Andrographis: Benefits, Side Effects and Dosage

Andrographis paniculata, often called the "King of Bitters," is a staple of traditional medicine throughout Asia. In recent decades, modern research has uncovered an impressive range of pharmacological activities for this herb, largely attributed to its main bioactive compound, andrographolide. From immune support to metabolic health and even potential anti-cancer effects, Andrographis is attracting interest from scientists and health-conscious individuals alike. But how strong is the evidence for its benefits? What are the risks and optimal dosages? This article explores the latest research to give you a comprehensive, evidence-based overview of Andrographis.

Benefits of Andrographis

Andrographis is renowned for its broad spectrum of health benefits, ranging from immune support to anti-inflammatory and metabolic effects. Let’s explore what the science says about its most promising uses and mechanisms.

Benefit	Description	Main Compound(s)	Evidence [Sources]
Anti-inflammatory	Reduces inflammation and related markers	Andrographolide	1 2 8
Immune support	Enhances immune function, may raise CD4+	Andrographolide	6 3
Antidiabetic	Lowers blood glucose and improves markers	Mixed extract, Andrographolide	2 5 3
Anticancer	Induces cancer cell death, chemosensitizer	Andrographolide, derivatives	4 9 1
Liver protection	Protects against chemical-induced damage	Andrographolide, derivatives	7
Antioxidant	Reduces oxidative stress	Andrographolide, flavonoids	2 3 7
Antimicrobial	Activity against bacteria, viruses, parasites	Andrographolide and others	3 8 12

Table 1: Main Benefits of Andrographis

Anti-Inflammatory and Immune Modulation

Andrographis is best known for its potent anti-inflammatory effects. Andrographolide, its primary bioactive compound, suppresses pro-inflammatory pathways such as NF-κB, and inhibits the production of inflammatory cytokines. These effects have been demonstrated in both preclinical and clinical studies, suggesting potential benefits for inflammatory diseases, infections, and even as an adjunct in chronic conditions 1 2 8.

Immune modulation is another standout benefit. Clinical studies in HIV-positive patients have shown that andrographolide can increase CD4+ lymphocyte levels, a critical measure of immune health 6. Traditional uses for colds, flu, and upper respiratory infections are supported by its role in boosting immune response and reducing symptom severity 3.

Antidiabetic and Metabolic Benefits

Recent clinical trials and animal studies have highlighted the antidiabetic potential of Andrographis. Supplementation with its extracts, alone or in combination with other herbs, has been shown to reduce fasting and postprandial blood glucose, improve body mass index, and favorably impact liver and kidney markers in diabetic patients 5. Andrographolide’s ability to modulate oxidative stress and inflammation also contributes to its protective effects against diabetic complications, such as diabetic cardiomyopathy 2 3.

Anticancer Effects and Chemosensitization

Andrographis and its derivatives have shown promise as anticancer agents. In vitro and in vivo studies reveal that andrographolide can induce apoptosis (programmed cell death) in various cancer cell types, including breast and colorectal cancer cells, without harming healthy cells. It can also sensitize resistant cancer cells to chemotherapy drugs such as 5-fluorouracil, primarily through the activation of ferroptosis and inhibition of the Wnt/β-catenin pathway 4 9. These findings suggest a role for Andrographis as an adjunct in cancer therapy, though clinical trials are still needed.

Liver Protection and Antioxidant Activity

Liver protection is another traditional and scientifically validated benefit. Andrographolide and its related diterpenoids reduce markers of liver injury, restore antioxidant levels, and prevent lipid peroxidation in animal models exposed to chemical toxins 7. These compounds act as antioxidants, scavenging harmful free radicals and preserving cellular health 2 3 7.

Antimicrobial and Other Benefits

Andrographis exhibits a wide range of antimicrobial activities, showing efficacy against bacteria, viruses, and parasites. It has been used in traditional medicine for conditions like diarrhea, malaria, and upper respiratory tract infections 3 8 12. Additionally, it has demonstrated analgesic (pain-relieving), antipyretic (fever-reducing), and anti-ulcerogenic properties, with favorable safety profiles in animal studies 8 12.

Side Effects of Andrographis

While Andrographis is generally considered safe for most people, especially when used short-term and at recommended dosages, some side effects and safety concerns have been reported, particularly at higher doses or with prolonged use.

Effect	Description	Severity	Evidence [Sources]
Gastrointestinal	Nausea, diarrhea, abdominal discomfort	Mild to moderate	13 5
Allergic reactions	Rash, itching, rare anaphylaxis	Rare but can be severe	6 13
Acute toxicity	No significant toxicity up to 5000 mg/kg (animal studies)	Very low	13
Liver/kidney impact	Generally safe, but monitor in high doses	Mild and reversible	5 13
Drug interactions	Possible with immunosuppressants, antidiabetics	Moderate	5

Table 2: Reported Side Effects and Safety Profile of Andrographis

Common Side Effects

The most commonly reported side effects are mild gastrointestinal issues, such as nausea, diarrhea, and abdominal discomfort. These tend to occur at higher dosages or in sensitive individuals and typically resolve upon discontinuation or dose adjustment 13 5.

Allergic and Hypersensitivity Reactions

Though rare, allergic reactions have been documented, including one case of anaphylaxis in a clinical trial of andrographolide in HIV-positive patients. Mild allergic symptoms such as rash or itching may also occur. Individuals with a known allergy to Andrographis or related plants should avoid its use 6 13.

Acute and Chronic Toxicity

Acute toxicity studies in animals have shown Andrographis extracts to be extremely safe, with no deaths or major adverse effects observed even at doses up to 5000 mg/kg. No significant organ damage or long-term toxicity was found in these studies 13. In clinical settings, no severe adverse events have been reported at standard dosages 5 6.

Impact on Liver and Kidneys

Human and animal studies generally report no significant toxic effects on the liver or kidneys at typical therapeutic doses. However, some mild and reversible changes in liver and kidney markers have been observed, particularly at higher doses or with prolonged use. Individuals with pre-existing liver or kidney conditions should use caution and consult a healthcare provider before using Andrographis 5 13.

Drug Interactions and Precautions

There is some potential for Andrographis to interact with medications, especially those affecting the immune system (like immunosuppressants) or blood sugar (antidiabetic drugs), as it can modulate both immune function and glucose metabolism. Caution is advised when combining Andrographis with such medications, and healthcare supervision is recommended 5.

Dosage of Andrographis

Determining the optimal dosage of Andrographis can be challenging, as it depends on the formulation, specific condition being treated, and individual factors. Current research and traditional use provide some guidance.

Formulation	Typical Dose Range	Duration	Evidence [Sources]
Extract (standardized)	300–1,500 mg/day (split doses)	1–8 weeks	5 14
Andrographolide (pure)	10–20 mg/kg/day (clinical trial)	Up to 6 weeks	6
Fixed herbal combination	900 mg/day (e.g., with Syzygium)	8 weeks	5
Kan Jang tablets	1 mg/kg/day Andrographolide (3x4 tablets)	5–7 days	11 14

Table 3: Common Dosages and Regimens of Andrographis

Standardized Extracts and Single Compounds

• Standardized extracts: Most commercial Andrographis supplements provide 300–400 mg per dose, to be taken 2–3 times daily. Short-term courses (5–10 days) are commonly used for acute infections, while up to 8 weeks may be used for chronic conditions under supervision 5 14.
• Pure andrographolide: Clinical trials have used 10–20 mg/kg/day, but higher doses may increase side effect risks 6.

Herbal Combinations

Andrographis is sometimes combined with other herbs for synergistic effects. A clinical trial using a mixture of Andrographis and Syzygium polyanthum at 900 mg/day for 8 weeks in diabetic patients showed good efficacy and safety 5.

Pharmacokinetics and Considerations

• Absorption: Andrographolide is rapidly absorbed after oral intake, reaching peak blood levels within 1.5–2 hours 11 14.
• Bioavailability: The bioavailability of andrographolide is moderate, and its levels can be influenced by dosage form and individual metabolism 11 14.
• Dose adjustment: Dosages may need to be adjusted based on age, weight, health status, and whether Andrographis is used alone or in combination.

Safety Margins

Animal studies indicate that very high doses (up to 5000 mg/kg) are not acutely toxic, but these levels are far above typical human use 13. For most people, staying within the recommended doses of standardized extracts or commercially available products is advisable.

Conclusion

Andrographis paniculata is a versatile medicinal plant with a growing body of scientific support for its use in a variety of health contexts. Here’s a quick recap:

• Broad Benefits: Anti-inflammatory, immune-modulating, antidiabetic, anticancer, liver-protective, and antimicrobial effects have been demonstrated in laboratory, animal, and some human studies [1–9,12].
• Generally Safe: Side effects are usually mild and uncommon, but rare allergic reactions can occur, and caution is advised for those on specific medications or with pre-existing health issues 5 6 13.
• Flexible Dosage: Typical dosages range from 300–1,500 mg/day for extracts, or 10–20 mg/kg/day for pure andrographolide, with courses lasting from a few days to several weeks depending on the indication 5 6 11 14.
• Consultation Recommended: As with any supplement, especially for chronic use or in combination with pharmaceuticals, talk to a healthcare provider before starting Andrographis.

In sum: Andrographis is an ancient herb with modern appeal, offering multiple health benefits when used wisely and with attention to quality and dosage.