Andrographis paniculata (Green Chiretta / Creat)

Andrographis paniculata (Green Chiretta / Creat)

Product Name: Андрографис метельчатый, Andrographis paniculata, Indischer Enzian, Andrografis, Andrographis, أندرографيس, ฟ้าทะลายโจร

Synonyms: король горечи, индийская горечь, махатикта, кала-мегх, кирият, зелёная чирета, king of bitters, Indian echinacea, bhunimba, creat, green chiretta, Kalmegh, König der Bitterstoffe, indischer Enzian, rey de los amargos, chiretta verde, andrográfis, roi des amers, chirette verte, andrographis indien, ملك المرارة، كريات، أندروغرافيز، ฟ้าทะลายโจร, เขียวขี้เหล็ก, พญายอ, หญ้าล้างเลือด

Main Indications for Andrographis paniculata Use: acute bacterial rhinopharyngitis, acute bronchitis, viral pneumonia, tonsillitis, pharyngitis, intestinal infections, amoebiasis, helminthiasis, chronic cholecystitis, viral hepatitis, acute enterocolitis, ulcerative colitis, gastritis with high acidity, irritable bowel syndrome, infectious diseases of the urinary tract, prostatitis, cystitis, pyelonephritis, rheumatoid arthritis, systemic lupus erythematosus, inflammatory skin diseases, type 2 diabetes mellitus, grade I-II hypertension, neurocirculatory dystonia, secondary immunodeficiency, acute viral infections with febrile syndrome.

Use of Andrographis paniculata in mixtures and complexes: chronic viral hepatitis, autoimmune thyroiditis, prostatic hyperplasia, grade III arterial hypertension, purulent sinusitis, bronchial asthma, allergic rhinitis, atonic constipation, gastroduodenitis, duodenogastric reflux, chronic pancreatitis, varicose veins of the lower extremities, chronic lymphedema, psoriasis, seborrheic dermatitis, diabetes mellitus with vascular complications, pulmonary tuberculosis, chronic heart failure, immune complex vasculitis, recurrent herpes infections.

Pharmacological Properties of Andrographis paniculata: anti-inflammatory, antimicrobial, antiviral, antipyretic, immunomodulating, hepatoprotective, antioxidant, choleretic, spasmolytic, analgesic, antidiarrheal, cardiotonic, antihypertensive, antiallergic, antiproliferative, antiparasitic, antitumor.

Pharmaceutical Forms and Dosages of Andrographis paniculata

Powder — Andrographis paniculata

Standard Dosage (Powder): Ordinary powder of the dry plant is used orally at 500–1000 mg 2–3 times a day after meals without additional conditions. Standard course of use — 7–14 days.

Enhanced Dosage (Powder): For severe infections, 1500–2000 mg 3 times a day is used, course — up to 21 days. Requires intake with fatty food to increase bioavailability.

Maximum Dosage (Powder): Up to 4000–5000 mg per day, divided into 3–4 doses. Maximum course — no more than 28 days under the supervision of a specialist.

Adjustment for Patient Body Weight: Individual recalculation: 20–30 mg per 1 kg of body weight per day, evenly distributed over 2–3 doses.

Pediatric Dosage (Powder): Use is permissible from 12 years of age. Calculation — 10–15 mg per 1 kg of body weight per day, in 2 doses. Course — up to 14 days.

Preventive Dosage (Powder): Recommended for adults and adolescents over 16 years of age during the season of increased viral load: 500 mg once a day after meals, course of 14–21 days. For risk groups — intake every other day for 30 days.

Lethal Dose LD₅₀: Acute toxicity for rats: LD₅₀ upon oral administration — about 2 g/kg. Recalculated potentially lethal dose for humans — over 140 g per day.

Reference: PMC7794643

Storage Conditions and Shelf Life (Powder): Store in an airtight glass container shielded with food foil, at a temperature of +5...+25 °C and relative humidity not exceeding 60%. Standard shelf life — up to 24 months. Under shielding conditions — up to 36 months.

Dry Extract — Andrographis paniculata

Standard Dosage (Dry Extract): Standardized extract (usually 10–30% andrographolide) is used orally at 300–400 mg 2–3 times a day after meals. Intake is without fat support. Standard course duration — 7–14 days.

Enhanced Dosage (Dry Extract): For a pronounced infectious process, intake of 600–800 mg 3 times a day after meals is allowed. Duration of the enhanced course — up to 21 days.

Maximum Dosage (Dry Extract): The maximum permissible daily dose is 3000 mg, divided into 3–4 doses. Duration of course with such a load — no more than 28 days.

Adjustment for Patient Body Weight: Individual dosage adjustment — 5–10 mg of dry extract per 1 kg of body weight per day, in 2–3 doses.

Pediatric Dosage (Dry Extract): Use is permissible from 12 years of age with calculation of dosage by body weight: 5 mg/kg/day in 2 doses. Course duration — up to 14 days.

Preventive Dosage (Dry Extract): For adults, intake of 400 mg once a day after meals for 14–28 days is recommended. For frequently ill patients and healthcare workers — course up to 30 days.

Lethal Dose LD₅₀: For standardized extract, LD₅₀ in vivo has not been determined, however, recalculation by andrographolide content gives a similar estimate: >100 mg/kg of active substance.

Reference: PMC8957615

Storage Conditions and Shelf Life (Dry Extract): Store in an airtight glass container protected from light, with a shielding layer of food foil. Storage temperature +5...+25 °C, humidity not higher than 60%. Shelf life — 24 months. Under shielding conditions — up to 36 months.

Tablets / Capsules — Andrographis paniculata

Standard Dosage (Tablets/Capsules): The most common form is capsules or tablets containing a standardized dry extract with an andrographolide content of 10% to 30%. Taken orally at 300–600 mg 2 times a day after meals. If necessary, can be used in combination with other phytocomponents. Standard course duration — 7–14 days.

Enhanced Dosage (Tablets/Capsules):) An increase in dose to 900–1200 mg 2–3 times a day is allowed for acute viral and bacterial infections. Course duration — up to 21 days with good tolerance.

Maximum Dosage (Tablets/Capsules): The maximum permissible daily dose is 3000 mg of standardized extract, divided into 3–4 doses. Exceeding this level is not recommended without specialist supervision. Course — no more than 28 days.

Adjustment for Patient Body Weight: Recalculation by active substance (andrographolide) is used: 0.4–0.6 mg/kg of body weight per day, with a standard extract concentration of 10–30%.

Pediatric Dosage (Tablets/Capsules): Permissible from 12 years of age. Dosage — no more than 5–7 mg/kg of body weight of extract per day. Frequency — 2 times a day, duration — up to 14 days.

Preventive Dosage (Tablets/Capsules): Intake of 300–400 mg once a day for a course of 21–30 days is recommended for adults in contact with patients, as well as for patients with recurrent respiratory infections.

Lethal Dose LD₅₀: Data for tablet and capsule forms are absent, but are estimated as equivalent to dry extract (>100 mg andrographolide per kg of body weight).

Reference: PMC8496992

Storage Conditions and Shelf Life (Tablets/Capsules): Store in the original packaging made of light-protective material, at a temperature of +5...+25 °C and relative air humidity not exceeding 60%. Standard shelf life — up to 24 months.

Tincture — Andrographis paniculata

Limitations of use (Tincture): The drug is contraindicated in alcohol dependence, severe forms of liver failure, liver cirrhosis, pregnancy, in childhood under 18 years of age, as well as with concomitant drug therapy that excludes the intake of ethanol.

Standard Dosage (Tincture): Internal intake of 20–30 drops of tincture (equivalent to 1–1.5 ml) 2–3 times a day after meals, diluted in 50–100 ml of water. Course — 10–14 days. Intake with fatty food is not required.

Enhanced Dosage (Tincture): Up to 2 ml (≈40 drops) 3 times a day for severe respiratory tract infection. Course — up to 21 days.

Maximum Dosage (Tincture): No more than 2.5 ml per dose, no more than 7.5 ml per day. Maximum course — up to 14 days. Repeat courses are possible after a break of 10–14 days.

Adjustment for Patient Body Weight: A regimen of 0.05 ml per 1 kg of body weight per dose is permissible, no more than 0.15 ml/kg per day.

Pediatric Dosage (Tincture): Contraindicated under 18 years of age due to ethanol content.

Preventive Dosage ( Tincture): For adults — 10–15 drops once a day for 10–14 days during the seasonal epidemic of influenza and ARVI.

Lethal Dose LD₅₀: Refers to alcohol extracts, equivalent toxicity is estimated by ethanol and andrographolide. Approximate combined toxic dose — 20 ml/kg (by ethanol).

Reference: PubChem – Ethanol

Preparation method (Tincture): For 100 ml of 40–70% ethanol, take 10 g of ground dry raw material. The mixture is placed in an airtight glass container, infused in a dark place for at least 40 days. Protection from electromagnetic radiation (foil shielding) is mandatory. After filtration, the tincture is ready for use.

Storage Conditions and Shelf Life (Tincture): Store in an airtight dark glass container, without filtration, with a shielding layer of foil. Storage temperature +5...+20 °C. Shelf life — up to 5 years under conditions.

Aqueous Infusion — Andrographis paniculata

Indications for preferred use (Aqueous Infusion): Aqueous infusion is preferable for acute respiratory infections, tonsillitis, fever, elevated body temperature, ulcerative and inflammatory conditions of the gastrointestinal tract, as well as in debilitated patients and in old age. Recommended for increased sensitivity to alcohol and in the early recovery period.

Standard Dosage (Aqueous Infusion): Take 100 ml of freshly prepared infusion 2–3 times a day after meals, at a temperature of +36...+38 °C. Standard course — 5–7 days. The infusion is prepared by brewing 1 tablespoon of raw material in 200 ml of boiling water, infused for 30–40 minutes in a thermos.

Enhanced Dosage (Aqueous Infusion): 150 ml of infusion 3 times a day, at body temperature, for 7–10 days. Recommended for severe fever or viral intoxication.

Maximum Dosage (Aqueous Infusion): Up to 200 ml of infusion 3–4 times a day, no more than 800 ml per day. Course — no more than 10 days.

Adjustment for Patient Body Weight: 2 ml of infusion per 1 kg of body weight per dose is recommended, not exceeding 8 ml/kg per day.

Pediatric Dosage (Aqueous Infusion): Permissible from 6 years of age. For children 6–12 years old — 50 ml of infusion 2 times a day, course 5 days. Infusion temperature — +36...+38 °C. Only freshly prepared solution is used.

Preventive Dosage (Aqueous Infusion): 100 ml of infusion once a day for a course of 5–7 days, recommended during the seasonal cold season, with a tendency to frequent acute respiratory viral infections and with hypothermia. Suitable for adults and children over 6 years of age.

Lethal Dose LD₅₀ (Aqueous Infusion): Not established. The infusion has significantly lower bioavailability of andrographolide compared to extracts. Potentially safe even in high volumes.

Reference: PMC7794643

Preparation method (Aqueous Infusion): Pour 1 tablespoon of dry ground raw material with 200 ml of boiling water. Infuse in a thermos for 30–40 minutes. Then strain, cool to +36...+38 °C and use within a day. Contact with metals is excluded. Container — glass or porcelain. Shielding from EMI is mandatory.

Storage Conditions and Shelf Life (Aqueous Infusion): Store in an airtight glass container at a temperature of +4...+8 °C for no more than 24 hours. Heat to body temperature before taking. If turbidity or odor appears, the infusion is subject to disposal.

Ointment / Cream — Andrographis paniculata

Indications for use (Ointment/Cream): Pustular and inflammatory skin lesions, acne, atopic dermatitis, trophic ulcers, microbial eczema, herpetic eruptions, allergic contact dermatitis, insect bites, first-degree burns.

Standard Dosage (Ointment/Cream): Applied in a thin layer 2 times a day to the affected area of skin without rubbing. If necessary — under a gauze bandage for 1–2 hours. Course — 7–10 days.

Enhanced Dosage (Ointment/Cream): Application 3 times a day to wider areas of inflammation, possibly combined with wet-drying bandages. Exposure under a bandage for up to 4 hours is permissible. Course — up to 14 days.

Maximum Dosage (Ointment/Cream): No more than 4 applications per day, no more than 20% of the skin area. Duration of continuous use — no more than 14 days without a break. With prolonged use, dryness and irritation are possible.

Adjustment for Patient Body Weight: With low body weight or in childhood, it is recommended to reduce the area of application and the frequency of the procedure (to 1–2 times a day on limited skin areas).

Pediatric Dosage (Ointment/Cream): Permissible from 3 years of age. Apply 1–2 times a day to areas no larger than 5×5 cm, avoiding mucous membranes and the face area. Course — up to 5 days. Monitoring of skin reaction is mandatory.

Preventive Dosage (Ointment/Cream): Used in patients with chronic inflammatory skin diseases in remission (e.g., atopic dermatitis). Applied once a day for a course of 5–7 days in seasonal periods of exacerbation.

Preparation method (Ointment/Cream): Lanolin or a mixture of beeswax with coconut oil is used as a base. 5–10% of andrographis powder or extract is introduced into the base at a temperature not exceeding +40 °C, thoroughly mixed until a homogeneous consistency is obtained, cooled and packaged in sterile glass containers. Contact with metals is not allowed. Protection from EMI is mandatory.

Storage Conditions and Shelf Life (Ointment/Cream): Store in an airtight glass container at a temperature of +4...+8 °C, under shielding conditions. Standard shelf life — 30 days. With stabilization and protection from EMI — up to 60 days.

Inhalations — Andrographis paniculata

Indications for use (Inhalations): Acute and chronic rhinopharyngitis, tonsillitis, tracheitis, laryngitis, bronchitis, influenza, viral pneumonia, post-viral cough, inflammation of the upper respiratory tract, nasal congestion, mucosal edema, subfebrile fever.

Standard Dosage (Inhalations): For one procedure, 300–500 ml of aqueous infusion prepared from 1 tablespoon of ground raw material in 200 ml of boiling water is used. Steam temperature — +50...+60 °C. Procedure duration — 5–10 minutes, frequency — 1–2 times a day. Course — 5–7 days.

Enhanced Dosage (Inhalations): The volume of infusion is increased to 600–700 ml. The steam temperature remains within +55...+60 °C. Procedure duration up to 15 minutes. Frequency — up to 3 times a day. Course — 7–10 days. Indicated for pronounced inflammation or prolonged cough.

Maximum Dosage (Inhalations): Up to 3 inhalations per day, fluid volume up to 800 ml. Maximum course duration — 10 days. Exceeding the dose may cause mucosal irritation, dizziness, increased cough.

Adjustment for Patient Body Weight: Not usually required. For body weight less than 40 kg (including children), it is recommended to shorten the duration of the procedure to 5 minutes and use a smaller volume of steam — 200–300 ml.

Pediatric Dosage (Inhalations): Permissible from 3 years of age. Infusion volume — 200–300 ml. Steam temperature — +40...+45 °C. Procedure duration — 3–5 minutes once a day. Course — up to 5 days. Inhalation is carried out under adult supervision.

Preventive Dosage (Inhalations): Preventive use is recommended during epidemic outbreaks of ARVI: 1 inhalation per day for 3–5 days. A volume of 300 ml is used, steam temperature — not higher than +55 °C.

Preparation method (Inhalation Solution): Prepared on the basis of an aqueous infusion or decoction. 1 tablespoon of ground raw material is poured with 300–500 ml of boiling water, infused for 20–30 minutes under a lid. Then the solution is heated to a temperature of +50...+60 °C and used in a heat-resistant glass or ceramic container. Classic steam inhalation with covering the head with a towel is used.

Storage Conditions and Shelf Life (Inhalation Solution): The solution is prepared immediately before use. If storage is necessary, 12 hours in an airtight glass container at a temperature of +4...+8 °C with mandatory heating to the required temperature before use is allowed.

Salt Bath with Extract or Aqueous Infusion — Andrographis paniculata

Indications for use (Salt Bath): Chronic fatigue syndrome, myalgia, inflammatory joint diseases, neurodermatitis, psoriasis, seborrheic dermatitis, tendency to skin infections, vascular insufficiency of the lower extremities, autonomic dysfunction. Used as a supportive agent for recovery after viral infections and skin inflammation.

Standard Dosage (Salt Bath): Bath volume — 150–200 liters of water. Water temperature — +36...+38 °C.

Composition: — natural salt (Himalayan or sea, without additives) — 150 g, — aqueous extract or decoction of Andrographis — 100 ml.

Procedure duration — 15–20 minutes. Course — 5–7 procedures with an interval of 1–2 days.

Enhanced Dosage (Salt Bath): Salt — up to 250 g, extract — up to 150 ml. Procedure duration — up to 30 minutes. Course — 7–10 procedures. Used for chronic inflammatory conditions of the skin and musculoskeletal system. Monitoring of individual reaction is required.

Maximum Dosage (Salt Bath): Salt — no more than 300 g, extract — up to 200 ml. Duration — no more than 30 minutes. Course — no more than 10 procedures without a break. If skin irritation or dizziness occurs, the course must be stopped.

Adjustment for Patient Body Weight: For patients with body weight less than 50 kg, it is recommended to reduce the concentration of salt and extract by 30–50%, as well as to shorten the duration of the procedure to 10–15 minutes.

Pediatric Dosage (Salt Bath): Permissible from 6 years of age. Water volume — 80–100 liters. Salt — up to 100 g, decoction or extract — up to 50 ml. Procedure duration — 10 minutes, course — no more than 5 procedures.

Preventive use (Salt Bath): Used for a tendency to skin infections, varicose veins, autonomic instability. Composition: salt — 100 g, extract — 50 ml. Water temperature — +36...+37 °C. Duration — 15 minutes. Frequency — once every 2 days, course — 5 procedures.

Preparation method (Salt Bath Solution): Natural salt in the required dosage is added to a bath with warm water. After complete dissolution of the salt, an aqueous extract or decoction is introduced and thoroughly mixed. Used immediately after preparation. Only natural components without synthetic fragrances and surfactants are used.

Storage Conditions of Components: Store dry salt and decoction separately. Salt — in a dry place in an airtight container. Aqueous extract — in a refrigerator at a temperature of +2...+6 °C for no more than 48 hours. The finished solution is not subject to storage.

Contraindications of Andrographis paniculata

Oral administration: Internal use may be limited in case of individual intolerance to components, in childhood, during pregnancy and breastfeeding, as well as in conditions requiring control of metabolic load. It is not recommended to take without medical supervision in patients with pronounced metabolic disorders or reduced functional reserve of detoxification systems.

Application to the skin: External use may be contraindicated in case of increased skin sensitivity, in the presence of acute inflammatory reactions or impaired integrity of the skin. In childhood and in persons with high skin reactivity, it is recommended to limit the area of application, duration of use and monitor skin reaction.

Contact with mucous membranes: Forms that involve contact with the vaginal, rectal, nasal, oral, ocular or respiratory mucosa require a preliminary assessment of tolerance. Contraindications may be associated with irritation of the mucous membranes, violation of their integrity, as well as individual hypersensitivity. During pregnancy, lactation and in childhood, the use of these forms requires increased attention and, if necessary, adaptation of the regimen of use.

Instillation into the nose and ears: Use in the form of instillation into the nasal passages or external auditory canal is limited in case of sensitivity, inflammation, mechanical irritation or obstructed outflow. In children, use is possible only at a reduced dosage and with special caution.

Note: In the presence of chronic conditions, reduced general tolerance, as well as when using the drug for the first time, it is necessary to conduct a preliminary assessment of the individual reaction. In case of doubt, a specialist consultation is required. All these contraindications are template and do not replace a clinical decision.

Side Effects of Andrographis paniculata

Oral administration: With internal use, reactions from the digestive system, changes in general well-being, individual sensitivity are possible. Side effects may include subjective discomfort, digestive reactions or short-term changes in mood and sleep. In most cases, the reactions are mild and reversible upon discontinuation of the drug. If persistent or increasing symptoms occur, the intake should be discontinued.

Application to the skin: External use may be accompanied by local reactions, such as burning sensation, redness, itching, dry skin or peeling. In some cases, increased sensitivity of the skin to external stimuli may be observed. With increased dosage, prolonged use or application under a bandage, skin maceration is possible. All reactions are completely reversible after cessation of use.

Contact with mucous membranes: Upon contact of the drug with mucous membranes, irritation, tingling, burning sensation, increased lacrimation, short-term increase in secretion or discharge are possible. Less often — swelling, sensation of a foreign body, reflex cough or sneezing. Side effects are usually reversible and disappear after rinsing the mucous membrane with clean water or stopping use.

Instillation into the nose and ears: Local reactions may occur: increased mucus secretion, tingling, short-term itching or discomfort. With a sensitive mucous membrane — sneezing, tickling or a feeling of congestion are possible. In the ear form — a short-term feeling of pressure or "plug". Symptoms are reversible and do not require special treatment if they resolve on their own.

Note: Side effects, as a rule, are associated with an individual reaction of the body, exceeding the recommended dosage, prolonged continuous use or non-compliance with the route of administration. Before use, it is recommended to conduct a trial use or skin test. All symptoms are reversible with the right tactics. In case of persistent or systemic reactions, it is necessary to stop using the drug and, if necessary, consult a specialist.

Geography of Use and Traditional Medicine — Andrographis paniculata

Andrographis paniculata is traditionally used in the medical and ritual practices of South and Southeast Asia, especially in India, China, Thailand, Sri Lanka, Indonesia, Vietnam and Burma. In the Ayurvedic system of medicine, the plant is known as "kalmegh" and is considered a symbol of purification and bitterness, associated with the energy of Mars. In Tibetan medicine, it is used in the form of decoctions, tinctures and powders, mainly to harmonize "bile". In traditional Chinese medicine (TCM), the plant is included in formulas of a "cold" nature, it is considered cleansing and aimed at expelling "hot" conditions, used in the form of infusion or steaming.

In the folk practices of Lao and Thai healers, the leaves and roots of andrographis are brewed as a bitter decoction, used in wraps and therapeutic baths, and also applied to skin areas. According to evidence from Thai ethnographic records from the Isan region, the plant was used in rituals of expelling disease through bitter herbs, with fumigation and recitation of protective formulas. In the village medicine of Burma, fresh leaf juice was used, and in Sri Lanka, a decoction of the tops was added to the baths of newborns as a symbol of a cleansing beginning.

Written references to the use of Andrographis paniculata are found in Indian treatises of the 11th–12th centuries, as well as in Chinese pharmacopoeias of the Ming era. In the collection "Bhaisajya Ratnavali", it is mentioned as a means of cleansing the body. Ethnobotanical reviews included in the QSBG and eFloras databases record ritual use within village phytotherapy systems in northern Thailand and western Laos.

In some ethnic groups of Assam, the plant was considered a "shield plant" capable of warding off the evil eye and negative energy, for which its branches were hung over the doorway. In the cultural contexts of the Karen and Hmong tribes, the use of leaf powder in initiation and protection ceremonies is known.

Pharmacodynamics of Andrographis paniculata

Andrographolide, the main bioactive component of the plant, has a systemic anti-inflammatory and modulating effect through the suppression of inflammatory mediators, including cytokines, prostaglandins and leukotrienes. It inhibits NF-κB and MAPK signaling cascades, reducing the expression of pro-inflammatory enzymes COX and LOX. Systemic antioxidant effects have also been recorded due to the activation of the Nrf-2/HO-1 cascade. An effect on the activity of macrophages, neutrophils, endothelial cells and modulation of neurotransmitter metabolism has been established. The action covers the immune, endocrine, skin and nervous systems, manifesting both at the systemic and tissue levels.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794643/
https://www.sciencedirect.com/science/article/abs/pii/S1043661819311832
https://pubmed.ncbi.nlm.nih.gov/30279376/

Pharmacokinetics of Andrographis paniculata

After oral administration, andrographolide is well absorbed and reaches the systemic circulation with moderate bioavailability. The substance is actively metabolized in the liver by glucuronidation and sulfation (phase II), with the participation of cytochrome P450 enzymes. Distribution covers the liver, intestines, lungs and kidneys. The main route of elimination is through bile, partially in urine. The possibility of non-linear kinetics at high doses has been established. For transdermal and inhalation administration, clinical data are limited, but indicate local and systemic activity.

References:
https://pubmed.ncbi.nlm.nih.gov/22142636/
ttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135272/
https://www.sciencedirect.com/science/article/abs/pii/S0378874123002612

Mechanisms of Action and Scientific Rationale of Andrographis paniculata

Andrographolide inhibits the activity of pro-inflammatory signaling cascades NF-κB, JAK/STAT and MAPK, reducing the expression of IL-1β, TNF-α, iNOS and COX-2. At the same time, the Nrf-2/HO-1 antioxidant system is activated, contributing to the reduction of oxidative stress. Direct suppression of GSK-3β activity has been shown, as well as an indirect effect on the expression of cell adhesion molecules and mediators of vascular permeability. The active compounds of the plant affect macrophages, epithelial cells and inflamed endothelium. Effects have been recorded in vitro and in vivo in a model of systemic inflammatory activation.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496992/
https://www.sciencedirect.com/science/article/abs/pii/S0944711323000586
https://pubmed.ncbi.nlm.nih.gov/28121206/

Synergy of Andrographis paniculata

Confirmed synergy of andrographolides with flavonoids (e.g., quercetin), glycosides and NSAIDs has been established. In vitro and in vivo studies have revealed potentiation of the anti-inflammatory effect when combined with substances that suppress the production of cytokines and prostaglandins. The combination with compounds that activate Nrf-2 exhibits a modulating and protective effect in systemic and tissue inflammation. An additive antioxidant effect is observed in an oxidative stress model. Modulating synergy with combined use with natural immunotropes and bioflavonoids has also been described.

References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8846357/
https://pubmed.ncbi.nlm.nih.gov/32753481/
https://www.sciencedirect.com/science/article/abs/pii/S2225411021001781