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, and used to shorten and soften upper respiratory infections. The Grade B evidence is fairly consistent for cold and respiratory symptoms: a meta-analysis of 33 randomised trials in over 7,000 patients found less coughing and less sore throat than placebo and a shorter time to feeling better, and a separate meta-analysis of herbal cough remedies rated the evidence for it strong. Both note that the individual trials were of poor quality, so the direction is clearer than the size. That makes it one of the better-supported herbs in this space for an infection you already have, though it is not a substitute for treating a serious one. We do not recommend it for general immune resilience, and the reason is scope rather than weakness: every trial we cite enrolled people who were already ill and measured how quickly their symptoms settled. None of them tested whether a well person taking it falls ill less often. 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 effect on platelets in laboratory studies, which did not show up in a small study in healthy volunteers, and 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 19 documented pairs we have explicitly assessed for Andrographis: 6 red and 13 amber. The pairs cluster around 6 mechanisms: CYP-mediated metabolism, Additive anticoagulation, Additive antiplatelet effect, CYP3A4 inhibition, Immunosuppression caution, and P-glycoprotein inhibition (raises drug levels). 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 28 August 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.
CYP-mediated metabolism
Red Does Andrographis interact with Efavirenz?
Andrographis may shift efavirenz levels, and efavirenz has a narrow band where it works well without causing side effects, so we treat this as a do-not-combine pair outside your HIV team's supervision. The main route your body uses to clear efavirenz has been tested against andrographis in the laboratory and did not appear to be affected, but the backup route is one andrographis does slow, and efavirenz is given without the booster drug that would otherwise mask that. There is a second reason to be careful: rashes are common in the first weeks of efavirenz and are also among the commonest side effects of andrographis, so taking both makes it harder for your team to tell which one is causing a rash and whether it is the dangerous kind.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive anticoagulation
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis interact with Rivaroxaban?
Andrographis may raise rivaroxaban levels by slowing the gut enzymes and pumps that clear it, and it has a mild blood-thinning action of its own, so the concern is added bleeding risk. Studies of andrographis with rivaroxaban have not been done, so this is a judgement from mechanism rather than a measured effect. If you take rivaroxaban, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising, nosebleeds, or blood in your urine or stool.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Additive antiplatelet effect
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
CYP3A4 inhibition
Amber Does Andrographis interact with Ticagrelor?
Andrographis may raise ticagrelor levels by slowing the gut enzymes and pumps that clear it, and it also has a mild blood-thinning action of its own, so both routes point the same way: more bleeding risk. Grapefruit juice, which slows the same gut enzyme, more than doubled ticagrelor levels in healthy volunteers, which is why this route is taken seriously even though studies of andrographis with ticagrelor have not been done. If you take ticagrelor, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising, nosebleeds, or blood in your urine or stool.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Immunosuppression caution
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis interact with Everolimus?
Andrographis may shift everolimus blood levels, and because everolimus is dosed to a narrow target range even a modest shift matters: too little risks the graft or lets the cancer off, too much brings mouth ulcers, kidney and blood-count problems. The direction is genuinely unsettled, because laboratory work shows andrographis slowing the gut enzymes and pumps that control how much everolimus gets into you, while its effect on the immune system itself has run both ways in studies. Studies of andrographis with everolimus have not been done, so speak to the specialist who manages your everolimus before starting it and ask whether an extra level check is sensible.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis interact with Sirolimus?
Andrographis may shift sirolimus blood levels, and because sirolimus is dosed to a narrow target range even a modest shift matters: too little puts the graft at risk, too much brings kidney and blood-count problems. The direction is genuinely unsettled, because laboratory work shows andrographis slowing the gut enzymes and pumps that control how much sirolimus gets into you, while its effect on the immune system itself has run both ways in studies. Studies of andrographis with sirolimus have not been done, so speak to your transplant team before starting it and ask whether an extra level check is sensible.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis 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: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
P-glycoprotein inhibition (raises drug levels)
Amber Does Andrographis interact with Dabigatran etexilate?
Andrographis may raise dabigatran levels by slowing a gut pump called P-glycoprotein, and dabigatran leans on that pump more than the other blood thinners in its class, so the concern is added bleeding risk. Studies of andrographis with dabigatran have not been done, so this is a judgement from mechanism rather than a measured effect. If you take dabigatran, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising, nosebleeds, or blood in your urine or stool.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
Reviewer-flagged: awaiting clinical-reviewer sign-off.
Amber Does Andrographis interact with Edoxaban?
Andrographis may raise edoxaban levels by slowing a gut pump called P-glycoprotein that normally limits how much edoxaban gets into you, so the concern is added bleeding risk. Studies of andrographis with edoxaban have not been done, so this is a judgement from mechanism rather than a measured effect. If you take edoxaban, tell your doctor or pharmacist before starting andrographis and watch for unusual bruising, nosebleeds, or blood in your urine or stool.
Evidence: No direct study of this exact combination yet; the caution rests on a plausible mechanism or on reports involving a related medicine.
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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