Note: This monograph does not include information on wormwood (absinthe, Artemisia absinthium) or mugwort (Artemisia vulgaris).
Background
Sweet annie (Artemisia annua) is also known as Chinese wormwood or sweet wormwood. Although it is in the same genus as both wormwood (absinthe, Artemisia absinthium) and mugwort (Artemisia vulgaris), each of these herbs has different uses and should not be confused.
For more than 1,500 years, sweet annie tea was used in traditional Chinese medicine (TCM) to treat fevers, although the herb fell out of favor for a few centuries. In 1970, a TCM handbook from the 5th Century was discovered and stimulated interest in sweet annie. Although originally used to treat fevers, sweet annie was not used specifically for malaria.
Sweet annie's main active constituent is artemisinin, which has shown rapid antimalarial activity in humans, especially when used as an adjuvant with standard antimalarial drugs. Considered a weed by some, the plant can be grown in many climates and a simple and effective preparation of Artemisia annua could be a much-needed inexpensive and convenient weapon against malaria. In addition to its promise in treating malaria, preliminary evidence indicates that sweet annie may have potential as an anticancer agent and an antiviral.
Evidence
DISCLAIMER:
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Cancer:
Certain constituents found in sweet annie show promise when used in combination with standard chemotherapy. However, currently there is not enough scientific evidence in humans to make a strong recommendation for this use.
Grade: C
Malaria:
Malaria is a serious health concern in many poorer parts of the world where modern antimalarial drugs may not be available. Although there has been some interest in using sweet annie as an antimalarial, there is currently not enough human evidence to make a strong recommendation.
Grade: C
Tradition
WARNING:
DISCLAIMER:
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below. Antibacterial, antioxidant, antiparasitic, antiviral, fever, immunosuppression, leukemia, melanoma, neonatal jaundice
Dosing
Adults (over 18 years old)
There is no proven safe or effective dose for sweet annie in adults.
Children (under 18 years old)
There is no proven safe or effective dose for sweet annie in children.
Safety
DISCLAIMER:
Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Allergies
Avoid in individuals with a known allergy or hypersensitivity to sweet annie or members of the Asteraceae/Compositae family such as dandelion, goldenrod, ragweed, sunflower, and daisy.
Side Effects and Warnings
Certain constituents in sweet annie (artemisinin and artesunate) have been well-tolerated when taken by mouth with no reported adverse effects. However, there is a lack of available information on the safety of sweet annie and caution is advised.
Use cautiously in patients with compromised heart or brain function, as a related species has shown potential toxicity.
Use cautiously in patients who are pregnant or recovering from surgery or other wounds.
Use cautiously in patients with compromised immune function, as sweet annie may have immunosuppressive activity.
Sweet annie is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence. Sweet annie may inhibit angiogenesis, which is the development of new blood vessels.
Interactions
Interactions with Drugs
Sweet annie may inhibit angiogenesis, which is the development of new blood vessels. Caution is advised in patients taking agents that affect angiogenesis.
Although not well studied in humans, sweet annie may also inhibit bacterial and fungal growth. Thus, patients taking antibiotics and antifungals should be aware that additive effects might occur.
Artesunate, a constituent found in sweet annie, may be incompatible with quinolines, which are used as food preservatives and in making antiseptics. These should not be confused with quinolones, which are a family of broad-spectrum antibiotics.
Sweet annie has been studied for its antimalarial and anticancer effects and use with other antimalarial or anticancer agents may have additive effects.
Sweet annie may have antioxidant and immunosuppressive activity. Consult with a qualified healthcare professional, including a pharmacist, to check for possible interactions.
Sweet annie may inhibit angiogenesis, which is the development of new blood vessels. Caution is advised in patients taking herbs or supplements that affect angiogenesis.
Although not well studied in humans, sweet annie may also inhibit bacterial and fungal growth. Thus, patients taking antibiotics and antifungals should be aware that additive effects might occur.
Sweet annie has been studied for its antimalarial and anticancer effects and use with other antimalarial or anticancer herbs or supplements may have additive effects.
Sweet annie may have antioxidant and immunosuppressive activity. Consult with a qualified healthcare professional, including a pharmacist, to check for possible interactions with herbs or supplements with these effects.
Attribution
This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Dawn Costa, BA, BS (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Julie Goodfriend, PharmD (Northeastern University); Jamie Hegarty, PharmD (Massachusetts College of Pharmacy); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).
Bibliography
DISCLAIMER:
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Berger TG, Dieckmann D, Efferth T, et al. Artesunate in the treatment of metastatic uveal melanoma--first experiences. Oncol Rep. 2005;14(6):1599-1603.
Bertea CM, Freije JR, van der Woude H, et al. Identification of intermediates and enzymes involved in the early steps of artemisinin biosynthesis in Artemisia annua. Planta Med 2005;71(1):40-47.
Chen HH, Zhou HJ, Wu GD, et al. Inhibitory effects of artesunate on angiogenesis and on expressions of vascular endothelial growth factor and VEGF receptor KDR/flk-1. Pharmacology 2004;71(1):1-9.
Efferth T. Molecular pharmacology and pharmacogenomics of artemisinin and its derivatives in cancer cells. Curr Drug Targets. 2006;7(4):407-421.
Haynes RK. From artemisinin to new artemisinin antimalarials: biosynthesis, extraction, old and new derivatives, stereochemistry and medicinal chemistry requirements. Curr Top Med Chem 2006;6(5):509-537.
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Lommen WJ, Schenk E, Bouwmeester HJ, et al. Trichome dynamics and artemisinin accumulation during development and senescence of Artemisia annua leaves. Planta Med 2006;72(4):336-345.
Mueller MS, Runyambo N, Wagner I, et al. Randomized controlled trial of a traditional preparation of Artemisia annua L. (Annual Wormwood) in the treatment of malaria. Trans.R.Soc.Trop.Med Hyg. 2004;98(5):318-321.
Rath K, Taxis K, Walz G, et al. Pharmacokinetic study of artemisinin after oral intake of a traditional preparation of Artemisia annua L. (annual wormwood). Am J Trop.Med Hyg. 2004;70(2):128-132.
Romero MR, Serrano MA, Vallejo M, et al. Antiviral effect of artemisinin from Artemisia annua against a model member of the Flaviviridae family, the bovine viral diarrhoea virus (BVDV). Planta Med 2006;72(13):1169-1174.
Singh NP, Lai HC. Synergistic cytotoxicity of artemisinin and sodium butyrate on human cancer cells. Anticancer Res 2005;25(6B):4325-4331.
Van der Meersch H. [Review of the use of artemisinin and its derivatives in the treatment of malaria]. J Pharm Belg. 2005;60(1):23-29.
Wu GD, Zhou HJ, Wu XH. Apoptosis of human umbilical vein endothelial cells induced by artesunate. Vascul.Pharmacol. 2004;41(6):205-212.
Yance DR Jr., Sagar SM. Targeting angiogenesis with integrative cancer therapies. Integr.Cancer Ther. 2006;5(1):9-29.
Remember, keep this and all other medicines out of the reach of children,
never share your medicines with others, and use this medication only for the indication prescribed.
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