Andrographis

Andrographis refers to preparations of the plant Andrographis paniculata, a herbaceous annual in the family Acanthaceae that grows across India, Sri Lanka, and parts of Southeast Asia. The whole plant is intensely bitter, a property reflected in its traditional name "king of bitters." Its characteristic active compounds are diterpenoid lactones, of which andrographolide is the most abundant and the most studied ^[2].

The plant has a long record of use in the Ayurvedic and Siddha systems of India and in traditional Chinese medicine, where it has been given for fever, sore throat, colds and influenza, digestive complaints, and liver conditions. This traditional reputation as a remedy for infection and inflammation set the direction for much of the modern research on the herb ^[2].

Contemporary interest centers on respiratory infections. A systematic review and meta-analysis of randomized trials concluded that Andrographis paniculata, alone or with usual care, appeared to relieve cough and sore throat and shorten time to recovery in acute respiratory infections, while cautioning that most of the underlying trials were of poor methodological quality ^[1]. The herb and its extracts have also been examined for antimicrobial, anti-inflammatory, hepatoprotective, and antiviral activity in laboratory and preclinical work ^[2], and a fixed herbal combination containing the plant was tested in a randomized trial in people with mild COVID-19 ^[3].

Reported side effects are usually mild and gastrointestinal, though allergic reactions can occur, and a semi-synthetic injectable derivative used in some countries has been associated with more serious hypersensitivity reactions. Andrographolide can affect drug-metabolizing enzymes, raising the possibility of interactions, and the herb is generally advised against in pregnancy because of traditional and experimental concerns about reproductive effects ^[2].

In most Western countries Andrographis is sold as a dietary supplement rather than an approved medicine, commonly as a standardized extract providing a defined amount of andrographolide, and often combined with other botanicals. Regulatory bodies have at times reviewed its safety, particularly with respect to rare allergic reactions.

It is generally well tolerated short-term, but its bitterness can cause nausea, and some people report digestive upset, headache, or fatigue. Because it can modulate the immune system, people on immunosuppressants or with autoimmune conditions should be cautious. It is not recommended in pregnancy, and there are theoretical concerns about fertility and about additive effects with blood-pressure or blood-thinning medications.