Written by Klara Rombauts, Arne Heyerick and the CAM-Cancer Consortium.
Updated January 29, 2015

Artemisia annua

Is it safe?

Toxicology

Artemisinin derived drugs are available for the treatment of malaria. Except for two case reports, no major side effects have been reported in humans at doses used for the treatment of malaria but it is still unknown whether the higher doses required for the treatment of cancer patients could cause major side effects. In vivo studies showed that doses of artemisinin-related endoperoxides of at least 5 times higher than those used for antimalaria therapy are required in order to induce an effect. The safety of such doses has not yet been evaluated in Phase I clinical trials.

A first case report describes a boy who received artesunate suppositories and died 13 days.25 He had received a dose 7-fold higher than the maximum recommended dose which reportedly led to toxicity of the brain stem.

In a second case report a woman with recently resected early breast carcinoma described symptoms of toxic brainstem encephalopathy.26 Since this neurotoxicity has also been seen in animals, the authors of the case report ascribe the toxicity to artemisinin consumption, although she received also chemotherapy and a mixture of other herbs on top.

On the other hand, a review of the toxicity of artemisinin derivatives suggested that the toxicity seen in laboratory animals does not necessarily occur in humans due to the differences in pharmacokinetic profile after different routes of administration. The oral administration used in humans is unlikely to cause the neurotoxicity seen after intramuscular administration in mice.27,28

Adverse events

It has been reported that the oral intake of A. annua may cause abdominal pain, bradycardia (abnormally slow heartbeat), diarrhoea, nausea, vomiting, decreased appetite, flu-like symptoms, fever, and decreased reticulocyte count.18

Topical application of A. annua may cause dermatitis.6

Interactions

Experimental studies showed additive or synergistic activities with antineoplastics, antibiotics, antifungals, sodium butyrate, and chloroquine, where it could become more effective in fever subsidence and disappearance of malarial symptoms.7

Citation

Klara Rombauts, Arne Heyerick, CAM-Cancer Consortium. Artemisia annua [online document]. http://www.cam-cancer.org/The-Summaries/Herbal-products/Artemisia-annua. January 29, 2015.

Document history

Assessed as up to date in January 2015 by Barbara Wider.
Summary assessed as up to date in August 2013 by Barbara Wider.

Summary fully revised and updated in August 2012 by Klara Rombauts.

Summary first published in March 2011, authored by Klara Rombauts and Arne Heyerick.

References

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  5. Weathers PJ, Towler MJ. The flavonoids casticin and artemetin are poorly extracted and are unstable in an Artemisia annua tea infusion. Planta Med 2012;78(10):1024-6.26. McGovern PE, Christofidou-Solomidou M, Wang W, Dukes F, Davidson T and El-Deiry WS. Anticancer activity of botanical compounds in ancient fermented beverages (review). Int J Oncol 2010;37:5-14.
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