Pelargonium
Pelargonium sidoides
South African geranium root extract (EPs 7630, Umckaloabo) has a Cochrane review and multiple RCTs suggesting it shortens acute bronchitis, sinusitis and the common cold, though study quality is mixed.
At a Glance
- Best known for
- Shortens duration and severity of acute bronchitis (several RCTs), May reduce symptoms of common cold and acute sinusitis, Immune-modulating and antiviral activity (interferon, mucociliary clearance)
- Evidence
- Moderate
- Typical dose
- 30 drops (1.5 mL) 3x daily before meals
- Type
- Herb
What is Pelargonium?
Pelargonium sidoides is a geranium relative native to the grasslands of South Africa and Lesotho, where its dark red tuberous root has long been used by Zulu, Xhosa and Basotho healers for coughs, chest infections and diarrhea. In the early 1900s an Englishman named Charles Stevens claimed the root cured his tuberculosis and marketed it in Europe as 'Umckaloabo'. The modern standardized extract, EPs 7630, has been licensed in Germany since 2005 for acute bronchitis and is sold across Europe and North America for respiratory infections. It is one of the few African traditional medicines with a substantial body of European clinical trials.
Known Health Benefits
How It Works
EPs 7630 does not kill bacteria directly at achievable concentrations; instead it acts on the host and on bacterial behavior. It prevents bacteria such as Streptococcus and Haemophilus from adhering to airway epithelial cells, stimulates ciliary beat frequency to clear mucus, and boosts non-specific immunity by increasing interferon-β, TNF-α and nitric oxide release from macrophages. It also interferes with viral replication and attachment for several respiratory viruses (influenza, RSV, coronaviruses, rhinovirus) in cell culture. The proanthocyanidins and coumarins appear jointly responsible, and the net effect in trials is a shorter, milder infection rather than a dramatic cure.
What Research Says
A 2013 Cochrane review of 8 randomized trials (about 1,100 participants, mostly adults with acute bronchitis) concluded that P. sidoides 'may be effective' in relieving symptoms of acute bronchitis, sinusitis and the common cold, but rated the evidence low quality because all trials were from the same manufacturer and conducted in Russia and Ukraine, with concerns about publication bias. Individual trials show meaningful effects: in a 468-patient bronchitis trial, symptom scores dropped significantly more with EPs 7630 than placebo by day 7, and patients returned to work about 2 days earlier. Pediatric trials in acute bronchitis and tonsillopharyngitis found similar benefits and reduced antibiotic prescribing. Later meta-analyses of pediatric studies reached similar conclusions. Safety data from over 10,000 patients show adverse event rates similar to placebo, though rare liver injury reports led German regulators to add a warning. Overall: probably useful for shortening acute respiratory infections by a day or two, with the caveat of a narrow research base.
Active Compounds
Highly oxygenated coumarins (umckalin, scopoletin derivatives), proanthocyanidins (prodelphinidins), gallic acid and gallic acid methyl ester, phenolic acids
Forms & Bioavailability
The coumarins and gallic acid derivatives are absorbed after oral dosing, while the larger proanthocyanidins are mostly metabolized by gut bacteria into smaller phenolics. Because the main actions are on immune cells and airway lining, systemic concentrations need not be high. Trials used EPs 7630 specifically, a 1:8–10 ethanolic extract; unstandardized tinctures may differ in composition. Effects on symptom scores separate from placebo around day 3–4, so it is best started at the first sign of infection.
Dosage Guidance
| Use Case | Dosage |
|---|---|
| Adults and children over 12 (liquid) | 30 drops (1.5 mL) 3x daily before meals |
| Adults (tablets) | 20 mg 3x daily |
| Children 6–12 | 20 drops 3x daily |
| Children 1–5 | 10 drops 3x daily (or syrup per label) |
Always consult a healthcare provider for personalized dosing.
Natural Food Sources
- None — not a food plant
Potential Side Effects
Mild gastrointestinal upset, rash and nosebleeds reported at rates similar to placebo; rare hypersensitivity reactions; case reports of liver injury prompted regulatory review, though causality was not established
Who Should Avoid It
- Known liver disease or history of drug-induced liver injury
- Bleeding disorders or anticoagulant therapy (caution rather than absolute contraindication)
- Severe kidney disease (limited data)
- Hypersensitivity to Pelargonium species
- Autoimmune disease on immunosuppressants (theoretical immune stimulation)
Pregnancy & Lactation
There are no adequate studies in pregnancy or lactation, and the manufacturer and EMA advise against use in these groups because data are lacking rather than because harm has been shown. Most liquid products contain alcohol. Pregnant or breastfeeding people with a chest infection should rely on rest, fluids and medical advice.
Known Drug Interactions
Coumarins in the extract lack the structure needed for anticoagulant activity, but caution with warfarin and antiplatelets is still advised; may theoretically increase immune activity in people on immunosuppressants; no significant CYP interactions documented
Evidence Classification
Supported by cohort studies, case-control studies, or multiple observational studies with consistent findings.
Frequently Asked Questions
Does Pelargonium really shorten a cold or bronchitis?
Randomized trials suggest it reduces symptom severity and shortens illness by roughly 1–2 days in acute bronchitis, with smaller effects in colds and sinusitis. The Cochrane reviewers called the evidence low quality because the trials share a sponsor and geography, so a confident 'yes' is not justified, but the direction of effect is consistent and side effects are rare.
What is the liver safety concern?
Between 2005 and 2012 German regulators received around 30 reports of liver problems in people taking Umckaloabo, mostly mild and with other possible causes. Reviews could not establish that the extract caused them, but a precautionary warning was added. The absolute risk appears very low; stop and seek care if you develop jaundice, dark urine or unusual fatigue.
How does it compare with echinacea or elderberry?
Pelargonium has more placebo-controlled bronchitis trials than either and a Cochrane review that cautiously supports it. Echinacea's cold evidence is inconsistent, and elderberry has a few small flu and cold trials. For acute bronchitis specifically, Pelargonium is the best-supported of the three; for cold prevention, none is well proven.
Should I take it instead of antibiotics?
Most acute bronchitis and colds are viral, and antibiotics do not help them, which is where Pelargonium fits. It is not a treatment for pneumonia, strep throat or bacterial sinusitis requiring antibiotics. See a doctor for high fever, breathlessness, chest pain, or symptoms lasting more than 10 days.
References
- Pelargonium sidoides extract for treating acute respiratory tract infections. Timmer A, Günther J, Motschall E, Rücker G, Antes G, Kern WV. Cochrane Database Syst Rev (2013)View study
- Efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) in adults with acute bronchitis. A randomised, double-blind, placebo-controlled trial. Matthys H, Eisebitt R, Seith B, Heger M. Phytomedicine (2003)
- Pelargonium sidoides preparations for acute bronchitis in children and adults: a meta-analysis. Agbabiaka TB, Guo R, Ernst E. Phytomedicine (2008)
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