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Andrographis Paniculata: a Review of Pharmacological Activities and Clinical E!Ects Shahid Akbar, MD, Phd

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Andrographis Paniculata: a Review of Pharmacological Activities and Clinical E!Ects Shahid Akbar, MD, Phd amr Monograph Andrographis paniculata: A Review of Pharmacological Activities and Clinical E!ects Shahid Akbar, MD, PhD Introduction combination with other medicinal plants. In Andrographis paniculata is a plant that has been modern times, and in many controlled clinical effectively used in traditional Asian medicines for trials, commercial preparations have tended to be centuries. Its perceived “blood purifying” property standardized extracts of the whole plant. results in its use in diseases where blood “abnor- Since many disease conditions commonly treated malities” are considered causes of disease, such as with A. paniculata in traditional medical systems skin eruptions, boils, scabies, and chronic undeter- are considered self-limiting, its purported benefits mined fevers. "e aerial part of the plant, used need critical evaluation. "is review summarizes medicinally, contains a large number of chemical current scientific findings and suggests areas where constituents, mainly lactones, diterpenoids, further research is needed. diterpene glycosides, flavonoids, and flavonoid glycosides. Controlled clinical trials report its safe and effective use for reducing symptoms of uncomplicated upper respiratory tract infections. Since many of the disease conditions commonly treated with A. paniculata in traditional medical systems are considered self-limiting, its pur- ported benefits need critical evaluation. "is review summarizes current scientific findings and suggests further research to verify the therapeutic Shahid Akbar, MD, PhD – efficacy of A. paniculata. Chairman and professor, A. paniculata, known on the Indian subconti- department of pharmacology, nent as Chirayetah and Kalmegh in Urdu and Qassim University, Saudi Ara- bia; former professor of phar- Hindi languages, respectively, is an annual plant, macology, Medical University 1-3 ft high, that is one of the most commonly of the Americas, Nevis, West used plants in the traditional systems of Unani Indies; Editor, International Journal of Health Sciences; and Ayurvedic medicines. It is called Creat in Uses in Traditional Medical Systems author of book Garlic – The English and is known as the “king of bitters.” It A. paniculata has been reported as having Stinking Magic Herb grows in hedge rows throughout the plains of India antibacterial, antifungal, antiviral, choleretic, Correspondence Address: 1,2 College of Pharmacy, and is also cultivated in gardens. It also grows in hypoglycemic, hypocholesterolemic, and adapto- 3 Qassim University, P.O. Box many other Asian countries and is used as a genic effects. In the Unani system of medicine, it 6800, Buraidah 51452, traditional herbal medicine in China, Hong Kong, is considered aperient, anti-inflammatory, emol- Kingdom of Saudi Arabia Email: the Philippines, Malaysia, Indonesia, and "ailand. lient, astringent, diuretic, emmenagogue, gastric [email protected] or "e aerial parts are most commonly used; and liver tonic, carminative, antihelmintic, and [email protected] however, the whole plant or roots are mentioned antipyretic. Due to its “blood purifying” activity it for certain limited purposes in some manuscripts. is recommended for use in cases of leprosy, gonor- Traditionally, the plant was used as an infusion, rhea, scabies, boils, skin eruptions, and chronic and decoction, or powder, either alone or in seasonal fevers.1 Juice or an infusion of fresh Volume 16, Number 1 Alternative Medicine Review 66 Copyright © 2011 Alternative Medicine Review, LLC. All Rights Reserved. No Reprint Without Written Permission. Monograph amr leaves is given to infants to relieve griping, irregu- identified as 5,7,2’,3’-tetramethoxyflavanone and lar bowel habits, and loss of appetite.2,4,5 "e leaves 5-hydroxy-7,2’,3’-trimethoxyflavone were isolated and root are also used in general debility, during from the whole plant,16 while 12 new flavonoids Key Words: andrographis, convalescence after fevers, for dyspepsia associated and 14 diterpenoids have been reported from the andrographolides, hepatopro- with gaseous distension, and in advanced stages of aerial parts.17,18 Two new flavonoid glycosides and a tection, colds, respiratory, 4,5 URTI, liver, hepatic dysentery. new diterpenoid (andrographic acid) were recently In China, the herb derived from the leaves or reported,19 and two new ent-labdane diterpenoid aerial parts of A. paniculata is known as glycosides were isolated from the aerial parts.20 Chuanxinlian, Yijianxi or Lanhelian. It is described as bitter and cold, is considered to be antipyretic, Mechanisms of Action detoxicant, anti-inflammatory, and detumescent, Hepatoprotective E!ects and is thought to remove “pathogenic heat” from A. paniculata is extensively used as a hepatostim- the blood. A. paniculata is used for the treatment of ulant and hepatoprotective agent in Indian systems pharyngolaryngitis, diarrhea, dysentery, cough of medicine.21 A. paniculata is also an ingredient in with thick sputum, carbuncle, sores, and snake several polyherbal preparations used as hepatopro- bites.6 Various preparations and compound tectants in India,22 one of which has been reported formulas of the herb have been used to treat as efficacious in chronic hepatitis B virus infec- infectious and non-infectious diseases, with tion.23 Very few studies on the effects of crude significant effective rates reported for conditions extracts of A. paniculata on liver function are such as epidemic encephalitis B, suppurative otitis available. Most studies for hepatic effects have media, neonatal subcutaneous annular ulcer, been conducted on either andrographolide or other vaginitis, cervical erosion, pelvic inflammation, purportedly active principles. herpes zoster, chicken pox, mumps, neurodermati- Shukla et al reported significant choleretic tis, eczema, and burns.6 effects of andrographolide in conscious rats and anesthetized guinea pigs. "e protection of Modern Uses andrographolide against acetaminophen-induced A primary modern use of A. paniculata is for the reduction in volume and contents of bile was better prevention and treatment of the common cold. It than that produced by silymarin.24 Multiple-dose appears to have antithrombotic actions, suggesting pretreatment with arabinogalactan proteins and a possible benefit in cardiovascular disease.7 andrographolide was protective against ethanol- Pharmacological and clinical studies suggest the induced hepatotoxicity in mice and was deemed potential for beneficial effects in diseases like comparable to the efficacy of silymarin.25 cancer8-12 and HIV infections.13 Choudhury and Poddar reported that oral pre- and post-treatment of adult rats with an extract of A. Phytoconstituents paniculata was protective against ethanol-induced A. paniculata contains diterpenes, lactones, and increase in serum transaminases. Administration flavonoids. Flavonoids mainly exist in the root, but of the extract to normal adult rats in single and have also been isolated from the leaves. "e aerial multiple doses for seven and 15 consecutive days parts contain alkanes, ketones, and aldehydes. did not significantly affect serum transaminases.26 Although it was initially thought that the bitter A comparative study on the effect of leaf extract substance in the leaves was the lactone androgra- or andrographolide on carbon tetrachloride pholide, later investigations showed that the leaves (CCl4)-induced hepatic microsomal lipid peroxida- contained two bitter principles – andrographolide tion revealed a protective effect of a single oral and a compound named kalmeghin. Four lactones dose of the extract and of andrographolide. – chuanxinlian A (deoxyandrographolide), B However, high concentration CCl4-induced micro- (andrographolide), C (neoandrographolide) and D somal lipid peroxidation in vitro was completely (14-deoxy-11, 12-didehydroandrographolide) protected by the extract but not by androgra- – were isolated from the aerial parts in China.6 A pholide, indicating that the hepatoprotective effect diterpene glucoside (deoxyandrographolide- is not solely due to the presence of androgra- 19beta-D-glucoside) has been detected in the pholide.27 Hepatoprotective effects of the crude 14 leaves and six diterpenoids of the ent-labdane alcohol extract of leaves against CCl4-induced liver type, two diterpene glucosides and four diterpene damage have also been reported by Rana and dimers (bis-andrographolides A, B, C, and D) have Avadhoot.28 been isolated from aerial parts.15 Two flavonoids 67 Alternative Medicine Review Volume 16, Number 1 Copyright © 2011 Alternative Medicine Review, LLC. All Rights Reserved. No Reprint Without Written Permission. amr Monograph Handa and Sharma compared andrographolide, hepatoprotection. Large, multicenter, clinical methanol extract of the whole plant containing studies are warranted to determine whether A. equivalent amounts of andrographolide, and an paniculata is efficacious in patients with liver andrographolide-free methanol extract against diseases of various origins. CCl4-induced liver damage in rats. "e CCl4-induced increases in serum transaminases, serum alkaline E!ects on Hepatic Metabolizing Enzymes phosphatase, serum bilirubin, and hepatic triglyc- Drug-herb and drug-nutrient interactions can erides were inhibited by 48.6-, 32- and 15 percent, adversely influence the clinical response to for andrographolide, methanol extract, and treatment. "erefore, the effect of herbal and andrographolide-free methanol extract, respec- nutrient compounds on hepatic metabolic enzymes tively. Since all three treatments resulted in that influence
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