Preprint / Version 1

COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

Authors

  • Dâmaris Silveira Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
  • Michal Tomczyk Faculty of Pharmacy, Medical University of Bialystok, Bialystok, Poland
  • Edson Pereira Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
  • Pérola Magalhães Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
  • Claudia Jamal Center of Health Sciences, Federal University of Espirito Santo, Vitória, Brazil
  • Yris Fonseca-Bazzo Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
  • Omar Estrada Biophysics and Biochemistry Center, Venezuelan Institute of Scientific Research, Caracas, Venezuela
  • Fabio Boylan School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
  • Jose Prieto-Garcia School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, United Kingdom
  • Michael Heinrich Pharmacognosy and Phytotherapy, School of Pharmacy, University College of London, London, United Kingdom

Keywords:

herbal medicine, coronavirus (2019-nCoV), COVID-19, benefit/risk assessment, respiratory diseases

Abstract

Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. Aims To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment. Method The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. Results A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. Conclusions Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches. Keywords: herbal medicine, coronavirus (2019-nCoV), COVID-19, benefit/risk assessment, respiratory diseases