Michael Heinrich is Head of University College London’s centre for Pharmacognosy and Phytotherapy and is a member of the FutureYou Cambridge Advisory Board.  Here he highlights the evidence of the use of herbal medicines as a supplementary symptomatic therapy for COVID-19. 

I recently contributed to a review article published in Frontiers of Pharmacology along with researchers from Brazil, Poland and Ireland. It looks at selected herbal medicines that could be used as adjuvant treatment to respiratory diseases in the context of COVID-19.

As we know the COVID-19 infection can be fatal but, in many instances symptoms can be mild and not very different from a common cold or flu. With vaccines only just beginning to be released, the current recommendations for the self-management of COVID-19 include self-isolation, rest and hydration. Pharmacological treatments are discouraged, and the use of NSAID (such as paracetamol and ibuprofen) is recommended only in case of high fever.

But what about a cough, which is one of the main symptoms? Granted it is not life threatening, but it can be very debilitating and greatly affect quality of life during the disease, as well as being a major contributor to the spread of the virus. Using a modified ProACT-URL framework approach, we assessed potential herbal remedies that could be used as adjuvant therapy, particularly looking at coughs.

ProACT-URL is a generic decision-making guide that is often used on the EMA (European Medicine Agency) to look at Benefit-Risk for decision-making of medicines. In other words, it is a tool to assess key information against certain criteria (including clinical evidence, benefits and adverse effects) to inform decision-making at high regulatory levels.

This assessment showed several herbal remedies such as liquorice (Glycyrrhiza glabra) that could be promising candidates as adjuvant therapy for respiratory diseases, including COVID-19. Interestingly, following this framework approach, ibuprofen managed to look ‘promising’, whereas we could not find any compelling evidence to endorse the use of paracetamol and/or codeine.

Being able to provide patients with an evidence-based approach to herbal remedies, and make them aware not only of the benefits but also of the potential risks, is one of the first steps to improve patient confidence and general wellbeing.