Andrographis and medications.
Andrographis is in the Distil supplement database, evidence Grade B. The page below lists every medication we have explicitly assessed it against.
Andrographis is a herb standardised to andrographolides, taken at 200 to 400mg a day during illness or 100 to 200mg as prevention, and used mainly to shorten and soften upper respiratory infections through immune and anti-inflammatory effects. The Grade B evidence is fairly consistent for cold and respiratory symptoms, with reviews and trials showing it beats placebo for symptom relief, so it is one of the better-supported herbs in this space, though it is not a substitute for treating a serious infection. Several interaction points deserve real attention. It is immune-active but not simply stimulating: the whole herb is used to help fight off colds, while its main compound andrographolide is anti-inflammatory and has even been trialled in multiple sclerosis, an autoimmune disease. Because the net effect on a carefully managed immune system is uncertain, it is best avoided by anyone on immunosuppressant medication (including after a transplant), with HIV or AIDS (where it may also interact with antiretroviral medication), or with an autoimmune condition, and any use in those situations belongs with the treating specialist rather than being self-managed. There is animal evidence of an anti-fertility effect, so it is best avoided when trying to conceive and during pregnancy. It also has a mild, reversible antiplatelet effect that becomes a consideration for people on anticoagulants, stacking several blood-thinning compounds, or planning surgery, where pausing it a couple of weeks beforehand is the standard precaution. Very high doses have rarely raised liver enzymes. A solid short-term cold remedy, used in the right situation.
Below are the 7 documented pairs we have explicitly assessed for Andrographis: 7 amber. The pairs cluster around 3 mechanisms: Additive anticoagulation, Additive antiplatelet effect, and Immunosuppression caution. Every call is cited to either a clinical reference (PMID) or the British National Formulary. Anything not listed here is either still to be assessed or beyond our database scope. The checker beneath surfaces assessments by medication, and the missing-item form at the bottom of the page routes any uncatalogued medication into our next curation pass.
Documented interactions
Last reviewed 14 June 2026. Each interaction below lists the evidence its assessment drew on: some rest on studies of the exact pair, others on mechanism evidence, where a citation may support one part of the reasoning rather than the exact combination. The evidence line on each entry says which.
Additive anticoagulation
Amber Does interact with Acenocoumarol?
Andrographis may raise the effect of acenocoumarol, both by a mild blood-thinning action of its own and by slowing how the body clears the drug. The direct evidence is from animal studies with a similar anticoagulant rather than from people taking acenocoumarol. If you take acenocoumarol, tell your anticoagulation clinic before starting andrographis and ask for an INR check a couple of weeks in.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Apixaban?
Andrographis may slow how the body clears apixaban and could also have a mild blood-thinning action of its own, so in theory it might raise apixaban levels and bleeding risk. This has not been studied in people, so it is a cautious flag. If you take apixaban, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising or bleeding.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Warfarin sodium?
Andrographis may raise warfarin's effect, both by mild blood-thinning of its own and by slowing how the body clears warfarin. The direct warfarin evidence so far is from animal studies rather than people. If you take warfarin, tell your anticoagulation clinic before starting andrographis and ask for an INR check a couple of weeks in.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive antiplatelet effect
Amber Does interact with Aspirin?
Andrographis has a mild blood-thinning signal in laboratory studies, so in theory it could add to aspirin's effect on platelets and slightly raise bleeding risk. A small one-day study in healthy people found no clear change, so any real effect looks modest. If you take aspirin, it is worth telling your doctor or pharmacist before starting andrographis, and watch for easy bruising or unusual bleeding.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Clopidogrel?
Andrographis has a mild blood-thinning signal in laboratory studies, so in theory it could add to clopidogrel's effect on platelets and slightly raise bleeding risk. A small one-day study in healthy people found no clear change, so any real effect looks modest. If you take clopidogrel, tell your doctor or pharmacist before starting andrographis, and watch for easy bruising or unusual bleeding.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Immunosuppression caution
Amber Does interact with Ciclosporin?
Andrographis is taken to stimulate the immune system, which in theory works against a medicine like ciclosporin that is meant to calm it. There is also a separate concern that andrographis may slow how the body clears ciclosporin and push its blood levels up. The human evidence for both effects is thin, so for a narrow-window transplant medicine the safe route is to check with your transplant team before starting.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does interact with Tacrolimus?
Andrographis is taken to stimulate the immune system, which in theory works against a medicine like tacrolimus that is meant to calm it. There is also a separate concern that andrographis may slow how the body clears tacrolimus and push its blood levels up. The human evidence for both effects is thin, so for a narrow-window transplant medicine the safe route is to check with your transplant team before starting.
Evidence: Based on an established mechanism, with no direct study of this exact combination yet.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
What this list does not say. Pairs not flagged here are not implicitly safe. They are either not yet in our database, or fall outside our inclusion scope. Use the checker below to surface any medication, and submit a missing item if you take something we have not catalogued.
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How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
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The interaction check is one section of the full report. You also get the reasoning behind each recommendation and the evidence references used.
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