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The Coronavirus disease which began in 2019 (COVID-19) was declared a global pandemic. It can increase inflammatory cytokines leading to organ failure. Efforts are being made to find drugs to treat or alleviate the severity. Andrographis paniculata (AP) is an herbal remedy for the respiratory system (cool tonic) in Thai traditional medicine theory. AP extracts have been reported to show potent inhibitory effects against SARS-CoV-2. The study aimed to investigate inflammatory cytokine changes and metabolomics profiling after high-dose AP extract had been given to patients with mild cases of COVID-19. Five patients received a high dose of AP extract (andrographolide 180 mg/day) for five consecutive days. The results showed that inflammatory cytokines related to COVID-19 infection tended to decrease. The metabolite profile showed a decrease of inflammatory metabolites and nucleotides. Moreover, the severity of the clinical symptoms was decreased within three days, especially cough. Side effects were not found by comparing the blood chemical analysis to pre-treatment controls. Therefore, a high dose of AP could be safely used in mild case COVID-19 patients. However, the absence of a placebo control meant that levels of pro-inflammatory cytokines and metabolite biomarkers related to clinical symptoms could not be determined. Therefore, further studies with comparative groups are needed and the number of patients studied should be increased.
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