Andrographis

Andrographis paniculata (Burm.f.) Wall. ex Nees is the name accepted by Kew’s Plants of the World Online (POWO). The plant was first described in 1768, in Burman’s Flora Indica, as Justicia paniculata, and the combination in Andrographis was published in Wallich’s Plantae Asiaticae Rariores in 1832. Other synonyms POWO lists include Justicia latebrosa, Justicia stricta, Andrographis subspathulata, and A. paniculata var. glandulosa. The genus belongs to the acanthus family, Acanthaceae, in the order Lamiales. POWO gives the native range as the Indian subcontinent, in India, Sri Lanka, Bangladesh, Nepal, Assam, and the western Himalaya, where the plant grows as an annual of the seasonally dry tropics. It has been introduced across much of Southeast Asia, including Thailand, Myanmar, Cambodia, Laos, Vietnam, the Malay Peninsula, Sumatra, and Borneo, into southern China and Hainan, and as far as Mexico, Cuba, Hispaniola, the Bahamas, and several Caribbean and Pacific islands. The Flora of China records it as cultivated and naturalized in many Chinese provinces while noting that it is native to India and Sri Lanka.

It is an erect, much-branched annual with distinctly four-angled (square) stems. The Flora of China describes plants up to 50 cm tall, and WHO’s monograph up to 1 m. The leaves are opposite, smooth, and lance-shaped to narrowly elliptic, about 1.5–7 cm long in the Flora of China’s measurements, while WHO gives 2–12 cm. Small flowers are carried in one-sided racemes gathered into loose, leafy panicles at the ends of the branches, the feature behind the species name paniculata. Each white corolla, about 0.9–1.5 cm long, is two-lipped: the upper lip is bent back and two-lobed, and the lower lip is marked with purple spots, which WHO describes as violet markings. Two stamens protrude beyond the petals. The fruit is a narrow, flattened capsule 1.5–2 cm long holding about 12 small, wrinkled seeds, and the Flora of China notes that plants flower and fruit throughout the year. WHO describes the taste of the dried herb as intensely bitter, and the bitterness runs through its common names: WHO lists king of bitters, rice bitters, and chiretta, and the TGA adds green chiretta.

The medicinal part is the aerial herb, especially the leaves. WHO’s monograph covers the dried aerial parts and requires at least 6% total diterpene lactones, calculated as andrographolide. The main lactones it lists are andrographolide, deoxyandrographolide, 11,12-didehydro-14-deoxyandrographolide, neoandrographolide, andrographiside, and deoxyandrographiside. Andrographolide (C20H30O5) makes up about 4% of the whole plant, according to the TGA’s 2015 review, which notes that commercial extracts are often concentrated about 14:1 and standardized to roughly 30–40% andrographolides. EMA’s assessment report observes that most quantification relies on andrographolide alone, and in 2021 EMA’s herbal committee abandoned a reassessment partly because the information it received was not coherent about which plant parts and preparations were meant. Kan Jang shows how specific products can be: in a 2021 Armenian trial, each capsule contained 195 mg of the andrographis extract SHA-10, standardized to 10 mg of diterpene lactones, plus 11.4 mg of eleuthero root extract. Hu and colleagues found that the products in their meta-analysis seldom came with manufacturing or quality-control details.

Andrographis has deep roots in South Asian medicine. EMA’s assessment report notes that it is known as kalmegh in Ayurveda, where it is a constituent of at least 26 formulations used for liver disorders, and that it was described in “Indigenous Drugs of India” in 1896 and later in the Indian Materia Medica. It reached British pharmacy as well: the British Pharmaceutical Codex of 1934 included the entire plant under the names Creyat, Kiryat, and Kreat (EMA). WHO’s monograph records a long run of regional names, including kalmegh, bhoonimba, mahatikta, nelavemu, sambiloto, and chiretta, and an equally long list of uses described in pharmacopoeias and traditional systems of medicine: bacillary dysentery, bronchitis, colitis, coughs, dyspepsia, fevers, hepatitis, malaria, mouth ulcers, sores, tuberculosis, and venomous snake bites. It adds folk uses for colic, ear infections, vaginitis, chickenpox, eczema, and burns. WHO separates these from the small group of uses it considered supported by clinical data, which were colds and related upper respiratory infections, lower urinary tract infections, and acute diarrhea, so most of the traditional list has never been tested in people.

In China the plant is chuan xin lian, and EMA notes that traditional Chinese medicine assigns it a “cold” property, used to clear heat, fever, and toxins. Modern Chinese medicine also developed injectable andrographolide preparations, and the TGA’s 2015 review cites reports of anaphylactic shock with “Chuanxinlian injection.” In Thailand, where it is fah talai jone, single-ingredient oral andrographis entered the National List of Essential Medicines in 1999 for non-infectious diarrhea and pharyngotonsillitis (sore throat with tonsillitis), and the common cold was added in 2006 (Suwankesawong and colleagues, BMC Complementary and Alternative Medicine 2014). During the COVID-19 pandemic, Thai PBS World reported in June 2021 that the Ministry of Public Health had added it to the national list of herbal medicines for mild COVID-19 symptoms through a notice in the Royal Gazette, despite resistance from some physicians, and the Bangkok Post reported that Thai health officials warned it does not prevent infection. The clinical trials that followed are described under uses.

In Europe, andrographis arrived mainly through Kan Jang, the Swedish Herbal Institute’s combination of andrographis and eleuthero extracts, which the authors of a 2021 trial say has been used in Scandinavia for more than 30 years; from the 1990s it was tested in trials in Chile, Armenia, and elsewhere. EMA’s herbal committee assessed andrographis leaf in 2014 and published a public statement that no monograph could be established: no single-herb product had the required 15 years of medicinal use in the European Union, the single-herb trials were too weak to support well-established use, and trials of combination products were outside its remit. After a new call for data in 2018, the committee cancelled a reassessment in 2021. Australia took a regulatory path of its own. The TGA saw a spike in allergic reaction reports in 2008 linked to cold and flu products, published its safety review in 2015, required an allergy warning on labels from 2020, and in September 2026, after an updated review, removed andrographis from the ingredients permitted in new listed medicines and asked sponsors to consider cancelling or recalling existing products.

Most laboratory work focuses on andrographolide and its relatives. In cell studies summarized by EMA, andrographis extracts and andrographolide inhibited NF-κB, a protein switch that turns on many inflammatory genes, which is one proposed explanation for the herb’s effect on cold symptoms. Andrographolide also inhibited the clumping of blood platelets triggered by platelet-activating factor, at a half-maximal concentration of about 5 micromolar (Amroyan and colleagues 1999, cited by EMA), and extracts lowered blood pressure in rats. In human liver preparations, an extract inhibited the drug-metabolizing enzymes CYP1A2, CYP2C9, and CYP3A4 (Pekthong and colleagues 2008, cited by EMA), a point taken up under interactions. These are plausible routes to the symptom relief seen in trials, but none has been shown to be what actually drives the results in people. The laboratory picture also does not settle whether andrographis acts against viruses in the body. In the Thai favipiravir trial described under uses, adding andrographis lowered blood levels of the inflammatory messenger interleukin-1 beta, yet it did not speed clinical recovery or clear the virus faster.

How much andrographolide reaches the bloodstream is a real question. In rats, oral andrographolide is absorbed quickly and about 55% binds to plasma proteins (EMA). In healthy volunteers, Songvut and colleagues (Pharmaceutical Biology 2025) found low blood levels of the main diterpenoids after an ethanol extract given at 60 or 120 mg of andrographolide every eight hours, and doubling the dose raised the peak concentration only slightly, a non-linear pattern the authors blamed partly on extract quality and dissolution. Suriyo and colleagues (Planta Medica 2017) gave 20 healthy Thai adults 4.2 g a day of a standardized crude-powder capsule for three days. All measured values stayed within normal ranges, but blood pressure fell rapidly and briefly about 30 minutes after the capsules were taken, and white blood cell counts rose by the third day. WHO attributes the stomach discomfort, vomiting, and loss of appetite seen with large doses to the herb’s bitterness, so some side effects may come from taste and gut irritation rather than from any drug-like action.

Why andrographis triggers anaphylaxis is not known. The TGA says that little is understood about the mechanism and that most people affected had no history of allergy or asthma. It adds that, in general, a viral infection, anti-inflammatory medicines such as ibuprofen, alcohol, or exercise around the time of exposure can make allergic reactions more likely or more severe, which is awkward for a product taken during a cold. Its 2015 review found anaphylaxis reports concentrated among methanol-based and highly concentrated extracts, but could not pin the problem on a single solvent, and by 2026 the agency concluded that formulation restrictions or stronger labels were not expected to reduce the risk enough. Andrographis is often marketed as “immune-boosting,” but human evidence is about symptoms, not immune function. In a phase I trial of andrographolide in 13 people with HIV and 5 healthy volunteers, CD4 immune cell counts rose from 405 to 501 cells per cubic millimeter, but the trial was stopped at six weeks because of adverse events, including an anaphylactic reaction (Calabrese and colleagues, Phytotherapy Research 2000).

Colds and other uncomplicated upper respiratory tract infections are the main modern use and the most studied. WHO’s 2002 monograph lists prevention and symptomatic treatment of colds, uncomplicated sinusitis, bronchitis, and pharyngotonsillitis as uses supported by clinical data. Coon and Ernst (Planta Medica 2004) reviewed seven double-blind controlled trials with 896 participants and concluded that andrographis was superior to placebo for relieving symptoms, with preliminary evidence for prevention. Poolsup and colleagues (Journal of Clinical Pharmacy and Therapeutics 2004) found that both Kan Jang and andrographis alone improved symptom scores compared with placebo. The largest analysis, by Hu and colleagues (PLoS One 2017), pooled 33 randomized trials with 7,175 patients: compared with placebo, andrographis improved cough (standardized mean difference −0.39, 596 patients) and sore throat (−1.13, 314 patients), and compared with usual care it shortened cough, sore throat, and sick leave. The authors judged the trials’ overall quality poor and urged caution. A 2015 meta-analysis of herbal cough remedies by Wagner and colleagues rated the andrographis evidence as strong, while NCCIH’s colds page, last updated in 2016, lists it among approaches with insufficient evidence.

Several trials used andrographis alone. Cáceres and colleagues (Phytomedicine 1999) gave 158 adults with colds in Valdivia, Chile, 1,200 mg a day of the standardized extract SHA-10 or placebo for five days; tiredness, sleeplessness, sore throat, and nasal discharge eased more with andrographis by day 2, and all symptoms measured did so by day 4, with no adverse effects reported. In an earlier pilot prevention trial at a rural Chilean school, 107 students took two tablets of a dried andrographis extract a day or placebo for three months; colds were less frequent with andrographis (30% versus 62%), but only in the third month (Cáceres and colleagues, Phytomedicine 1997). In India, Saxena and colleagues (Phytomedicine 2010) gave 223 patients the extract KalmCold at 200 mg a day or placebo and reported better overall symptom relief by day 5, though EMA criticized the trial’s lack of objective endpoints. In Thailand, a 1991 trial in 152 adults with pharyngotonsillitis compared 3 or 6 g a day of the dried herb with paracetamol (acetaminophen): the high dose and paracetamol worked better than the low dose at day 3, but there was no placebo and differences had vanished by day 7 (EMA).

Kan Jang has its own body of trials, and its results apply to that product. Melchior and colleagues (Phytomedicine 2000) reported a pilot study in 46 patients and a phase III trial in 179 patients taking Kan Jang or placebo for three days; total symptom and doctor-assessed scores improved significantly, with throat symptoms improving most. Gabrielian and colleagues (Phytomedicine 2002) analyzed 95 patients on Kan Jang and 90 on placebo for five days, including people with sinusitis; headache, nasal and throat symptoms, and malaise improved, but cough and eye symptoms did not differ. In 130 children aged 4 to 11, Kan Jang added to standard care eased symptoms more than an echinacea preparation (Spasov and colleagues, Phytotherapy Research 2004). Most recently, Narimanyan and colleagues (Journal of Traditional and Complementary Medicine 2021) randomized 179 Armenian adults with early respiratory symptoms to six capsules a day for five days or placebo; sick leave averaged 2.38 versus 3.02 days, and symptoms improved from day 2. Several authors of these trials were linked to the manufacturer, and EMA excluded combination trials from its review.

COVID-19 trials did not bear out Thailand’s 2021 enthusiasm. Kanokkangsadal and colleagues (Research in Pharmaceutical Sciences 2023) gave 165 adults with COVID-19 an extract providing 60 mg of andrographolide three times a day or placebo for five days and found no difference in progression or overall symptoms, apart from small early differences in headache and loss of smell. In the APFaVi trial, Siripongboonsitti and colleagues (Phytomedicine 2023) added 180 mg a day of andrographolide to the antiviral favipiravir in 146 patients and found no added clinical or virological benefit. A 2025 meta-analysis by Prabhakornritta and colleagues (Frontiers in Pharmacology) pooled six randomized trials in 660 adults and found that single-herb andrographis products, compared with antivirals or supportive care, did not significantly improve resolution of fever (relative risk 1.12) or cough (0.98), C-reactive protein, or interleukin-6. Mild adverse events, chiefly raised liver enzymes, resolved. The authors still saw a possible adjunctive role worth studying, but the trials give no reason to rely on andrographis for COVID-19.

Other uses are preliminary. In ulcerative colitis, Sandborn and colleagues (American Journal of Gastroenterology 2013) randomized 224 adults with mild to moderate disease to an andrographis extract, HMPL-004, at 1,200 or 1,800 mg a day or placebo for eight weeks; clinical response was 45% and 60% versus 40%, significant only for the higher dose, and remission did not differ significantly. A larger phase III trial (NCT01805791) was stopped in 2014 after an interim analysis found it unlikely to succeed. In 60 people with rheumatoid arthritis, an andrographis tablet for 14 weeks did not reduce pain significantly more than placebo, though some joint and laboratory measures improved within the group (Burgos and colleagues, Clinical Rheumatology 2009). Small multiple sclerosis trials reported less fatigue but no effect on relapses (Bertoglio and colleagues, BMC Neurology 2016) and, in progressive disease, a small difference in disability scores without a significant effect on brain shrinkage (Ciampi and colleagues, BMC Neurology 2020). In 103 people with knee osteoarthritis, the extract ParActin reduced pain scores more than placebo (Hancke and colleagues, Phytotherapy Research 2019). None of these has been confirmed in larger independent trials.

Traditional doses use the dried herb. WHO’s monograph gives, for fever, a decoction made from 3 g of the dried aerial parts twice daily; for colds, 1.5–3 g of the powdered herb three times a day; and for diarrhea, a decoction of 3–9 g, or two 500 mg tablets four times a day. The TGA’s 2015 review quotes traditional doses of 1.5–6 g of dried aerial parts a day. The herb is intensely bitter, so most people take it as capsules or tablets rather than as a tea. Modern products are mostly concentrated extracts standardized to andrographolide or total diterpene lactones, and the doses in trials varied widely: 1,200 mg a day of the extract SHA-10 for five days in the Chilean cold trial, 200 mg a day of KalmCold in the Indian trial, six Kan Jang capsules a day (about 60 mg of diterpene lactones) for five days in the 2021 Armenian trial, and 180 mg of andrographolide a day in Thai COVID-19 studies. These numbers are not interchangeable, because the extracts differ in strength and solvent.

Combination products are common. Kan Jang pairs andrographis extract with eleuthero extract; EMA describes a capsule containing 85 mg of andrographis extract, equivalent to 5 mg of andrographolides, plus eleuthero extract equivalent to 120 mg of the dried root, while the 2021 trial capsules contained 195 mg of SHA-10 and 11.4 mg of eleuthero extract. Another studied combination added schisandra and licorice. In Australia, the TGA says andrographis has often been combined with echinacea, and its 2015 review found that most of the 63 andrographis products on its register in 2013 contained several ingredients. That matters for safety: if a multi-ingredient cold product causes a reaction, andrographis may be the cause even when it is not the headline ingredient. EMA’s and the TGA’s reviews both underline that product quality is variable, and Hu and colleagues found that most trial products came without manufacturing or quality-control details, so results from one brand do not transfer to another.

Practical points: if you choose to use andrographis, use a product that names Andrographis paniculata, the plant part, the extract ratio, and the andrographolide content, and keep to the label dose for a short course, as in the trials. Check the ingredient list of any cold, flu, or “immune” product for andrographis, including combinations. Because anaphylaxis can occur with the first dose or after earlier trouble-free use and usually begins within 30 minutes, the TGA advises considering how quickly you could reach medical care if a reaction occurred, and it suggests that people reconsider whether they need andrographis at all. Do not take it if you have ever reacted to an andrographis product. Stop and seek medical advice at the first sign of hives, itching, or swelling, and call emergency services for breathing difficulty, throat or tongue swelling, or collapse. Never inject andrographis preparations; WHO warns that crude extracts must not be given by injection because of anaphylaxis.