Andrographis
Summary
Andrographis paniculata is a bitter herb sold for colds and sore throats. Pooled trials suggest modest relief of cough and sore throat, but trial quality was poor. Australia's regulator has linked it to more than 300 allergy reports, including a fatal anaphylaxis, and in 2026 removed it from low-risk medicines and recalled products.
Key facts
- Australia's TGA has received more than 300 reports of anaphylaxis or hypersensitivity since 2005, including a fatal case in June 2024; reactions occurred even in people who had used it before[6]
- The TGA removed andrographis from its list of ingredients allowed in low-risk listed medicines and products were recalled from October 2026[7]
- 33 RCTs (7,175 patients): improved cough (SMD -0.39) and sore throat (SMD -1.13) versus placebo, with overall poor trial quality[1]
- 1,800 mg/day of an extract gave clinical response in 60% vs 40% on placebo at 8 weeks; remission did not differ significantly; funded by the extract's developer[2]
- Non-serious adverse events, mostly gastrointestinal and skin, occurred in about 103 per 1,000 trial patients[4]
- 3 graded human outcomes on this page
- October 13, 2026
How it works
ProposedAndrographolide and related diterpene lactones inhibit TNF-alpha, IL-1beta and NF-kB signalling in laboratory studies, which is the proposed basis for anti-inflammatory effects. Lab studies also show inhibition of platelet aggregation and of CYP1A2, 2C9 and 3A4, with clinical relevance unclear.[2][8]
What the human research says
Human trials only, one row per outcome. The form column shows what each trial actually tested. Grades follow our evidence-grading policy.
At a glance: strongest evidence per outcome
| Outcome | Grade | Effect | Strongest evidence | Rows |
|---|---|---|---|---|
| Colds | Grade C | Improved | Meta-analysis · n = 7,175 · 2017 | 1 row |
| Gut | Grade C | Mixed | RCT · n = 224 · 2013 | 1 row |
| Fatigue | Grade D | Improved | RCT · n = 22 · 2016 | 1 row |
Every graded row
| Outcome | Effect | Grade | Best evidence | PMID |
|---|---|---|---|---|
| Symptoms of acute respiratory tract infections | Improved | Grade C | Meta-analysis · n = 7,175 · 2017 Adults and children with acute respiratory tract infections in 33 RCTs (English and Chinese databases) Form: Oral Andrographis paniculata alone or in herbal mixtures · Dose: Varied by trial · Duration: Days Cough (SMD -0.39, 95% CI -0.67 to -0.10; n = 596) and sore throat (SMD -1.13, 95% CI -1.37 to -0.89; n = 314) improved versus placebo; overall symptoms and time to resolution also improved. Minor side effects were mainly gastrointestinal. | 28783743 (opens PubMed)Source [1] |
| Clinical response in mild-to-moderate ulcerative colitis | Mixed | Grade C | RCT · n = 224 · 2013 Adults with mild-to-moderately active ulcerative colitis (multicentre) Form: Andrographis paniculata extract (HMPL-004) · Dose: 1,200 or 1,800 mg/day · Duration: 8 weeks Clinical response: 60% at 1,800 mg (P = 0.018) and 45% at 1,200 mg (not significant) vs 40% with placebo. Remission (38% and 34% vs 25%) did not differ significantly. Adverse events were similar across groups. | 23044768 (opens PubMed)Source [2] |
| Fatigue in relapsing-remitting multiple sclerosis | Improved | Grade D | RCT · n = 22 · 2016 Adults with relapsing-remitting MS on interferon beta (Chile; 25 enrolled) Form: Andrographis paniculata dried extract tablets · Dose: 170 mg twice daily · Duration: 12 months Fatigue Severity Scores fell significantly versus placebo, a reduction equivalent to 44% at 12 months; relapse rate, disability scores and inflammatory markers did not differ. One person had a skin rash needing antihistamines. | 27215274 (opens PubMed)Source [3] |
Forms
| Form | Elemental % | Absorption (human data) | GI tolerance | Studied for |
|---|---|---|---|---|
| Standardised extract (andrographolides) | Varies[1] | No head-to-head human absorption data in the cited sources.[1] | Serious adverse events were very rare in trials (0.02 per 1,000), but non-serious events were common; anaphylaxis is reported outside trials.[4][6] | Cold and sore-throat trials; ulcerative colitis trial (1,200-1,800 mg/day) |
| Multi-herb cold and immune products (often with echinacea) | Varies[6] | Not separately studied for absorption.[6] | More than 80% of Australian adverse event reports involved products combining andrographis with echinacea.[6] | Several cold trials used fixed combinations |
Studied doses
Doses studied in human trials ranged from 340 mg/day of dried extract for 12 months (MS fatigue) to 1,200-1,800 mg/day of extract for 8 weeks (ulcerative colitis); cold trials used varied products for several days.[1][2][3]
Interactions
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
Medicines
- Blood-pressure-lowering medicinesReviewA study in healthy people showed transient blood-pressure reductions at cold-treatment doses, so effects may add up.[8]
- Anticoagulants and antiplatelet drugsReviewLab studies show andrographolide inhibits platelet aggregation; a 10-person human study found no significant change in platelet measures, so caution rather than a proven interaction.[8][5]
- Drugs metabolised by CYP1A2, 2C9 or 3A4ReviewAndrographis extract inhibits these enzymes in lab studies; clinical relevance is not established. Memorial Sloan Kettering lists aminophylline as a reason not to take it, based on preclinical data.[8]
- Chemotherapy drugsReviewMemorial Sloan Kettering lists chemotherapy as a reason not to take andrographis, because its antioxidant effects may interfere with some chemotherapy drugs. This is based on lab findings; no human interaction data were found.[8]
Who should be careful
- Anyone with a past reaction to andrographis or echinacea
- Later reactions may be more severe, and severe reactions have occurred in people who used it before without problems.[6]
- People with a history of severe allergies or anaphylaxis
- Australia's regulator advises them to avoid medicines containing andrographis.[6]
- People on blood-pressure or blood-thinning medicines
- Additive blood-pressure lowering and antiplatelet effects are possible.[8]
- Pregnancy and breastfeeding
- No safety data in the cited trials, which enrolled non-pregnant adults.[2][3]
- People having chemotherapy
- Memorial Sloan Kettering advises against andrographis during chemotherapy because its antioxidant effects may interfere with treatment (lab data only).[8]
Talk to your pharmacist or clinician before starting a supplement, especially if you take prescription medicines.
Safety first
Severe allergic reactions are the main concern.
- Australian reports
- More than 300 anaphylaxis or hypersensitivity reports since 2005, over 200 of them since 2019, despite a mandatory label warning.[6]
- Fatal case
- In June 2024 the TGA received a report of fatal anaphylaxis after an andrographis-containing medicine.[6][7]
- Recall
- In 2026 the TGA decided the risk could not be managed within its low-risk listed-medicine framework, and sponsors recalled products.[7]
- Taste changes
- Altered taste is a listed side effect.[8]
How to read the label
- Check blendsAndrographis often appears in multi-herb cold and immune products, frequently with echinacea.[6]
Frequently asked questions
Why was andrographis recalled in Australia?
The TGA kept receiving anaphylaxis reports, including a death, and in 2026 decided the risk could not be managed in low-risk medicines.[7]
Can andrographis cause an allergic reaction the first time?
Yes. Reactions have occurred on first use and in people who had used it before without problems.[6][7]
Does andrographis help colds?
Pooled trials found modest improvements in cough and sore throat, but most trials were of poor quality.[1]
Sources
- [1]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. meta-analysis
- [2]Andrographis paniculata extract (HMPL-004) for active ulcerative colitis.. Am J Gastroenterol, 2013. RCT
- [3]Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study.. BMC Neurol, 2016. RCT
- [4]Safety of Andrographis paniculata: A systematic review and meta-analysis.. Pharmacoepidemiol Drug Saf, 2021. meta-analysis
- [5]The Effects of Andrographis paniculata on Platelet Activity in Healthy Thai Volunteers.. Evid Based Complement Alternat Med, 2018. open-label
- [6]Medicines containing Andrographis paniculata safety advisory. Therapeutic Goods Administration (Australia), 2024. safety-communication
- [7]Andrographis recalls: Concerns over allergy risk. Therapeutic Goods Administration (Australia), 2026. safety-communication
- [8]Andrographis (About Herbs). Memorial Sloan Kettering Cancer Center, 2021. database
What changed
- Initial editorial evidence review: source titles and years taken from NCBI E-utilities esummary (no retraction or expression-of-concern flags), every evidence row, dose, n and duration read against the PubMed abstract or full text, funding and author affiliations checked where available, and grades held conservative.