Saturday Botanical: Andrographis paniculata

BOTANICAL NAME/FAMILY

• Andrographis paniculata (family Acanthaceae)

OTHER NAMES

• Andrographis, chirayata, chiretta, green chiretta, Indian echinacea, kalmegh, king of bitters

PLANT PARTS USED

·        Leaves, aerial parts

CHEMICAL COMPONENTS

• The main active constituent group is considered to be the bitter diterpenoid lactones known as andrographolides. This group consists of andrographolide (AP1), 14-deoxy-11,12-didehydroandrographolide (AP3) and neoandrographolide (AP4).
• Other constituents include diterpenoid glucosides, diterpene dimers, flavonoids and xanthones.

MAIN ACTIONS                                

·        Immunomodulating via constituent andrographolide by decreasing IFN-gamma and IL-2.

Other actions include

·        Anti-cancer, antimicrobial, antimalarial, cardiovascular support(prevents atherosclerotic build up, prevention of myocardial reperfusion injury, and antihypertensive), hypoglycemic, hepatoprotective, digestive stimulant/choleretic, antipyretic, anti-inflammatory, antiplatelet and antithrombotic activity.

DOSAGE RANGE

·       Prevention dose

1200–3000 mg andrographis (standardised to contain no less than 11.2 mg andrographolides) or 4–6 mL of 1:2 liquid extract, daily in divided doses, taken for at least 3 months for preventive effects to become established.

·       Treatment dose for infection

1200–6000 mg/day or fluid extract (1:2): up to 12 mL/day or equivalent in solid dose form.

 ADVERSE REACTIONS

• Generally well tolerated, but high doses may cause vomiting, anorexia and gastrointestinal discomfort. One source states that urticaria is also possible

SIGNIFICANT INTERACTIONS

·       Anticoagulants

Increased risk of bruising and bleeding is theoretically possible, because andrographolide and other constituents in andrographis inhibit PAF-induced platelet aggregation. However andrographis used together with warfarin did not produce any significant effects on the pharmacokinetics of warfarin, and had even less effect on its pharmacodynamics in vivo. Caution should still be exercised until further research is available.

·       Antiplatelet drugs

Additive effects are possible, because the herb exhibits antiplatelet activity — observe the patient.

·       Barbiturates

Additive effects are possible, according to an animal study — observe the patient. Beneficial interaction is theoretically possible under professional supervision.

·       Hepatotoxic drugs (paracetamol, tricyclic antidepressants)

Hepatoprotection is possible, according to studies in various experimental models — interaction is beneficial.

·       Hypoglycaemic agents

Additive effects are theoretically possible — andrographis has hypoglycaemic activity comparable to that of metformin in vivo. Use together with caution; however, interaction may be beneficial.

·       Drugs metabolised chiefly via the cytochrome p450 system

It is currently unclear whether there is a significant interaction between andrographis and these medications, as in vivo evidence is suggestive of enzyme induction, but this observation has not yet been investigated in clinical studies. Recently andrographolide was shown to strongly induce the CYP 1A1 induction pathway; however, the clinical significance of this is unknown. Another in vitro study has demonstrated an inhibitive effect of andrographis extract and andrographolide on CYP3A and 2C9 pathways. It is recommended that patients be observed to ensure that drug effectiveness is not compromised.

·       Immunosuppressants

Reduced drug activity is theoretically possible, as immunostimulant activity has been demonstrated in vivo — use caution in the immunosuppressed.

CONTRAINDICATIONS AND PRECAUTIONS

• Suspend use of concentrated extracts 1 week before major surgery.

 PREGNANCY USE

Not recommended for use in pregnancy. There is conflicting evidence about the safety of andrographis in pregnancy.