Artemisia Annua (Sweet Wormwood)
Also called sweet wormwood, sweet Annie, annual wormwood, qinghao, Arthrem.
Best grade C across 5 graded outcomes Botanical Last checked
The short answer
From 12 sourcesSweet wormwood is the source plant of the malaria drug artemisinin, but the herb itself is not a malaria remedy: in trials, tea cleared parasites at first and then many infections returned, and the WHO does not support its use. Arthritis trials are weak: one was not compared directly with placebo and the other had no placebo. Liver injury has been reported.
Every graded outcome on this page
5 rows · line = participants- CGrade CDisease activity in active rheumatoid arthritis (added to methotrexate and leflunomide)Rheumatoid arthritis (add-on)n 159
- DGrade DCD4 count and viral load in people living with HIV on antiretroviral therapyHIV (add-on)n 282
- DGrade DPain, stiffness and function (WOMAC) in hip or knee osteoarthritisOsteoarthritisn 42
- DGrade DLonger-term tolerability and WOMAC scoresOsteoarthritisn 28
- DGrade DResponse rates in uncomplicated falciparum malaria over 28 daysMalarian 19
- 2 more graded outcomes, in the evidence chapter
Key facts
- WHO position
- WHO does not support the promotion or use of Artemisia plant material in any form for the prevention or treatment of malaria (2019)1
- Malaria tea trial
- After 7 days, average response rates were 74% with Artemisia tea vs 91% with quinine, and recrudescence was high in the tea groups2
- Arthritis pilot
- 150 mg twice daily improved WOMAC and pain scores from baseline in 14 people with hip or knee osteoarthritis; 300 mg twice daily and placebo did not4
- Rheumatoid arthritis add-on trial
- Added to methotrexate and leflunomide for 48 weeks, an A. annua extract improved joint counts and quality-of-life scores versus the drugs alone in 159 people; there was no placebo9
- Liver signal
- New Zealand received 29 reports of liver reactions with one A. annua extract; 9 people were admitted to hospital7
- HIV add-on trial
- Leaf powder added to antiretroviral therapy raised CD4 counts versus placebo plus standard care over 12 months in one Ugandan trial; it was not a replacement for HIV medicines6
What it is
Artemisia annua (sweet wormwood) is the plant artemisinin, a malaria-drug ingredient, is extracted from; the herb is sold as tea, powder and extracts.
How it works
ProposedThe plant contains artemisinin, the compound used to make artemisinin-based malaria drugs; a tea sample linked to liver injury also contained arteannuin B, deoxyartemisinin, camphor and scopoletin. WHO reviewed the evidence on non-pharmaceutical forms in 2019 and does not support their use for malaria. Anti-inflammatory effects proposed for joint pain come from extract studies, not from a defined active compound.1248
Forms, side by side
2 forms named in our sources. The rest show what our data holds, and say plainly where it holds nothing yet.
Artemisia Annua (Sweet Wormwood) forms compared
2 forms| 2 forms | Dried leaf tea or powder | Standardised extract capsules (for example a supercritical CO2 extract in grapeseed oil) |
|---|---|---|
| Absorption in people | In 14 healthy men, 1 litre of tea made from 9 g of leaves held 94.5 mg of artemisinin (about 19% of the usual daily drug dose); artemisinin was absorbed faster than from solid drug forms, with similar bioavailability. WHO does not support plant material in any form for malaria.111 | Not reported in the cited abstracts.4 |
| GI tolerance | Hepatitis with jaundice has been reported after drinking the tea as malaria prophylaxis.8 | Well tolerated at 150 mg twice daily in a 12-week pilot, but linked to 29 liver-reaction reports in New Zealand.47 |
| Studied for | Malaria, HIV add-on (leaf powder) | Hip and knee osteoarthritis; rheumatoid arthritis (added to standard drugs) |
- Dried leaf tea or powder
- Absorption in people
- In 14 healthy men, 1 litre of tea made from 9 g of leaves held 94.5 mg of artemisinin (about 19% of the usual daily drug dose); artemisinin was absorbed faster than from solid drug forms, with similar bioavailability. WHO does not support plant material in any form for malaria.111
- GI tolerance
- Hepatitis with jaundice has been reported after drinking the tea as malaria prophylaxis.8
- Studied for
- Malaria, HIV add-on (leaf powder)
- Standardised extract capsules (for example a supercritical CO2 extract in grapeseed oil)
What the human research says
Human trials only, one row per outcome. The form line shows what each trial actually tested. Grades follow our evidence-grading policy.
Trial map
5 graded outcomes, largest study first5 graded outcomes: 3 improved, 2 mixed. The largest, a 2024 randomized trial of 282 people on CD4 count and viral load in people living with HIV on antiretroviral therapy, found an improvement.
1CD4 count and viral load in people living with HIV on antiretroviral therapy
Improved · Grade D · RCT, 282 people, 2024
Adults on antiretroviral therapy with CD4 ≤ 350 cells/µl in Uganda
Dose, result and source| Outcome | Found | People | Study | Who was studied |
|---|---|---|---|---|
| CD4 count and viral load in people living with HIV on antiretroviral therapy | Improved | 282 | Grade D · RCT, 2024 | Adults on antiretroviral therapy with CD4 ≤ 350 cells/µl in Uganda |
| Disease activity in active rheumatoid arthritis (added to methotrexate and leflunomide) | Improved | 159 | Grade C · RCT, 2017 | People with active rheumatoid arthritis |
| Pain, stiffness and function (WOMAC) in hip or knee osteoarthritis | Mixed | 42 | Grade D · Pilot RCT, 2016 | Adults with hip or knee osteoarthritis (14 per group) |
| Longer-term tolerability and WOMAC scores | Improved | 28 | Grade D · Open-label trial, 2016 | Completers of the pilot trial (34 entered, 28 completed) |
| Response rates in uncomplicated falciparum malaria over 28 days | Mixed | 19 | Grade D · RCT, 2008 | Semi-immune adults in Tanzania (10 tea, 9 sulfadoxine-pyrimethamine) |
Every graded row
5 rowsShowing 5 of 5 outcomes. Human trials only.
CGrade CDisease activity in active rheumatoid arthritis (added to methotrexate and leflunomide)Rheumatoid arthritis (add-on)Better joint counts and HAQ at 48 weeksRCT
n 159 · 2017
Improved At 48 weeks tenderness, painful and swollen joint counts, HAQ quality-of-life score, CRP, rheumatoid factor and anti-CCP antibodies were better than with the drugs alone (P < 0.01 or P < 0.05), and overall efficacy was higher at 24 and 48 weeks. More people stopped corticosteroids within 12 weeks, and adverse effects were less frequent.
- Design
- RCT, n = 159, 2017
- Population
- People with active rheumatoid arthritis
- Form
- A. annua extract added to methotrexate and leflunomide vs the two drugs alone
- Dose
- 30 g/day of extract (as stated in the abstract)
- Duration
- 48 weeks
- Source
- Reference 9 · PubMed 28035541 (opens PubMed)
DGrade DCD4 count and viral load in people living with HIV on antiretroviral therapyHIV (add-on)ImprovedRCT
n 282 · 2024
Improved Versus placebo plus standard care, A. annua raised mean CD4 count by 60.84 cells/µl (p = 0.001) and A. annua plus moringa by 105.06 cells/µl (p < 0.001). Viral load fell significantly only in the combination arm. Antiretroviral plasma levels did not differ between groups.
- Design
- RCT, n = 282, 2024
- Population
- Adults on antiretroviral therapy with CD4 ≤ 350 cells/µl in Uganda
- Form
- A. annua leaf powder alone or with Moringa oleifera, added to standard care
- Dose
- 4 g/day of A. annua leaf powder (from the full text; the combination arm added 10 g/day of moringa)
- Duration
- 12 months
- Source
- Reference 6 · PubMed 38627722 (opens PubMed)
DGrade DPain, stiffness and function (WOMAC) in hip or knee osteoarthritisOsteoarthritisLow dose only; WOMAC −12.2Pilot RCT
n 42 · 2016
Mixed Low dose: WOMAC total improved from baseline (−12.2, p = 0.0159) and VAS pain fell by 21.4 mm (p = 0.0082). Placebo (−7.8, p = 0.10) and the high dose showed no significant change from baseline. The low dose was well tolerated.
- Design
- Pilot RCT, n = 42, 2016
- Population
- Adults with hip or knee osteoarthritis (14 per group)
- Form
- A. annua extract (Arthrem) vs placebo
- Dose
- 150 mg or 300 mg twice daily
- Duration
- 12 weeks
- Source
- Reference 4 · PubMed 26631103 (opens PubMed)
DGrade DLonger-term tolerability and WOMAC scoresOsteoarthritisImprovedOpen-label trial
n 28 · 2016
Improved The extract was well tolerated for up to 9 months in total, and WOMAC improvements seen in the double-blind phase were maintained.
- Design
- Open-label trial, n = 28, 2016
- Population
- Completers of the pilot trial (34 entered, 28 completed)
- Form
- A. annua extract (Arthrem), open label
- Dose
- Not stated in the abstract
- Duration
- 6 months
- Source
- Reference 5 · PubMed 27806033 (opens PubMed)
DGrade DResponse rates in uncomplicated falciparum malaria over 28 daysMalariaMixedRCT
n 19 · 2008
Mixed Day-7 response: 7/10 with tea and 7/9 with the drug, falling to 4/10 and 4/9 at day 14 and to 1/9 and 3/8 at day 28.
- Design
- RCT, n = 19, 2008
- Population
- Semi-immune adults in Tanzania (10 tea, 9 sulfadoxine-pyrimethamine)
- Form
- A. annua tea vs sulfadoxine-pyrimethamine
- Dose
- Tea preparation (amount not stated in the abstract)
- Duration
- 7 days, follow-up to day 28
- Source
- Reference 3 · PubMed 18453510 (opens PubMed)
What the numbers add up to
Each point is worked out from the data and the sources numbered on this page, with the arithmetic shown under it. It adds no new data and is not medical advice.
Early clearance does not last
Osteoarthritis data rest on one tiny pilot
Studied doses
Doses used in research, shown against the official limits. They describe the studies, not a recommendation for you.
Studied doses in research, not advice. These are amounts used in research, not personal advice. Your clinician or pharmacist can say what fits you.
Doses studied in human trials
Doses studied in human trials ranged from 150 mg of an extract twice daily (300 mg/day) for 12 weeks in osteoarthritis to 30 g/day of an extract added to arthritis drugs for 48 weeks; an HIV trial used 4 g/day of leaf powder for 12 months, and malaria trials used tea in amounts not stated in their abstracts. These are research doses, not recommendations.496
When trials measured an effect
1 outcome| Outcome | Measured at | Basis |
|---|---|---|
| Rheumatoid arthritis pain and painful joints (add-on) | Better than the drugs alone at 12 weeks; more measures improved by 48 weeks | Randomized trial in 159 people, without placebo9 |
Interactions and safety
Published interactions only: each row cites a source. No row means none was found in our sources, not that a combination is safe.
What Artemisia Annua meets
2 cited rows 1 tested togetherMedicines 2
Supplements and foods 1
- Measured in a human study
- Reference summary
- Tested together in a graded trial
Choose a medicine or supplement above to read its cited rows here.
Also cited: 1 tested together
Antiretroviral drugs
RCTMeasured in a human study
Antiretroviral drugs, for example HIV antiretroviral therapy: In a 12-month Ugandan trial, antiretroviral plasma levels did not differ between people adding A. annua leaf powder and those on standard care alone.
Source 6, AIDS Res Ther (2024)
Strong CYP3A4 inducers or inhibitors
ReviewReference summary
Strong CYP3A4 inducers or inhibitors, for example rifampin, phenytoin, St John's wort, itraconazole, ritonavir: LiverTox notes that artemisinin, the plant's best-known compound, is metabolised mainly by CYP3A4 and is prone to interactions with strong inducers or inhibitors of that enzyme. This has not been studied for the herb itself; in the HIV trial, antiretroviral levels did not change.
Source 12, LiverTox (NCBI Bookshelf) (2017); Source 6, AIDS Res Ther (2024)
MoringaMoringa page
Tested together
CD4 count and viral load in people living with HIV on antiretroviral therapy. Graded on the Artemisia Annua page; tested together is not a claim that they work better together.
Interactions
2 agents| Agent | What the source says | Evidence |
|---|---|---|
| Medicines2 | ||
| Antiretroviral drugse.g. HIV antiretroviral therapy | In a 12-month Ugandan trial, antiretroviral plasma levels did not differ between people adding A. annua leaf powder and those on standard care alone.6 | RCT |
| Strong CYP3A4 inducers or inhibitorse.g. rifampin, phenytoin, St John's wort, itraconazole, ritonavir | LiverTox notes that artemisinin, the plant's best-known compound, is metabolised mainly by CYP3A4 and is prone to interactions with strong inducers or inhibitors of that enzyme. This has not been studied for the herb itself; in the HIV trial, antiretroviral levels did not change.126 | Review |
Check with what you take
Kept on this device onlyAdd what you take. We list every interaction our evidence profiles cite between Artemisia Annua and your picks, and between your picks.
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Add a supplement or medicine you take to check it against Artemisia Annua.
Starting from one medicine? The interaction checker rates how serious each pair is, on a curated list of 19 entries for 11 medicines. This cabinet has no severity rating: it lists every interaction row our supplement pages cite.
Who should be careful
4 groups- Anyone with suspected or confirmed malaria
- WHO does not support any Artemisia plant material for malaria in any way. In tea trials, infections often returned after initial clearance, unlike with modern antimalarials.123
- People living with HIV
- The only HIV trial added A. annua leaf powder to antiretroviral therapy. It does not support using the herb in place of antiretroviral medicines.6
- People with liver disease or a history of liver injury
- Liver injury has been reported with both an A. annua extract (29 New Zealand reports, 9 hospital admissions) and A. annua tea (cholestatic hepatitis rated a probable cause). LiverTox rates artemisinin derivatives a possible rare cause of liver injury (likelihood score D) and notes that most published cases involved herbal supplements containing artemisinin and extended use.7812
Liver injury reports
3 notesA safety signal from case reports, not from trials.
- New Zealand case series
- By January 2019 the national pharmacovigilance centre had 29 reports of liver reactions with an A. annua extract in grapeseed oil (patients aged 47–93). Onset was within 12 weeks in 19 of 23 cases with timing data; 27 recovered or improved after stopping, and 9 were admitted to hospital.7
- Tea case report
- A traveller who drank A. annua tea as malaria prophylaxis developed severe cholestatic hepatitis; causality was rated probable and bilirubin normalised about 3 months later.8
- LiverTox
- LiverTox gives artemisinin derivatives a likelihood score of D (possible rare cause of clinically apparent liver injury); most published hepatotoxicity reports were linked to herbal supplements containing artemisinin and to extended treatment.12
How to read the label
What to check on the Supplement Facts panel.
How to read the label
2 checksHerb is not the drug
Label dose vs studied dose
The osteoarthritis pilot found benefit only at 150 mg twice daily of one extract; 300 mg twice daily did no better than placebo.4
Frequently asked questions
Short answers to common questions; the numbers link to the sources below.
Common questions
7 answersCan Artemisia annua tea be used for malaria?
Is Artemisia annua tea useful as malaria protection when travelling?
Does it help joint pain?
Evidence is thin. A 12-week pilot in 42 people with hip or knee osteoarthritis found improvement from baseline at 150 mg twice daily but not at the higher dose. In rheumatoid arthritis, an extract added to methotrexate and leflunomide improved joint counts over 48 weeks in 159 people, without a placebo (grade C).49
What are the side effects of Artemisia annua?
Is Artemisia annua safe for the liver?
Does it interact with HIV medicines?
Sources
12 sources: trial abstracts, NIH fact sheets and reference databases. Numbers in the text link here.
Sources cited on this page
12 sources- 1The use of non-pharmaceutical forms of Artemisia (WHO/CDS/GMP/2019.14)Guideline World Health Organization, 2019 · who.int
- 2Randomized controlled trial of a traditional preparation of Artemisia annua L. (Annual Wormwood) in the treatment of malaria.RCT Trans R Soc Trop Med Hyg, 2004 · PMID 15109558
- 3Herba Artemisiae annuae tea preparation compared to sulfadoxine-pyrimethamine in the treatment of uncomplicated falciparum malaria in adults: a randomized double-blind clinical trial.RCT Trop Doct, 2008 · PMID 18453510
- 4A pilot randomized, placebo-controlled clinical trial to investigate the efficacy and safety of an extract of Artemisia annua administered over 12 weeks, for managing pain, stiffness, and functional limitation associated with osteoarthritis of the hip and knee.Pilot RCT Clin Rheumatol, 2016 · PMID 26631103
- 5An open-label six-month extension study to investigate the safety and efficacy of an extract of Artemisia annua for managing pain, stiffness and functional limitation associated with osteoarthritis of the hip and knee.Open-label trial N Z Med J, 2016 · PMID 27806033
- 6Evaluation of the effects of Artemisia Annua L. and Moringa Oleifera Lam. on CD4 count and viral load among PLWH on ART at Mbarara Regional Referral Hospital: a double-blind randomized controlled clinical trial.RCT AIDS Res Ther, 2024 · PMID 38627722
- 7Suspected Hepatotoxicity With a Supercritical Carbon Dioxide Extract of Artemisia annua in Grapeseed Oil Used in New Zealand.Observational Front Pharmacol, 2019 · PMID 31920644
- 8Danger of Herbal Tea: A Case of Acute Cholestatic Hepatitis Due to Artemisia annua Tea.Observational Front Med (Lausanne), 2019 · PMID 31681778
- 9Effect of Artemisia annua extract on treating active rheumatoid arthritis: A randomized controlled trial.RCT Chin J Integr Med, 2017 · PMID 28035541
- 10Phytochemical synergy in artemisia annua herbal tea against malaria: a systematic review of its efficacy and safety in the context of emerging Pfkelch13 resistance.Systematic review Infect Dis Poverty, 2026 · PMID 42596018
- 11Pharmacokinetic study of artemisinin after oral intake of a traditional preparation of Artemisia annua L. (annual wormwood).PK study Am J Trop Med Hyg, 2004 · PMID 14993622
- 12ArtemisininDatabase LiverTox (NCBI Bookshelf), 2017 · ncbi.nlm.nih.gov
What changed
Every dated change to this page: what changed, who made it and why.
Change log
3 entries| Date | Change | Who and why |
|---|---|---|
| evidence, safety, interactions, forms, FAQ, questions | Added a graded row for the 2017 rheumatoid arthritis trial (extract added to methotrexate and leflunomide, 159 people, 48 weeks) with its time to effect, and corrected the HIV row to say placebo plus standard care. Added LiverTox (artemisinin derivatives, likelihood score D) to the liver notes, a CYP3A4 interaction note from LiverTox, the 2026 systematic review of tea trials (mild side effects; pregnancy and child safety data insufficient) to the pregnancy note and FAQ, and the 2004 tea pharmacokinetic study to the forms table. Updated summary, studied doses, key facts, the joint insight, three FAQ answers (travel prophylaxis and side effects added), three page questions and two goal-hub links. PubMed search to October 2026 found no other human trials of the herb; a large 2019 tea-versus-ACT malaria trial is retracted and is not cited; LactMed has no entry. | Writer: Kymata Health EditorialTrigger: A–Z audit against docs/supplements/AUDIT-STANDARD.md |
| all | Independent adversarial review: corrected the HIV trial note (the full text describes a cornstarch placebo in the control arm, not standard care without placebo) and added its 4 g/day dose; added a who-should-avoid line that the herb is not a substitute for antiretroviral therapy; disclosed that the osteoarthritis pilot and extension were co-authored by the extract's maker (Promisia Ltd). | Writer: Kymata Health EditorialTrigger: review |
| all | Initial editorial evidence review (first draft). Every PMID checked against NCBI E-utilities esummary (titles and years taken from the record, none retracted) and the abstract read for each cited row. Studied doses are reported as research doses, not dosing advice. | Writer: Kymata Health EditorialTrigger: new page |
Supplement & Nutrient Encyclopedia. Educational information only; it is not medical advice and does not replace a clinician. Dietary supplements are not intended to diagnose, treat, cure or prevent any disease. Statements about supplements have not been evaluated by the FDA.