Usage
Kalmegh dry extract, derived from the Andrographis paniculata plant, is traditionally used for its immunostimulant and antipyretic properties. It is prescribed for various conditions, including common cold, influenza, viral fevers (including dengue and chikungunya), and upper respiratory tract infections. It’s also used for osteoarthritis, and tonsilitis. It is classified as an antiviral, anti-inflammatory, immunostimulant, and hepatoprotective herbal medicine. It boosts the immune system and prevents viruses from attaching to cells, while reducing inflammation and offering liver protection.
Alternate Names
Kalmegh is also known as Green Chireta, King of bitters, Creat, Chuan Xin Lian, and Andrographis paniculata. Some brand names under which it is marketed include ParActin.
How It Works
Pharmacodynamics: Kalmegh exerts its therapeutic effects through multiple mechanisms. Its main active component, andrographolide, has anti-inflammatory effects by inhibiting iNOS and COX-2 expression. Andrographolide also exhibits antiviral activity by inhibiting viral replication and stimulating antibody production. Kalmegh extract is hepatoprotective, reducing liver damage from toxins and free radicals, due to its antioxidant and anti-inflammatory properties. It may also have hypolipidemic effects.
Pharmacokinetics: Limited data is available regarding the pharmacokinetics of Kalmegh dry extract. Andrographolide is absorbed orally and metabolized in the liver. Elimination pathways are not well-documented, but may involve hepatic and renal excretion.
Mode of Action: Andrographolide, the primary active constituent, inhibits viral attachment to cells, reduces inflammation, and promotes antioxidant effects.
Dosage
Dosage information for Kalmegh dry extract is mostly based on traditional use and varies depending on the form and condition being treated. As such, the information below is valid as of today and might change.
Standard Dosage
Adults:
- Capsules/Tablets: 1-3 grams of dried Kalmegh root per day, divided into multiple doses, or 1-2 capsules of standardized extract (500-1000mg andrographolides) twice daily.
Children:
- Limited studies on children. Traditional use suggests 1/2 – 1 gram of dried Kalmegh roots per day in tea or capsule form. Consider 250-500mg andrographolides twice daily in capsule form. Pediatric use should be under the guidance of a healthcare professional.
Special Cases:
- Elderly Patients: Start with a lower dose and adjust based on tolerance and clinical response.
- Patients with Renal Impairment: Dose adjustments may be necessary. Consult a nephrologist.
- Patients with Hepatic Dysfunction: Use cautiously and monitor liver function.
- Patients with Comorbid Conditions: Consider individual patient factors and potential drug interactions.
Clinical Use Cases
The dosage of Kalmegh for specific clinical situations has not yet been specifically researched or standardized.
Dosage Adjustments
Adjustments should be made based on patient-specific factors like renal/hepatic impairment, other medical conditions, or concurrent medications.
Side Effects
Common Side Effects
- Digestive issues (nausea, vomiting, diarrhea)
- Headache
- Fatigue
- Rash, pruritus
- Altered taste (bitter/metallic)
- Runny nose
Rare but Serious Side Effects
- Allergic reactions (including anaphylaxis)
- Lymphadenopathy
- Elevated liver enzymes
Long-Term Effects
Chronic complications from prolonged use are largely unknown.
Adverse Drug Reactions (ADR)
Significant ADRs require immediate medical attention and discontinuation of the drug.
Contraindications
- Pregnancy (risk of miscarriage)
- Breastfeeding (safety unknown)
- Hypersensitivity to Kalmegh or its components
- Autoimmune diseases (may exacerbate symptoms)
- Bleeding disorders (may increase bleeding risk)
- Hypotension
- Active peptic ulcer disease
Drug Interactions
- Antihypertensives: May potentiate their effects, leading to hypotension.
- Immunosuppressants: May counteract their effects.
- Anticoagulants/Antiplatelets: May increase bleeding risk.
- Antidiabetic medications: May enhance hypoglycemic effects.
- Isoniazid: May have a synergistic effect.
Pregnancy and Breastfeeding
Kalmegh is contraindicated in pregnancy due to a risk of miscarriage. Safety during breastfeeding is unknown; therefore, it should be avoided.
Drug Profile Summary
- Mechanism of Action: Antiviral, anti-inflammatory, immunostimulant, hepatoprotective.
- Side Effects: Digestive issues, headache, fatigue, rash, altered taste, runny nose. Rarely, allergic reactions, lymphadenopathy, elevated liver enzymes.
- Contraindications: Pregnancy, breastfeeding, hypersensitivity, autoimmune diseases, bleeding disorders, hypotension, active peptic ulcer disease.
- Drug Interactions: Antihypertensives, immunosuppressants, anticoagulants/antiplatelets, antidiabetic medications, isoniazid.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy and breastfeeding.
- Dosage: Adults: 1-3g dried root/day or standardized extract 500-1000 mg twice daily. Pediatric dosing is not well-established.
- Monitoring Parameters: Monitor for adverse effects, particularly liver function and blood pressure.
Popular Combinations
Limited data is available on specific Kalmegh combinations. Traditional medicine combines it with other herbs for synergistic benefits.
Precautions
- Evaluate for allergies and contraindications before use.
- Monitor liver function and blood pressure.
- Caution in patients with renal impairment.
- Advise against concurrent use with contraindicated medications.
- Avoid alcohol during treatment.
- Discontinue use two weeks prior to surgery.
FAQs (Frequently Asked Questions)
A: The standard dosage for adults is 1-3 grams of dried root per day or 500-1000 mg of standardized extract twice daily. Pediatric and special population dosing needs individualized consideration.
Q2: What are the primary uses of Kalmegh?
A: It’s mainly used for viral infections (common cold, flu, dengue, chikungunya), upper respiratory tract infections and as a liver protectant.
Q3: How does Kalmegh work against viral infections?
A: It boosts the immune system and may inhibit viral replication. It also prevents viral attachment to cells.
Q4: Is Kalmegh safe for pregnant women?
A: No, it is contraindicated during pregnancy due to the risk of miscarriage.
Q5: What are the common side effects of Kalmegh?
A: Common side effects include digestive issues, headache, fatigue, rash, and altered taste.
Q6: Does Kalmegh interact with other medications?
A: Yes, it can interact with antihypertensives, immunosuppressants, anticoagulants, and antidiabetic medications. Always check for potential interactions before prescribing.
Q7: Can Kalmegh be used in children?
A: Limited data is available for pediatric use. Traditional practices suggest smaller doses but always consult with a specialist.
Q8: Are there any long-term side effects associated with Kalmegh use?
A: Long-term effects are largely unknown, and more research is needed.
A: Store in a tightly sealed, light-resistant container in a cool, dry place.
Q10: What should I do if a patient experiences an allergic reaction to Kalmegh?
A: Discontinue the medication immediately and provide appropriate medical care for the allergic reaction, which may include antihistamines, corticosteroids, and epinephrine.
