Andrographis
Three systematic reviews found less cough, sore throat and overall cold symptoms than placebo, from trials of mostly poor quality. In ulcerative colitis, a meta-analysis found no difference from placebo in response or remission, while one trial found more response at 1,800 mg a day. Mild digestive and skin effects were common. Thai reports describe anaphylaxis and angioedema.
Add to Bio HackChecked 2026-11-09
- Status
- Dietary supplement in the US. Not approved by the FDA as a drug for any use.
- Also called
- Andrographis paniculata, andrographolide, king of bitters, Chuan Xin Lian, kalmegh, fah talai jone, sambiloto, HMPL-004, Kan Jang, KalmCold, ParActin
- Taken for
- colds, sore throat, cough, respiratory infections, immunity, ulcerative colitis, gut inflammation, rheumatoid arthritis, multiple sclerosis, autoimmune disease, inflammation
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help2
What people take it for, and what was found
Shown to help2
Colds, cough and sore throat
Shown to ease cough, sore throat and overall cold symptoms more than placebo in adults and children, though trial quality was mostly poor.
The numbers and sources
- Effect
- Across 33 RCTs (7,175 patients), andrographis improved cough (SMD -0.39, 95% CI -0.67 to -0.10, 596 people) and sore throat (SMD -1.13, 95% CI -1.37 to -0.89, 314 people) against placebo, and improved overall symptoms against placebo, usual care and other herbs [1]. A review of 7 double-blind trials (896 people) found andrographis relieved symptoms of uncomplicated upper respiratory infection more than placebo [2]. In a meta-analysis of 3 trials (433 patients), andrographis alone lowered symptom severity by 10.85 points against placebo (95% CI 10.36 to 11.34) [3].
- Population
- Adults and children with acute respiratory tract infections [1][2][3].
- Sources
- [1], [2], [3]
- Caveats
- Methodological quality of the trials was overall poor, with heterogeneity [1]. Products seldom reported manufacturing or quality control details [1]. Some trials tested andrographis combined with Eleutherococcus (Acanthopanax) senticosus [3].
Fatigue in multiple sclerosis
One pilot study of 22 people with MS found fatigue scores fell 44% against placebo over 12 months. Relapses and disability did not differ.
The numbers and sources
- Effect
- In relapsing-remitting multiple sclerosis patients on interferon beta, 170 mg of dried extract twice a day for 12 months lowered fatigue severity scores by 44% against placebo. Relapse rate, disability scores (EDSS) and inflammatory markers did not differ [8].
- Population
- 25 enrolled, 22 analyzed [8].
- Sources
- [8]
- Caveats
- A pilot study with 22 patients [8].
Mixed results1
Ulcerative colitis
Mixed results: pooled trials found no difference from placebo in ulcerative colitis, while one trial found more response at 1,800 mg a day, 60% against 40%.
The numbers and sources
- Effect
- In a meta-analysis of herbal medicines for active ulcerative colitis, andrographis did not differ from placebo in clinical response (RR 0.95, 95% CI 0.71 to 1.26) or clinical remission (RR 1.31, 95% CI 0.86 to 2.01) [4]. In 224 adults over 8 weeks, clinical response was 45% on 1,200 mg a day (P 0.59) and 60% on 1,800 mg a day (P 0.018) against 40% on placebo. Remission was 34% and 38% against 25% (not significant) [5]. In 120 patients in China, remission and response were 21% and 76% on 1,200 mg a day of extract against 16% and 82% on 4,500 mg a day of mesalazine, with no significant difference [6].
- Population
- Adults with mild to moderate active ulcerative colitis [4][5][6].
- Sources
- [4], [5], [6]
- Caveats
- The pooled result and the 1,800 mg arm of the placebo trial point in different directions [4][5]. The mesalazine trial had no placebo arm [6]. Both trials lasted 8 weeks [5][6].
Not shown to help1
Rheumatoid arthritis
One small trial found joint pain did not fall significantly more than on placebo over 14 weeks in 60 adults with rheumatoid arthritis.
The numbers and sources
- Effect
- In 60 patients with active rheumatoid arthritis given andrographis tablets (30% andrographolides) three times a day for 14 weeks, joint pain fell more than on placebo, but the difference was not significant. Tender and swollen joint counts and HAQ scores fell within the active group, with lower rheumatoid factor, IgA and C4 [7].
- Population
- 60 patients with active rheumatoid arthritis, Chile [7].
- Sources
- [7]
- Caveats
- One small trial. The joint count changes were reported within the active group, not as differences from placebo [7].
Doses studied
The ulcerative colitis trials used 1,200 and 1,800 mg a day of HMPL-004 extract for 8 weeks [5][6]. The multiple sclerosis trial used 170 mg of dried extract twice a day for 12 months [8]. In Thai reports of hypersensitivity, doses ranged from 352 mg to 1,750 mg [9].
Risks
Reported risks1
Allergic reactions
Case reports: Thailand logged 106 allergic reactions to andrographis, including anaphylaxis. The 3 reported deaths followed injected derivative drugs, while oral products caused mostly mild reactions.
The numbers and sources
- Effect
- Thailand's national pharmacovigilance database held 106 reports of hypersensitivity with andrographis as the only suspected cause, from 2001 to 2012. 18 were serious, 16 needed hospital care, and 13 met critical criteria: anaphylactic shock in 5, anaphylactic reaction in 4 and angioedema in 4. Symptoms began 5 minutes to 1 day after a dose [9]. A review of 262 clinical studies and case reports found 55 cases of life-threatening anaphylactic shock and 3 deaths attributed to injected andrographolide derivatives. Oral herbal preparations had mainly mild to moderate digestive and skin reactions [11]. One patient in the multiple sclerosis trial had a mild skin rash treated with antihistamines [8].
- Population
- Spontaneous and monitored reports in Thailand [9]. Clinical studies and case reports [11]. 22 trial patients [8].
- Sources
- [9], [11], [8]
- Caveats
- Spontaneous reports give no rate. The deaths in [11] followed injections of derivative drugs, not oral andrographis.
Checked, no increase found1
Side effects in trials
Serious side effects were rare in trials, about 0.02 per 1,000 patients, and minor ones were mainly digestive and skin.
The numbers and sources
- Effect
- Across 10 RCTs and 3 intensive monitoring studies of oral andrographis, serious adverse events had a pooled incidence of 0.02 per 1,000 patients in RCTs. Nonserious adverse events had a pooled incidence of 102.6 per 1,000 patients in RCTs, mainly digestive and skin [10]. In the 224-patient ulcerative colitis trial, adverse events occurred in 60% and 53% on andrographis and 60% on placebo [5]. In respiratory trials, minor adverse events were mainly digestive [1].
- Population
- Patients with respiratory infection, noninfective diarrhea and autoimmune disease [10]. Ulcerative colitis trial patients [5]. Respiratory trial patients [1].
- Sources
- [10], [5], [1]
- Caveats
- The confidence interval for nonserious events was wide, 10.7 to 256.1 per 1,000 [10].
Claims tested and not found
Sources
- Hu XY, Wu RH, Logue M, et al. 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. https://doi.org/10.1371/journal.pone.0181780
- Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Medica. 2004. https://doi.org/10.1055/s-2004-818938
- 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. Journal of Clinical Pharmacy and Therapeutics. 2004. https://doi.org/10.1046/j.1365-2710.2003.00534.x
- Iyengar P, Godoy-Brewer G, Maniyar I, et al. Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis. Nutrients. 2024. https://doi.org/10.3390/nu16070934
- Sandborn WJ, Targan SR, Byers VS, et al. Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. American Journal of Gastroenterology. 2013. https://doi.org/10.1038/ajg.2012.340
- Tang T, Targan SR, Li ZS, et al. Randomised clinical trial: herbal extract HMPL-004 in active ulcerative colitis, a double-blind comparison with sustained release mesalazine. Alimentary Pharmacology & Therapeutics. 2011. https://doi.org/10.1111/j.1365-2036.2010.04515.x
- Burgos RA, Hancke JL, Bertoglio JC, et al. Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. Clinical Rheumatology. 2009. https://doi.org/10.1007/s10067-009-1180-5
- Bertoglio JC, Baumgartner M, Palma R, et al. Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study. BMC Neurology. 2016. https://doi.org/10.1186/s12883-016-0595-2
- Suwankesawong W, Saokaew S, Permsuwan U, et al. Characterization of hypersensitivity reactions reported among Andrographis paniculata users in Thailand using Health Product Vigilance Center (HPVC) database. BMC Complementary and Alternative Medicine. 2014. https://doi.org/10.1186/1472-6882-14-515
- Worakunphanich W, Thavorncharoensap M, Youngkong S, et al. Safety of Andrographis paniculata: A systematic review and meta-analysis. Pharmacoepidemiology and Drug Safety. 2021. https://doi.org/10.1002/pds.5190
- Shang YX, Shen C, Stub T, et al. Adverse Effects of Andrographolide Derivative Medications Compared to the Safe use of Herbal Preparations of Andrographis paniculata: Results of a Systematic Review and Meta-Analysis of Clinical Studies. Frontiers in Pharmacology. 2022. https://doi.org/10.3389/fphar.2022.773282