Although sometimes investigated as a sole treatment, andrographis is also tested as part of a herbal combination known as Kan Jang. This is a standardised formula of Andrographis panlculata extract 85 mg, containing 5.25 mg andrographolide and deoxyandrographolide per tablet, and Eleutherococcus senticosus extract 9.7 mg, containing total eleutheroside B and eleutheroside E 2% (Melchior et al 2000). Although more representative of real-life practice, results obtained with Kan Jang make it difficult to assess the individual role of andrographis.
COMMON COLD — SYMPTOM RELIEF AND REDUCED INCIDENCE
In 2004, two different systematic reviews that investigated whether andrographis is a suitable treatment in acute respiratory infections were published (Coon & Ernst 2004, Poolsup et al 2004). The one conducted by Coon and Ernst from the Peninsula © 2007 Elsevier Australia
Medical School, Universities of Exeter and Plymouth, Exeter, UK was a review of seven double-blind, controlled trials (n = 896), from which the authors concluded that A. paniculata is more effective than placebo in treating uncomplicated URTI and is associated with relatively few adverse events. They also concluded that preliminary data suggested a protective effect. In five of the seven trials, the daily dose was equivalent to 60 mg of andrographolide, which was administered for 3-8 days.
The second systematic review conducted by Poolsup et al from the Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon-Pathom, Thailand, was a review of four randomised controlled trials (n = 433) and they came to a similar conclusion, finding that Andrographis paniculata either by itself or in combination with Eleutherococcus senticosus (Kan Jang) is effective for uncomplicated acute URTI. Symptoms responding According to double-blind studies, numerous symptoms respond to treatment with andrographis. According to two trials that used a dose of 340 mg andrographis taken three times daily, total symptom scores improved, with throat signs and symptoms responding most strongly (Melchior et al 2000). A third study observed a decrease in rhinitis, sinus pain and headache compared with placebo (Hancke et al 1995). A fourth study using a treatment dose of 1200 mg andrographis daily found a significant reduction in tiredness and sleepiness, as well as in sore throat and nasal secretions, by day 4 (Caceres et al 1999).
A double-blind placebo-controlled study (n = 185) that tested Kan Jang in the treatment of acute URTI and sinusitis showed it effectively reduced headache, nasal and throat symptoms and general malaise, but had no significant effects on cough and ocular symptoms. Additionally, fever was moderately reduced with active treatment (Gabrielian et al 2002).
Comparisons with Echinacea Although no direct head-to-head study could be located, one study was found that compared the effects of Kan Jang to a product known as Immunal (containing Echinacea purpurea (L.) extract) when both were used as adjuncts to standard treatment in children with the common cold. One hundred and thirty children were divided into three groups and received either of the combination treatments or solely standard treatment over a 10-day period (Spasov et al 2004). The addition of Kan Jang was shown to be significantly more effective than Immunal when started at an early stage and produced better symptomatic relief. The amounts of nasal secretion and congestion were particularly improved. In regards to altering recovery time, Kan Jang was also superior to Immunal and children required less standard medication than in the other two groups. Additionally, Kan Jang treatment was well tolerated and no side-effects or adverse reactions were reported. Andrographis 38
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