Andrographis paniculata Nees Kan Jang SHA10

Background:

The leaves of Andrographis paniculata have been as part of Indian folk medicine and Ayurveda for centuries. The Chinese and Thai herbal medicine systems have also used this herb, mostly for its "bitter" properties, as a treatment for digestive problems and for a variety of fever-causing illnesses. More recently, this herb has become popular in Scandinavia as a remedy for upper respiratory infections (URIs) and the flu.
The most widely tested product is a product called Kan Jang® (Swedish Herbal Institute). This product is available with andrographis alone and in combination with Eleutherococcus senticosus.
There is reasonably strong evidence from clinical trials to suggest that andrographis effectively reduces the severity and the duration of URIs. Based on animal and laboratory studies, andrographis may have a number of other potential therapeutic uses, including as an anti-inflammatory agent and as a treatment for chemically-induced liver damage. It has also been studied in human clinical trials for the flu and familial Mediterranean fever.

Related Terms:

Andrographolide, Chuan Xin Lin, Green chiretta, Kalmegh leaf extract, Kan Jang®, King of Bitters, Kold Kare®, Remdex®.

Evidence Table:

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.	Grade*
Upper respiratory tract infection: treatment Research suggests that andrographis may reduce symptom severity and duration in active infections if started within 36-48 hours after symptoms develop. Additional studies are needed, especially those that test the effects of andrographis alone.	A
Familial Mediterranean fever Familial Mediterranean fever is a genetic disorder that mainly affects ethnic groups around the Mediterranean causing recurrent episodes of fever and swelling of serous membranes. While early studies suggest that a combination product containing andrographis may reduce the duration, frequency, and severity of attacks among children, more studies using andrographis alone are needed.	C
Influenza (flu) Early studies suggest that andrographis may reduce the duration and severity of flu symptoms, as well as the amount of sick time taken of of work by patients with the flu. More research is needed to confirm these results.	C
Upper respiratory tract infection: prevention Early studies suggest that andrographis extract may help prevent URIs during the winter months if taken daily. Larger studies are required to confirm these results.	C

Dosing:

Adults (over 18 years old)

Preparations that contain 48-60 milligrams of andrographolide constituents have been taken in divided doses three or four daily for respiratory infections. A 300 milligram Kan Jang® tablet containing 4 percent andrographolides has been taken four times daily for cold treatment (for a total daily dose of 48 milligrams andrographolides). Lower daily doses, such as 200-300 milligrams, have been tested for respiratory infection prevention. Use appears to be safe for up to two weeks. Higher doses may be unsafe and cause side effects. Long-term use of andrographis preparations (beyond two weeks) has not been well studied.
Doses of 500-3,000 milligrams of andrographis leaf have been taken by mouth three times daily.
For digestive problems, a tea made with one teaspoon of herb per one cup of water, steeped for 5-10 minutes, has been taken with meals.

Children (under 18 years old)

There is limited research available in children. Children between ages four and 11 years have taken two tablets three times daily (about 30 milligrams daily of andrographolide and deoxyandrographolide) for 10 days.
In Indian Ayurvedic formulas, andrographis leaves and juice are mixed with cardamom, clove, and cinnamon to treat colic and other stomach ailments in infants. However, these uses are not well supported by scientific evidence.

Safety:

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

There have been cases of severe allergic reactions (anaphylaxis), including one case of shock associated with andrographis.

Side Effects and Warnings

Andrographis taken at common doses appears to be relatively safe. Reported side effects include nausea, vomiting, and abdominal discomfort. At high doses (5-10 milligrams per kilogram body weight), patients have experienced nausea, diarrhea, and metallic taste. Rare side effects include headache, dizziness, drowsiness, fatigue, chest discomfort, increased nasal discharge, "blocked nose," and lymph node pain.
Use cautiously in patients with low blood pressure, diabetes or bleeding disorders.

Pregnancy and Breastfeeding

Andrographis is not recommended during pregnancy due to possible contraceptive effects observed in animal studies. Safety during breastfeeding is unknown. In theory, andrographis may decrease sperm count.

Interactions:

Interactions with Drugs

Andrographis may increase the risk of bleeding. Use cautiously in patients taking anticoagulant agents, such as warfarin (Coumadin®) or heparin or with anti-platelet agents such as ibuprofen (Motrin®, Advil®) or clopidogrel (Plavix®). Andrographis use should be stopped before some surgeries; discuss this with a healthcare professional.
Andrographis may lower blood pressure and may therefore, add to the effects of drugs taken to lower blood pressure. Patients with high or low blood pressure who are considering taking any of these agents should discuss options with their healthcare professionals. Dosing adjustments may be necessary.
Andrographis may decrease blood sugar and may add to the effects of drugs taken to lower blood sugar, including insulin. Patients should be closely monitored by their healthcare professionals because dosing adjustments may be necessary.
Andrographis may also interact with allergy, anti-inflammatory, anti-cancer, antiviral, fertility, and immunomodulatory drugs.

Interactions with Herbs and Dietary Supplements

Andrographis may increase the risk of bleeding. Use cautiously in patients taking anticoagulant agents. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
In theory, andrographis may lower blood pressure and may therefore, add to the effects of agents that also lower blood pressure. Patients with high or low blood pressure who are considering taking any of these agents should discuss options with their healthcare professionals.
Andrographis may lower blood sugar. Patients taking other herbs or supplements that may affect blood sugar levels, such as bitter melon (Momordica charantia), should be monitored closely by a healthcare professional while taking andrographis.
Andrographis may also interact with anti-inflammatory, anti-cancer, antiviral, immunomodulatory, and fertility herbs and supplements.

Attribution:

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Jen Woods, BS (Natural Standard Research Collaboration).

References:

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Amaryan G, Astvatsatryan V, Gabrielyan E, et al. Double-blind, placebo-controlled, randomized, pilot clinical trial of ImmunoGuard--a standardized fixed combination of Andrographis paniculata Nees, with Eleutherococcus senticosus Maxim, Schizandra chinensis Bail. and Glycyrrhiza glabra L. extracts in patients with Familial Mediterranean Fever. Phytomedicine 2003;10(4):271-285.
Calabrese C, Berman SH, Babish JG, et al. A phase I trial of andrographolide in HIV positive patients and normal volunteers. Phytother Res 2000;14(5):333-338.
Carr RR, Nahata MC. Complementary and alternative medicine for upper-respiratory-tract infection in children. Am J Health Syst.Pharm 1-1-2006;63(1):33-39.
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):293-298.
Dua VK, Ojha VP, Roy R, et al. Anti-malarial activity of some xanthones isolated from the roots of Andrographis paniculata. J Ethnopharmacol 2004;95(2-3):247-251.
Gabrielian ES, Shukarian AK, Goukasova GI, et al. A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis. Phytomedicine 2002;9(7):589-597.
Iruretagoyena MI, Tobar JA, Gonzalez PA, et al. Andrographolide interferes with T cell activation and reduces experimental autoimmune encephalomyelitis in the mouse. J Pharmacol Exp Ther 2005;312(1):366-372.
Kligler B, Ulbricht C, Basch E, et al. Andrographis paniculata for the treatment of upper respiratory infection: a systematic review by the natural standard research collaboration. Explore (NY) 2006 Jan;2(1):25-9.
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 Pharmacother 2003;3(1):77-93.
Kumar RA, Sridevi K, Kumar NV, et al. Anticancer and immunostimulatory compounds from Andrographis paniculata. J Ethnopharmacol 2004;92(2-3):291-295.
Mandal SC, Dhara AK, Maiti BC. Studies on psychopharmacological activity of Andrographis paniculata extract. Phytother Res 2001;15(3):253-256.
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(5):341-350.
Panossian A, Davtyan T, Gukassyan N, et al. Effect of andrographolide and Kan Jang--fixed combination of extract SHA-10 and extract SHE-3--on proliferation of human lymphocytes, production of cytokines and immune activation markers in the whole blood cells culture. Phytomedicine 2002;9(7):598-605.
Poolsup N, Suthisisang C, Prathanturarug S, et al. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. J Clin Pharm Ther 2004;29(1):37-45.
Spasov AA, Ostrovskij OV, Chernikov MV, et al. 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.

Disclaimer :

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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