Pelargonium ( Pelargonium sidoides )

| Practice points|

Pelargonium appears to be useful for the treatment of respiratory tract infections, especially bronchitis, in adults and children.

| Key indications |

Acute bronchitis: Reduces symptoms of acute bronchitis (systematic review and meta-analysis).1,2 In adults Pelargonium extract (EPs® 7630) signifi cantly improves bronchitis symptom scores after 7 days, with improvements in coughing, pulmonary rales, sputum, chest pain while coughing and dyspnoea.3 In adults Pelargonium extract (EPs® 7630) signifi cantly improves bronchitis symptom scores after 7 days, with improvements in coughing, pulmonary rales, sputum, chest pain while coughing and dyspnoea.3

Paediatric bronchitis: Pelargonium extract (EPs® 7630) has been shown to signifi cantly reduce coughing, sputum and pulmonary rales in children and adolescents suffering from acute bronchitis within 7 days.4,5

Sinusitis: In adults with persistent symptoms (> 7days) of acute rhinosinusitis, presumably of bacterial origin, Pelargonium extract (EPs® 7630) improves recovery time and signifi cantly reduces nasal obstruction, purulent nasal secretion and discharge, maxillary pain and headache.6

Chronic Obstructive Pulmonary Disease (COPD): Pelargonium extract (EPs® 7630) prolongs the time to acute exacerbation in patients with COPD stage II/III (from 43 to 57 days). Patients may experience fewer exacerbations, less antibiotic use and improved quality of life.7

Children’s asthma: In children with mild asthma Pelargonium extract (EPs® 7630) reduces cough frequency and nasal congestion and may reduce the risk of having an asthma attack during a viral infection of the upper respiratory tract.8

| Key actions9 |AntibacterialAntiviralImmune modulating

| Recommended Doses |The majority of successful studies have been conducted on the proprietary extract EPs® 7630 (Kaloba®)Acute bronchitis: Adults EPs® 7630, 20 - 30 mgthree times daily3

Paediatric bronchitis: In children over 6 years the optimal dose of EPs® 7630 is 60 - 90 mg daily.5For example: EPs® 76304 2-6 years: 10 drops three times daily6-12 years: 20 drops three times daily 12-18 years: 30 drops three times daily Sinusitis: EPs® 7630, 60 drops three times daily.6COPD: EPs® 7630, 30 drops three times daily.7Children’s asthma: EPs® 7630, dose as perpaediatric bronchitis.8

| Adverse Effects |Mild adverse effects may include gastrointestinal complaints such as nausea, vomiting, diarrhoea or heartburn, or allergic skin reactions with pruritus and urticaria.1 There have been reports of hepatotoxicity resulting from the use of Pelargonium however causality has not been established and effects may have been due to confounding variables including comedication with synthetic drugs and major comorbidities.10

| Cautions/ Contraindications |Human studies confi rming safety in pregnancy/ lactation are lacking, but animal models have not demonstrated adverse effects.9Consider risk versus benefi t in patients with liver impairment.

| Possible Interactions |Immunosuppressant medications: may theoretically decrease effect

REFERENCES 1. Timmer A, Gunther J, Motschall E, et al. Pelargonium sidoides extract for treating acute respiratory tract infections. Cochrane database of systematic reviews 2013;10:CD006323. 2. Agbabiaka TB, Guo R, Ernst E. Pelargonium sidoides for acute bronchitis: a systematic review and meta-analysis. Phytomedicine : international journal of phytotherapy and phytopharmacology 2008;15(5):378-85. 3. Matthys H, Lizogub VG, Malek FA, et al. Effi cacy and tolerability of EPs 7630 tablets in patients with acute bronchitis: a randomised, double-blind, placebo-controlled dose-fi nding study with a herbal drug preparation from Pelargonium sidoides. Current medical research and opinion 2010;26(6):1413-22. 4. Kamin W, Ilyenko LI, Malek FA, et al. Treatment of acute bronchitis with EPs 7630: randomized, controlled trial in children and adolescents. Pediatrics international : offi cial journal of the Japan Pediatric Society 2012;54(2):219-26. 5. Kamin W, Maydannik VG, Malek FA, et al. Effi cacy and tolerability of EPs 7630 in patients (aged 6-18 years old) with acute bronchitis. Acta paediatrica (Oslo, Norway : 1992) 2010;99(4):537-43. 6. Bachert C, Schapowal A, Funk P, et al. Treatment of acute rhinosinusitis with the preparation from Pelargonium sidoides EPs 7630: a randomized, double-blind, placebo-controlled trial. Rhinology 2009;47(1):51-8. 7. Matthys H, Pliskevich DA, Bondarchuk OM, et al. Randomised, double-blind, placebo-controlled trial of EPs 7630 in adults with COPD. Respiratory medicine 2013;107(5):691-701. 8. Tahan F, Yaman M. Can the Pelargonium sidoides root extract EPs(R) 7630 prevent asthma attacks during viral infections of the upper respiratory tract in children? Phytomedicine : international journal of phytotherapy and phytopharmacology 2013;20(2):148-50. 9. Braun L, Cohen M. Pelargonium. Herbs & natural supplements: an evidence based guide.[Vol. 2]. 4th ed. Australia: Elsevier; 2015. p.733-7. 10. Teschke R, Frenzel C, Wolff A, et al. Initially purported hepatotoxicity by Pelargonium sidoides: the dilemma of pharmacovigilance and proposals for improvement. Annals of hepatology 2012;11(4):500-12.

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