to corroborate some of these applications.

Recent Research

Studies performed in the last 15 years in several locations and published in Western journals have confirmed and adapted many of the traditional uses of andrographis for ailments of our own. The use of andrographis in reducing the incidence or severity of upper respiratory tract infections, including colds and other manifestations, such as tonsillitis and laryngitis, has been popular in Scandinavia over the last decade, and is beginning to gain acceptance in North America. A good review has been published in The Natural Pharmacist (www.TNP.com).

Publications resulting from several clinical studies by researchers in Chile and Sweden provide a credible body of literature. Andrographis paniculata reduces the incidence and severity of the common cold. In a randomized, placebo-controlled, double-blind study to assess the possible preventive effect of Andrographis paniculata against the common cold, 107 students were randomized to the Andrographis group (n=54, 200 mg Andrographis supplying a minimum of 11 mg of andrographolides, a very low dose) or to the control group (n=53, placebo). The study was carried out for three months during the winter. The incidence of colds in the Andrographis-treated subjects was 30%, as compared to 62% in the control group (association between Andrographis and absence of colds significant, p[less than]0.01). [4]

In the first of several controlled studies aimed at assessing the effect of Andrographis on symptoms of the common cold, 33 patients received 1,200 mg of Andrographis paniculata containing a minimum of 48 mg of andrographolides, while 28 control patients received a placebo.[6] After four days, Andrographis was found to have a significant beneficial effect on tiredness, shivering, sore throat, muscular aches, rhinitis, sinus pains, and overall disease, but not on lymphatic swelling. Similar results have been obtained in additional studies using the same or similar doses. [3,8,11] Altogether, controlled studies involving over 500 subjects indicate that Andrographis paniculata is effective at reducing the prevalence and intensity of colds and sinusitis, and shortening the duration of the symptoms.

What is the mechanism of this effect? One possibility is that Andrographis is an immune booster, a possibility supported by the fact that it stimulates several immune parameters in mice. The results suggest that extracts are more potent than purified andrographolides. [13] In addition, research suggests that andrographolides have a direct antiviral effect [5] and a direct antiparasitic effect, [14] but not a direct antibacterial effect. [10] Although the present results are insufficient for a general recommendation for use in viral or parasitic conditions, they open the door for potential future applications.

Coronary Artery Disease and Liver Protection

In addition to its usefulness in colds, preliminary research in animals has indicated that Andrographis may be useful in preventing coronary heart disease (CHD), and especially in preventing a condition associated with the treatment of CHD that has been very difficult to control — restenosis. Restenosis is defined as the rapid return of atherosclerotic blockage following coronary angioplasty, a technique widely used by cardiologists to open up blocked coronary arteries. It is well accepted that fish oil has beneficial effects in the prevention and management of cardiovascular disease. [12] However, even though it may help, fish oil has not conclusively been shown to reduce restenosis following angioplasty. In an animal model, andrographis was shown to be twice as effective as fish oil in preventing the incidence and severity of restenosis following angioplasty. [17] The mechanism may be the antithrombotic effect of andrographis, which may occur as a result of decreases in thromboxane and platelet aggregation . [19]

Andrographis paniculata has also been shown to be a liver-protecting substance. Andrographis is hepatoprotective in mice treated with carbon tetrachloride or tertbutylhydroperoxide, both highly toxic compounds. [9] Using this model, the results indicate that andrographolides compare well with the known hepatoprotective agent silymarin. Andrographis was also found to be superior to silymarin in protecting the liver against paracetamol toxicity [16] and against paracetamol and galactosamine. [7]

Pharmacokinetics and Safety of And rographolides

According to recent research, andrographolides are highly bioavailable in humans. Following oral administration, doses of 20 mg of andrographolides are readily absorbed, reach a peak plasma value in 1.5-2 hours, and have a mean plasma residence time of 10 hours. [12] Labeled andrographolide is readily distributed throughout the body, including brain and spinal cord. After 72 hours, nearly 90% of andrographolides are excreted, mostly by urinary excretion, although there is still some discussion about this. [18]

Possibly the best indication of the safety of Andrographis paniculata has been its use for many years as a traditional remedy in Southeast Asia and China, in addition to extensive use in Europe, for the prevention and treatment of colds. For all of these uses, there have been no reports of concerns or safety warnings associated with Andrographis. In addition, there have been reports in the Chinese medical literature of administration of high doses of Andrographis paniculata in animals and humans. [15]

In animals, there was no acute or short term toxicity of very high doses (1-10 g/kg body weight) in three species, and no effect of these levels on any of the major organs. No effect levels (NOEL) in animals are probably greater than 100 mg/kg body weight and may even approach the gram level.

Although no systematic long-term studies have been done in humans, subjects given Andrographis at recommended doses had no changes in hepatic or renal function, blood cell counts, or blood chemistries. [6] According to Barilla, [2] humans have also been treated with high levels, including a study in which levels of 50-80 mg/ kg were administered intravenously to subjects for periods of two months, with no observed toxicity. [2]

It should be made clear to all potential users of Andrographis that it has clear antifertility effects in experimental animals, both in males and in females. Male rats become infertile at intakes of 20 mg/day, [1] and female rats become infertile at high doses [20] and may abort. [15]

Summary and Conclusion

Andrographis paniculata, a plant originating in India, is a traditional remedy for fever and various infections. Controlled clinical studies have indicated that Andrographis paniculata is effective at reducing the prevalence and intensity of colds and sinusitis, and shortening the duration of the symptoms. Preliminary research has indicated that Andrographis paniculata may also be useful in cardiovascular disease and in preventing liver toxicity. Although Andrographis paniculata has no reported toxicity on any organs, it has been reported to decrease fertility in both male and female animals. Therefore, it should not be used by women seeking to conceive or by their partners, and should not be used by pregnant women.

About the Author

Stephen R. Behr, PhD, received his Master’s in Human Nutrition at Columbia University (1977) and his doctorate in Nutritional Biochemistry at Cornell University (1983). He is the Director of Scientific Affairs at Atrium Biotechnologies, Quebec, Canada. Dr. Behr is the author of over 50 published scientific articles. He is a frequent lecturer in the health care industry regarding such topics as antiangiogenesis, immune system function, sports nutrition, cardiovascular health, and lipid metabolism.

REFERENCES

(1.) Akbarsha MA, Manivannan B, Shahul HK, et al. “Antifertility effect of Andrographis paniculata (Nees) in male albino rat.” Indian J Exp Biol, 1990;28:421-426.

(2.) Barilla J. Andrographis paniculata. Keats Publishing, Los Angelos, CA, USA; 1999.

(3.) Caceres DD, Hancke JL, Burgos RA, et al. “Use of visual analogue scale measurements to assess the effectiveness of standardized Andrographis paniculata extract in reducing the symptoms of common cold. A randomized double-blind placebo study.” Phytomedicine, 1999;6(4):217-223.

(4.) Caceres DD, Hancke JL, Burgos RA, and Wikman GK. “Prevention of common colds with Andrographis paniculata dried extract. Phytomedicine, 1997;4(2):101-104.

(5.) Chang RS, Ding L, Chen GQ, et al. “Dehydroandrographolide succinic acid monoester as an inhibitor against the human immunodeficiency virus.” Proc Soc Exp Biol Med, 1991;197:59-66.

(6.) Hancke J, Burgos R, Caceres D, and Wilkman G. “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.

(7.) Handa SS and Sharma A. “Hepatoprotective activity of andrographolide against galactosamine and paracetamol intoxication in rats.” Indian J Med Res, 1990;92:284-292.

(8.) Melchior J, Spasov AA, Ostovskij 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(5):351-364.

(9.) Kapil A, Koul IB, Banerjee SK, and Gupta BD “Antihepatotoxic effects of major diterpenoid constituents of Andrographis paniculata.” Biochem Pharmacol, 1993; 46 (1):182-185.

(10.) Leelarasamee A, Trakulsomboon S, and Sittisomwong N. “Undetectable anti-bacterial activity of Andrographis paniculata.” J Med Assoc Thal, 1990; 73:299-304.

(11.) Melchior J, Palm S and Wikman G. “Controlled clinical study of standardized Andrographis paniculata extract in common cold.” Phytomedicine, 1996; 3(4):315-318.

(12.) Panossian A, Ovhannisyan A, Mamikonyan G, et al. “Pharmacokinetic and oral bioavailability of andrographolide from Andrographis paniculata fixed combination Kan Jang in rats and human.” Phytomedicine, 2000; 7(5):351-364.

(13.) Puri A, Saxena R, Saxena RP, et al. “Immunostimulant agents from Andrographis paniculata.” J Nat Prod, 1993; 56:995-999.

(14.) Raj RK: Screening of indigenous plants for anthelminthic action against human Ascaris lumbricoides.” Indian J Physiol Pharmacol, 1975; 19(1).

(15.) Sandberg F. Andrographidis herba Chuanxinlian, A Review. American Botanical Council, Austin, Texas, USA; 1994.

(16.) Visen PK, Shukla B, Patnaik GK, and Dhawan BN. “Andrographolide protects rat hepatocytes against paracetamol-induced damage.” J Ethnopharmacol, 1993; 40(2):131-136.

(17.) Wang DW and Zhao HY. “Experimental studies on prevention of atherosclerotic arterial stenosis and restenosis after angioplasty with Andrographis paniculata and fish oil.” J Tongji Med Univ, 1993; 13(4):193-198.

(18.) Wuxi Medicine Institute, Sushow Medical Academy, Acta Bio-chemica Biophysica Sinica, 1979; 11: no pages listed.

(19.) Zhao HY and Fang WY. “Antithrombotic effects of Andrographis paniculata nees in preventing myocardial infarction.” Chin Med J (Engl), 1991; 104(9):770-775.

(20.) Zoha MS, Hussain AHM, and Choudhury SAR. Antifertility effect of Andrographis paniculata in mice. Bangladesh Med Res Counc Bull, 1989; 15:34-37.

(21.) Simopoulos AP. “Omega-3 fatty acids in the prevention-management of cardiovascular disease.” Can J Physiol Pharmacol, 1997; 75(3)234-239.

COPYRIGHT 2001 Original Internist, Inc.

COPYRIGHT 2007 Gale Group