Pelargonium sidoides DC · herb
Evidence tier: limited
A traditional South African respiratory herb with strong modern evidence for bronchitis and cold duration.
The root extract does not appear to kill respiratory viruses directly in any decisive way. The leading explanation is that its proanthocyanidins and coumarins make it harder for bacteria to stick to the lining of the airway, and that they nudge the local immune response, including interferon release, so the body clears the infection faster. This is laboratory reasoning, not a mechanism demonstrated to be operating in the people who took it in the trials.
Limited, and the reason is not the size of the trial base but who ran it. The 2013 Cochrane review of Pelargonium sidoides for acute respiratory tract infections (Timmer, CD006323) included 8 trials in roughly 1,668 people and did find benefit: for acute bronchitis in adults (3 trials, 746 patients) and in children (3 trials, 819 children), the standardised LIQUID root extract relieved symptoms, while the TABLET form did not. But Cochrane graded that evidence LOW quality, graded acute sinusitis and the common cold VERY LOW, and its stated reasons are the whole story: unvalidated outcome assessment, minor attrition problems, INVESTIGATOR INITIATED TRIALS ONLY, and suspected publication bias. In plain terms, essentially the entire evidence base was generated by parties connected to the product's manufacturer, and one review author had received sponsorship from Dr Willmar Schwabe GmbH, the maker of the preparation studied. Cochrane's own bottom line is hedged: Pelargonium sidoides MAY be effective in alleviating symptoms of acute rhinosinusitis and the common cold in adults, but doubt exists. Europe's regulator is more conservative than the seed implies: the EMA HMPC registers Pelargonium sidoides root as a TRADITIONAL herbal medicine, not well established use, for symptoms of the common cold in patients aged 6 and over, meaning the registration rests on long standing use rather than on clinical trial evidence. Safety is the other half. The EMA product information carries a hepatotoxicity warning: liver problems have been reported and the frequency is not known. This warning exists because the German drug regulator BfArM and Germany's Drug Commission collected case reports of hepatitis in users of Umckaloabo and concluded a causal relationship could not be ruled out. Later re evaluation by industry linked authors argued causality was never confirmed in any of the analysed cases, and the EMA has kept the warning on the label while asking that hepatotoxicity cases be closely monitored. There is NO NIH LiverTox chapter for Pelargonium sidoides, and an absent LiverTox chapter is not a safety clearance.
The trials Cochrane assessed used the standardised liquid root extract known as EPs 7630. The LIQUID preparation is the one that showed benefit; the TABLET form did not, which is an unusually specific finding and should not be blurred. EMA registers it as a traditional herbal medicine for adults and children over 6, with dosing per the registered product's leaflet. Courses in the trials were short, on the order of a week. The sources do not establish a supplement dose outside a registered medicinal product.
Tincture or syrup: 30 drops three times daily, or as label directs. Up to 7 to 14 days.
Generally well tolerated. Rare cases of hepatotoxicity reported, discontinue if jaundice.
Pregnancy: avoid
Breastfeeding: avoid
Active compounds: proanthocyanidins, coumarins (including umckalin), gallic acid derivatives
Remedies using Pelargonium · Browse by body system · Check it against what you take
*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.