A comprehensive review on disposition kinetics and dosage of oral administration of Andrographis paniculata, an alternative herbal medicine, in co-treatment of coronavirus disease

Abstract

Coronavirus disease 2019 (COVID-19) is a present global health crisis that is driving the investigation of alternative phytomedicines for antiviral purposes. The evidence suggests that Andrographis paniculata crude or extract is a promising candidate for treating symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review aims to consolidate the available reports on the disposition kinetics of andrographolide, a main active component of A. paniculata. The second objective of this review is to summarize the available reports on an appropriate oral dosage for the use of andrographolide in upper respiratory tract infections (URTIs) and other viral infectious diseases. The data were collected from the literature on absorption, distribution, biotransformation, and excretion of andrographolide, and information was also obtained from scientific databases about the use of A. paniculata. The finding of this review on pharmacokinetics indicates that andrographolide is slightly absorbed into the blood circulation and exhibits poor oral bioavailability, whereas its distribution process is unrestricted. In the termination phase, andrographolide preferentially undergoes biotransformation partly through phase I hydroxylation and phase II conjugation, and it is then eliminated via the renal excretion and hepatobiliary system. The key summary of the recommended dosage for andrographolide in uncomplicated URTI treatment is 30 mg/day for children and 60 mg/day for adults. The dose for adult patients with pharyngotonsillitis could be increased to 180 mg/day, but not exceed 360 mg/day. Co-treatment with A. paniculata in concert with the standard supportive care for influenza reduced the severity of symptoms, shortened treatment duration, and decreased the risk of developing post-influenza complications. The recommended starting dose for use in patients with mild COVID-19 is 180 mg/day of andrographolide, based on the dose used in patients experiencing a URTI with inflammation. This review is not only applicable for evaluating the appropriate doses of andrographolide for antiviral treatments but also encourages future research evaluating the effectiveness of these recommended dosages during the COVID-19 pandemic.

Synergistic inhibition effects of andrographolide and baicalin on coronavirus mechanisms by downregulation of ACE2 protein level

“…With new variants of coronavirus still possible, it is essential to prevent its spread, and there are currently no effective antiviral drugs targeting SARS-CoV 1 . This global health crisis has led people to explore the use of TCM as antiviral treatment 28 .…”

Antidiabetic effects of Andrographis paniculata supplementation on biochemical parameters, inflammatory responses, and oxidative stress in canine diabetes

“…Although oral A. paniculata tablets were absorbed via the GI tract in dogs, the information about the pharmacokinetics involved is currently lacking ( Xu et al, 2015 ). Furthermore, variations in bioavailability across studies beyond species variations may be related to the use of various forms of A. paniculata ( Loureiro Damasceno et al, 2022 ; Songvut et al, 2022 ). Andrographolide metabolism and clearance variations have been observed among species ( Panossian et al, 2000 ; Zhao et al, 2013 ).…”

“…First, the doses and treatment period of A. paniculata supplementation were insufficient. Secondly, the pharmacokinetic variations among species and dosage forms of A. paniculata may impact the plasma concentrations of andrographolide, leading to variations in the pharmacological response ( Zhao et al, 2013 ; Loureiro Damasceno et al, 2022 ; Songvut et al, 2022 ). Lastly, the biomarkers we used were not sensitive enough to identify the changes in the etiology and complications of DM.…”

Effect ofAndrographis paniculatatreatment for patients with early-stage COVID-19 on the prevention of pneumonia: A retrospective cohort study

“…Second, its anti-inflammatory effects are related to the reduced expression of interleukin-6 and tumour necrosis factor-alpha (Zhu et al, 2021) which cause tissue damage. Third, it systemically distributes to various organs, including the lungs (Songvut et al, 2022). It was found that C-reactive protein, an inflammatory biomarker that is stimulated by interleukin-6, is related to the severity of COVID-19 (Mueller et al, 2020).…”