Drug & supplement interaction

Andrographis + Treprostinil

Moderate Interaction
The bottom line Moderate

Treprostinil falls into 2 drug categories that Andrographis can interact with; the most serious is rated moderate. Theoretically, andrographis might increase the risk of hypotension when used with antihypertensive drugs.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Andrographis and Treprostinil

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Andrographis interacts with whole categories of medication. Treprostinil falls into 2 of those categories, so it can interact with Andrographis in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

ANTIHYPERTENSIVE DRUGS

1 of 2

Why this applies to Treprostinil

Treprostinil falls under ANTIHYPERTENSIVE DRUGS — the group Andrographis interacts with.

Theoretically, andrographis might increase the risk of hypotension when used with antihypertensive drugs.
Animal research suggests that andrographis has hypotensive effects.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: Treprostinil (Orenitram) is a medicine that widens blood vessels to treat pulmonary arterial hypertension, and one of its known effects is lowering blood pressure. Andrographis, based on animal studies, may also nudge blood pressure down. So putting the two together could add up and drop your blood pressure more than expected.

If that happened, you might feel lightheaded, dizzy, flushed, or have a pounding heart, especially when standing up quickly. I want to be honest, though: this concern comes only from lab and animal research, not human studies, so it's more of a theoretical caution than a proven problem. Don't change anything on your own. Just check with your pharmacist or doctor before adding andrographis.

References
  1. Zhang CY, Tan BK. Mechanisms of cardiovascular activity of Andrographis paniculata in the anaesthetized rat. J Ethnopharmacol 1997;56:97-101. PubMed
  2. Zhang C, Kuroyangi M, Tan BK. Cardiovascular activity of 14-deoxy-11,12-didehydroandrographolide in the anaesthetised rat and isolated right atria. Pharmacol Res 1998;38:413-7. PubMed
Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

2 of 2

Treprostinil also falls under ANTICOAGULANT/ANTIPLATELET DRUGS.

Theoretically, andrographis might increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.
Animal and laboratory studies suggest that andrographis has antiplatelet effects.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing about Treprostinil (Orenitram): besides relaxing your blood vessels to help with pulmonary hypertension, it also makes your platelets a little less sticky. In other words, it can slightly nudge you toward easier bleeding on its own. Andrographis appears to do something similar, slowing platelets down, so stacking the two together could add up and raise your bleeding risk a bit.

I want to be honest about the evidence here. The bleeding concern with andrographis comes only from lab and animal studies, not real patient data, so this is more of a theoretical caution than a proven problem. Still, watch for things like easy bruising, nosebleeds, or bleeding gums, and check with your pharmacist or doctor before adding andrographis.

References
  1. Zhao HY, Fang WY. Antithrombotic effects of Andrographis paniculata nees in preventing myocardial infarction. Chin Med J (Engl) 1991;104:770-5.
  2. Amroyan E, Gabrielian E, Panossian A, et al. Inhibitory effect of andrographolide from Andrographis paniculata on PAF-induced platelet aggregation. Phytomedicine 1999;6:27-31. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Andrographis Also Interacts With Other Medications

Andrographis has 407 moderate, 5 minor known drug interactions in our database — the Treprostinil one above is among them. If you take anything else, check it against the full list below.

Taking anything else?

Check Another of Your Medications Against Andrographis

Covers the 2,830 medications we’ve checked against Andrographis. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Treprostinil

This page covers Andrographis only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Treprostinil page lists 291 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), American Mistletoe (major), Danshen (major) and Piracetam (major).

By severity: 6 major · 258 moderate · 27 minor.

Open the Treprostinil interaction page

One more smart check

Taking Andrographis as Part of a Dietary Supplement Product? Check It for Interactions

We hold 656 real supplement products containing Andrographis, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Andrographis. Your product may carry other ingredients that interact with Treprostinil too, on top of Andrographis — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Andrographis and Treprostinil Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Andrographis
Top 25%

#159 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Treprostinil
Steady interest

#2,555 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Andrographis

What is Andrographis?

Andrographis
  • Common cold and flu symptoms
  • Upper respiratory infections
  • Sore throat
  • Fever
  • Immune support
  • Digestive complaints

Andrographis is a bitter Asian herb traditionally used for colds, flu, and infections, and some studies suggest it may ease cold symptoms and shorten how long they last. The evidence is limited and the quality of studies varies, so it should not replace standard care. Talk to your pharmacist or doctor before using it, and avoid it during pregnancy.

Read the full Andrographis monograph & all interactions
Medication

About Treprostinil

What Is Treprostinil Used For?

Treprostinil treats pulmonary arterial hypertension (PAH; WHO Group 1) — high blood pressure in the arteries of the lungs. Depending on the product and route, it is used to improve exercise ability, delay disease progression, or reduce symptoms tied to physical activity. Remodulin and treprostinil injection products are also indicated for patients who need to transition away from another PAH medicine called epoprostenol.

Tyvaso, Tyvaso DPI, and Yutrepia (inhaled forms) are additionally approved to treat pulmonary hypertension associated with interstitial lung disease (PH-ILD; WHO Group 3) — lung-pressure problems caused by scarring or inflammation in the lung tissue itself. Orenitram (extended-release oral tablet) is specifically indicated to delay disease progression and improve exercise capacity in PAH.

See full Treprostinil drug information
Keep checking

Other Drugs & Andrographis

Browse every other medication we’ve checked against Andrographis — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
407Moderate
5Minor
2,417No known interaction
Moderate

407 interactions

Showing 60 of 407 moderate interactions — see all 407 on the Andrographis page.

Minor

5 interactions

No interaction 2,417 drugs checked — show the list
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

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Pharmacist Counseling Corner

Taking Andrographis and Treprostinil Together: Common Questions

Can you take Andrographis with Treprostinil?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Andrographis and Treprostinil?
Treprostinil belongs to more than one drug category, and Andrographis interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Andrographis and Treprostinil interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.