African Geranium

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Traditional Medicinal Uses, Side Effects, and Contraindications of African Geranium (Pelargonium sidoides)

African geranium (Pelargonium sidoides), a plant native to South Africa, has been integral to traditional medicine for centuries, particularly for respiratory and gastrointestinal ailments. Modern research confirms its efficacy in treating acute bronchitis and upper respiratory infections, with clinical trials demonstrating symptom relief and reduced recovery times. While generally safe, its use carries specific contraindications, including pregnancy and liver/kidney disorders, and potential side effects such as gastrointestinal discomfort and allergic reactions.

Traditional Medicinal Uses

Respiratory Health Applications

African geranium roots have been used traditionally to treat tuberculosis, bronchitis, and respiratory infections. Indigenous healers prepared decoctions to alleviate coughs, chest infections, and sinusitis^[1][2][3]. The plant’s introduction to Western medicine in the late 19th century followed its reported success in treating tuberculosis^[2][4]. Modern phytopharmaceuticals  derived from root extracts, are now widely used for acute bronchitis and common colds^[1][5].

Gastrointestinal and Antimicrobial Uses

Traditional applications extend to gastrointestinal disorders, including diarrhea, dysentery, and stomach ailments. Root extracts were administered orally to treat diarrhea in infants and livestock, while leaf preparations were used for gastritis and colic^[1][3][6]. The plant’s antimicrobial properties, though not directly bactericidal, interfere with microbial adhesion and enhance host immune responses, explaining its historical use against bacterial infections like Helicobacter pylori^[1][7].

Dermatological and Immune Support

Topical applications of African geranium extracts treated skin conditions such as acne and wounds, leveraging its anti-inflammatory and astringent properties^[1][3]. Additionally, it was used to strengthen immunity, with recent studies suggesting it modulates cytokine production and enhances antiviral defenses^[7][6].

Active Constituents and Mechanisms

Key Phytochemicals

The therapeutic effects of Pelargonium sidoides arise from compounds like coumarins, phenolic acids (e.g., gallic acid), and flavonoids (quercetin, luteolin)^[7][4]. These constituents inhibit bacterial adhesion to host cells, stimulate nitric oxide production, and reduce pro-inflammatory cytokines like IL-6 and TNF-α^[1][7]. Tannins contribute to its astringent properties, while umckalin (a unique coumarin) underpins its antiviral activity^[7][4].

Synergistic Effects

EPs® 7630, a standardized extract, demonstrates broad-spectrum effects by enhancing phagocytosis and interferon signaling, which explains its efficacy in reducing bronchitis symptom severity and duration^[8][5]. Computational studies suggest interactions with lactoferrin, potentiating anti-inflammatory and antiviral responses against pathogens like SARS-CoV-2^[7].

Side Effects and Adverse Reactions

Gastrointestinal Discomfort

Clinical trials report mild to moderate gastrointestinal side effects, including nausea (1.5%), vomiting (1.5%), and epigastric pain (0.9%)^[8][9][10]. These effects are dose-dependent and typically resolve without intervention^[8][10].

Allergic Reactions and Hepatotoxicity

Hypersensitivity reactions, including rash and urticaria, occur in 1–3% of users, particularly those allergic to plants in the Geraniaceae family^[9][5]. Elevated liver enzymes (AST/ALT) were observed in 1.2% of pediatric patients, though causality remains unclear^[8][10].

Drug Interactions

While no severe interactions are documented, concomitant use with anticoagulants or antiplatelet drugs warrants caution due to potential additive effects from coumarin derivatives^[9][11].

Contraindications

Pregnancy and Lactation

Pelargonium sidoides is contraindicated during pregnancy and breastfeeding due to insufficient safety data. Animal studies are lacking, and traditional preparations’ effects on uterine activity or fetal development remain unknown^[9][5][11].

Hepatic and Renal Impairment

Patients with severe liver or kidney diseases should avoid use, as metabolites may accumulate and exacerbate dysfunction^[9][5]. Elevated hepatic enzymes in clinical trials suggest cautious use in those with preexisting conditions^[8][10].

Pediatric Use

Safety in children under six years is unestablished, though trials in older children (6–18 years) report tolerability at reduced doses^[8][5].

Clinical Considerations and Safety Monitoring

Dosage and Administration

Standardized extracts (EPs® 7630) are administered as 30 drops (1.5 mL) thrice daily for 7–10 days^[9][5]. Tablets or syrups should adhere to manufacturer guidelines to minimize gastrointestinal adverse events^[8][10].

Preclinical Screening

Patients with allergies to geraniums or aspirin (due to salicylate content) require screening before use^[9][11]. Baseline liver function tests are advisable for long-term or high-dose regimens^[8][10].

Conclusion

African geranium (Pelargonium sidoides) offers significant therapeutic benefits for respiratory and gastrointestinal conditions, rooted in both traditional practice and clinical evidence. Its safety profile is favorable for most adults, with mild, self-limiting side effects. However, contraindications in pregnancy, hepatic/renal impairment, and young children necessitate cautious use. Further research is needed to elucidate long-term safety and interactions with conventional medications, ensuring its integration into evidence-based herbal

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1.       https://pmc.ncbi.nlm.nih.gov/articles/PMC7127097/     

2.       https://www.feelgoodhealth.co.za/blogs/feelgood-health-blog/umckaloabo-south-africas-amazing-medicinal-herb 

3.       https://www.gaiaherbs.com/blogs/seeds-of-knowledge/pelargonium-sidoides  

4.       https://afrigetics.com/pelargonium-sidoides-a-comprehensive-review-of-efficacy-safety-and-uses/  

5.       https://www.reliasmedia.com/articles/86330-extract-of-i-pelargonium-sidoides-i-for-treatment-of-acute-bronchitis-and-tonsillopharyngitis      

6.       https://gokaibae.com/blogs/blog/10-incredible-health-benefits-of-pelargonium-sidoides 

7.       https://pmc.ncbi.nlm.nih.gov/articles/PMC9101775/     

8.       https://pmc.ncbi.nlm.nih.gov/articles/PMC9971625/       

9.       https://www.drugs.com/npp/pelargonium.html      

10.    https://pmc.ncbi.nlm.nih.gov/articles/PMC6601435/     

11.    https://www.webmd.com/vitamins/ai/ingredientmono-1135/pelargonium-sidoides

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