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POSSIBLY EFFECTIVE

• Acute Bronchitis. Oral Pelargonium sidoides may be beneficial in adults and children with acute bronchitis when initiated within 48 hours of symptom onset. Details: Several clinical studies and a meta-analysis of 6 small-to-moderate sized clinical studies in adults and children with acute bronchitis show that taking Pelargonium sidoides extract daily, starting within 48 hours of symptom onset, significantly reduces symptoms such as cough intensity and rales after 7 days of treatment when compared with placebo. Additionally, patients report an earlier onset of effect and increased remission of cough when compared with placebo (14258,16647,16649,16651,81557,81565,94580,110015,112124). Another meta-analysis of 6 clinical trials in children aged 6-10 years with acute bronchitis or acute tonsillopharyngitis shows that taking a specific Pelargonium sidoides extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) 20 drops three times daily for 6 days reduces the amount of acetaminophen co-medication required to treat fever when compared with placebo (112126). However, most of the outcomes in these studies were patient-reported. Additionally, it is unclear whether any improvements are clinically significant. Various formulations of Pelargonium sidoides have been investigated. A specific liquid extract of Pelargonium sidoides containing the active ingredient EPs 7630 (Dr. Willmar Schwabe Pharmaceuticals) has been used in most studies (14258,16647,16649,16651,81557,81565,94580,110015,112124). In adults, this specific extract is administered as 30 drops of solution three times daily or in tablet form as 10-30 mg three times daily for 7 days (14258,16649,16651,81557,81565,94580). In children, this specific extract is administered as 10 drops three times daily in patients under 7 years of age or 20 drops three times daily for 7 days in those 7 years of age and older (16651,112124). In children aged 1-5 years of age, this specific extract is also available as a syrup dosed at 2.5 mL 3 times daily, which is equivalent to 10 drops of solution 3 times daily (112123). Some studies used extracts in tablet form; however, these tablet formulations have only been shown to be beneficial in adults, not in children (17417,94580).
• Chronic obstructive pulmonary disease (COPD). Oral Pelargonium sidoides extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) may decrease the frequency of exacerbations, improve symptoms, and reduce the need for antibiotics in patients with COPD; however, it does not seem to reduce the overall risk of exacerbations. Details: One clinical study in patients with moderate to severe COPD shows that taking Pelargonium sidoides (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) 1.5 mL three times daily in addition to standard treatment for 24 weeks lengthens the average time to COPD exacerbation by 14 days when compared with placebo (97319). The addition of Pelargonium sidoides to standard therapy is also associated with a reduction in total COPD symptoms, antibiotic use, and missed workdays (97319,97325). However, Pelargonium sidoides does not seem to decrease the overall number of COPD exacerbations (97325).
• Common cold. Oral Pelargonium sidoides extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) may reduce the severity and duration of cold symptoms and improve sleep quality in adults with the common cold. Details: Some clinical research in adults with the common cold shows that taking Pelargonium sidoides extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) 1.5 mL three times daily reduces symptoms of the common cold and increases the rate of complete resolution after 10 days of treatment, but not after 5 days of treatment, when compared with placebo (81569,94580). The same product taken at a higher dose of 3 mL three times daily reduces cold symptoms by an additional 10% and has a higher rate of complete resolution after 5 days of treatment. However, this dose is associated with a higher rate of mild to moderate adverse effects (97318). Additionally, a small uncontrolled study shows that this extract is equally effective for reducing common cold symptoms in patients testing positive for human coronavirus infection (not including COVID-19) when compared with other viruses (106648). Meta-analyses have evaluated the effects of this specific extract in adults with the common cold. One meta-analysis of 5 studies, some unpublished, using Pelargonium sidoides (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals)extract 1.5-3 mL three times daily, or tablets 20-40 mg three times daily, for 10 days shows that the mean reduction in a subjective, 40-point, total cold intensity score is 2.3 points at 5 days and 1.2 points at 10 days. Although it is unclear if these decreases are clinically significant, the extract was associated with fewer lost work days, lower acetaminophen consumption, and improved sleep quality when compared with placebo (103604). A separate meta-analysis of five small-to-moderate size studies, some of which were included in the previous meta-analysis, shows that taking Pelargonium sidoides (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) in the same formulations and doses reduces cough intensity and increases remission of cough at day 5 when compared with placebo (110015). However, all outcomes in this meta-analysis were patient-reported. Lastly, a network meta-analysis comparing 18 herbal medicines often used for the common cold suggests that Pelargonium sidoides is the most beneficial of those studied for the relief of symptoms associated with the common cold (112122). However, it is unclear whether any improvements in cold symptoms are clinically significant.

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Asthma. It is unclear if oral Pelargonium sidoides extract is beneficial in children with asthma who have an active viral upper respiratory tract infection. Details: One small clinical study in children with mild asthma and an active viral upper respiratory tract infection shows that taking 5-10 drops of a specific extract of Pelargonium sidoides (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) three times daily for 5 days reduces the number of children experiencing asthma attacks by 28% when compared with no treatment. It also reduces the number of children experiencing nasal symptoms by 34% and cough by 31% when compared with no treatment (94577).
• Genital herpes. Although there has been interest in using oral Pelargonium sidoides for genital herpes, there is insufficient reliable information about the clinical effects of Pelargonium sidoides for this purpose.
• Herpes labialis (cold sores). Although there has been interest in using oral Pelargonium sidoides for herpes labialis, there is insufficient reliable information about the clinical effects of Pelargonium sidoides for this purpose.
• Rhinosinusitis. Small clinical studies suggest that oral Pelargonium sidoides root extract may improve symptoms in adults with rhinosinusitis. Details: One small clinical study in adults with rhinosinusitis of unclear etiology shows that taking Pelargonium sidoides root extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) 60 drops three times daily for 21 days reduces symptoms of rhinosinusitis and increases the chance of complete resolution after treatment by 57% when compared with placebo (94580). Additionally, a small open-label study in adults with acute bacterial rhinosinusitus shows that taking this same product in tablet form as 60 mg daily for 10 days reduces the total symptom score, as well as subjective measures of nasal obstruction, facial pain and pressure, impaired sense of smell, mucosal edema, and mucopurulent secretions, when compared with taking amoxicillin 1500 mg daily for 10 days (103605). Additionally, a network meta-analysis comparing 18 herbal medicines often used for acute post-viral rhinosinusitis suggests that Pelargonium sidoides is the most beneficial after cineole for the relief of symptoms (112122).
• Tonsillopharyngitis. It is unclear if oral Pelargonium sidoides extract is beneficial in children with tonsillopharyngitis. Details: A small clinical study in children aged 6-10 years with acute tonsillopharyngitis shows that taking a specific Pelargonium sidoides extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) 20 drops three times daily for 7 days reduces symptoms such as sore throat and difficulty swallowing after 4 days of treatment when compared with placebo (14262). A meta-analysis of 6 clinical trials in children aged 6-10 years old with acute tonsillopharyngitis or acute bronchitis, including the study mentioned above, shows that taking a specific Pelargonium sidoides extract (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) 60-240 drops daily for 6 days reduces the amount of acetaminophen co-medication required to treat fever when compared with placebo (112126).
• Upper respiratory tract infection (URTI). A small clinical study suggests that oral Pelargonium sidoides root extract may improve symptoms in children with URTIs. Details: One clinical trial in children with uncomplicated URTIs shows that taking a specific Pelargonium sidoides root extract (Pelumm) three times daily for 7 days reduces total symptom scores when compared with placebo, with cough frequency and sneezing improving significantly within 3 days of treatment. The extract dose was based on patient age, with children 1-5 years of age taking 10 drops three times daily, children 5-12 years of age taking 20 drops three times daily, and children 13 years of age taking 30 drops three times daily (106646). More evidence is needed to rate Pelargonium sidoides for these uses.

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LIKELY SAFE ...when used orally or appropriately, short-term. A specific extract of Pelargonium sidoides (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals), in doses of 4.5-9 mL daily when administered as a solution or 90 mg daily when administered as a tablet, has been safely used for up to 24 weeks (14258,16641,16647,16649,16651,17417,81557,81565,94580,97318)(97319,106647). There is insufficient reliable information available about the safety of Pelargonium sidoides when used orally, long-term.

CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term. A specific extract of Pelargonium sidoides (EPs 7630, Dr. Willmar Schwabe Pharmaceuticals) in doses of 3 mL daily has been used with apparent safety in children aged 6-10 years for up to 7 days (14262,16641,16651,17417,94580).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Minor Be watchful with this combination. Severity = Moderate •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, Pelargonium sidoides might increase the risk of bleeding when taken with anticoagulant and antiplatelet drugs.  Details Pelargonium sidoides contains coumarin, which may reduce platelet aggregation (14259). However, in animal models, Pelargonium sidoides extract does not appear to inhibit coagulation or interact with warfarin (16648). This interaction has not been documented in humans.

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, Pelargonium sidoides might decrease the effectiveness of immunosuppressant therapy.  Details In vitro research suggests that Pelargonium sidoides has immunostimulant effects (14258,14259,16646,16650,16652).

(Read more about PELARGONIUM SIDOIDES)

General ...Orally, Pelargonium sidoides is generally well tolerated.
Most Common Adverse Effects:
Orally: Allergic skin rash, diarrhea, gastrointestinal upset.

Cardiovascular ...Orally, Pelargonium sidoides has been reported to cause small increases in body temperature and pulse during clinical trials (16649,17417).

Dermatologic ...Orally, Pelargonium sidoides has been associated with allergic skin rash (14262,81557).

Gastrointestinal ...Orally, Pelargonium sidoides has been associated with gastrointestinal upset and diarrhea (14262,81557,97318,97319,106647,112123).

Hematologic ...Orally, Pelargonium sidoides has been associated with epistaxis in one clinical trial (97318).

Hepatic ...Orally, Pelargonium sidoides does not appear to cause hepatotoxicity. Evaluations of hepatotoxicity cases in patients taking Pelargonium sidoides show it was only possibly associated in 4 of the 28 reported cases. In the remaining 24 cases, Pelargonium sidoides was unlikely to be the cause of hepatotoxicity, or was excluded as the cause. Other causes of hepatotoxicity in these cases included infectious disease, pre-existing liver disease, acute pancreatitis, and hepatotoxicity due to conventional medication use (94578,94579).

Immunologic ...Orally, Pelargonium sidoides has been associated with over 34 reports of allergic reactions (81567). Urticaria is the most common reaction but there were also cases of conjunctivitis, rhinitis, and systemic allergic reactions including bronchospasm, dyspnea, tachycardia, and circulatory failure (16651,81567).

(Read more about PELARGONIUM SIDOIDES)