Related Terms

• Alkamides, alkylamides, American coneflower, Asteraceae (family), black sampson, black susan, caffeic acid derivatives, caffeoyl derivatives, cichoric acid and polysaccharides, cock-up-hat, combflower, compositae, cynarin, dodeca-2E,4E,8Z,10Z(E)-tetraenoic acid isobutylamide, dodecanoic acid derivatives, EC31J0, Echinacea® (Strong Nature, Serbia), Echinacea angustifolia, Echinacea laevigata, Echinacea Moench, Echinacea pallida, Echinacea Plus®, Echinacea purpurea, Echinacea purpurea L. Moench, Echinacea simulata, Echinacea tennesseensis, Echinacin®, Echinacin® EC31, echinacoside, Echinaforce®, Echinaforce® Forte, EchinaFresh® (Enzymatic Therapy, Green Bay, WI), Echinaguard®, Echinilin® (Factors R & D Technologies, Burnaby, BC, Canada), echino (Greek), EFLA® 894, glycoconjugates, hedgehog, hydrophilic polysaccharides, Igelkopf (German), Indian head, Kansas snake root, Kegelblume (German), narrow-leaved purple coneflower, N-isobutyldodeca-2E,4E,8Z,10Z-tetraenamide, Pascotox®, pentadeca-(8Z,13Z)-dien-11-yn-2-one, Polinacea™, polysaccharide, purple coneflower, red sunflower, rudbeckia, SB-TOX, scurvy root, sea urchin, snakeroot, solhat (Danish), sonnenhut (German), sun hat, undeca-2-ene-8,10-diynoic acid isobutylamide, undecanoic acid derivatives, unsaturated N-alkylamide lipids.

• Combination product examples: ChizukitTM, an echinacea product that contains extract of the upper plant parts of Echinacea purpurea and roots of Echinacea angustifolia, propolis, and vitamin C; Cold-X® (Vitamin C, Echinacea purpurea root extract, eucalyptus leaf extract, fennel seed extract); Kan Jang® (Adhatoda vasica, Echinacea purpurea, and Eleutherococcus senticosus); Esberitox® liquid (ethanolic-aqueous extracts of herba Thuja occidentalis, radix Echinacea, and radix Baptisia tinctoria); Esberitox® tablets (vitamin C, Thuja occidentalis, radix Echinacea, and radix Baptisia tinctoria); Erbavita® (Andrographis paniculata, Echinacea, grapefruit, papaya, Tabebuia, and Uncaria); Imoviral® Junior (an herbal combination therapy that contains Echinacea angustifolia, arabinogalactan, vitamin C, beta-glucan, and zinc).

Background

• Echinacea species belong to the aster family (Asteraceae), which originated in eastern North America. Of the nine identified species, three are used as medicine. The roots and herbs of the species have been studied for potential immune benefits.

• Echinacea has been taken by mouth in Europe and the United States to help prevent or treat the common cold. In the United States, echinacea sales are thought to make up 10% of the dietary supplement market. Although much research has been done on the potential cold-fighting effects of echinacea, results are conflicting. There have been reports of a lack of benefit, as well as reports of rash in children caused by echinacea.

• Early studies looking at the potential benefits of echinacea for herpes and radiation poisoning have found a lack of evidence. Applying echinacea juice to the skin has been suggested for wound healing, and taking echinacea by mouth or injecting it has been suggested for vaginal yeast infections. However, clear evidence is lacking in these areas.

Scientific Evidence

Tradition/Theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

• Abscesses (pus buildup in tissue), acne, antioxidant, attention deficit-hyperactivity disorder (ADHD), bacterial infection (staph, strep), bee stings, boils, bronchitis, burns, catarrh (inflammation of nose and airways), diphtheria (bacterial infection of nose and throat), dizziness, dyspepsia (heart burn), eczema (itchy inflamed skin), flu, heart disease, hemorrhoids, HIV infection, insect bites, liver inflammation, liver protection, malaria, menopause, migraine headache, mouth sores, pain, psoriasis (flaky skin patches), respiratory infections in dogs, rheumatism (joint pain), septicemia (blood infection), skin ulcers, snakebites, stomachache, sun protection, syphilis (sexually transmitted disease), typhoid (infection causing diarrhea and rash), urinary disorders, urinary tract infection, whooping cough.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

• For blood pressure control, a single dose of 350 milligrams of Echinaceapurpurea by mouth has been studied.

• For exercise performance, five 400-milligram doses of Echinacea purpurea have been taken by mouth four times daily for 28 days.

• To stimulate the immune system, five 400-milligram doses of echinacea have been taken by mouth four times daily for 28 days. A total of eight doses of Echinilin® (five milliliters each) have been taken by mouth in a single day at the onset of two symptoms of common cold, followed by three doses of five milliliters daily for six days. A combination dose containing 675 milligrams of Echinacea purpurea and 600 milligrams of Echinacea angustifolia has been taken by mouth twice daily for 14 days. A combination of 780 milligrams of Echinacea purpurea whole herb extract and 680 milligrams of ultrarefined Echinacea purpurea whole herb and Echinacea angustifolia root has been taken by mouth in two capsule doses twice daily. A combination of 908 milligrams of Echinacea purpurea whole herb extract, 464 milligrams of Echinacea purpurea whole herb, and 36 milligrams of Echinacea angustifolia root has been taken by mouth in two capsule doses twice daily. A dose of 7.5 milliliters of alcohol extract of Echinacea purpurea has been taken by mouth twice daily for seven days.

• To treat low white blood cell count caused by radiation, two Echinacea® tablets (275 milligrams each) have been taken by mouth twice daily for two weeks.

• To prevent the common cold in adults and children, doses of 300 milligrams of Echinacea purpurea, 176 milligrams of Echinacea purpurea, or 300 milligrams of Echinacea angustifolia have been taken by mouth three times daily for up to three weeks. Three capsules of Echinacea purpurea at an unknown dose have been given by mouth for eight weeks. A 1.5-milliliter tincture containing the equivalent of 300 milligrams of Echinaceaangustifolia root has been taken by mouth three times daily for seven days before experimental infection or starting on the day of experimental infection and continuing for five days. Echinaforce® Forte has been taken by mouth. Echinacea purpurea juice (four milliliters twice daily) has been taken by mouth for eight weeks. Pressed juice of Echinacea purpurea (Echinacin® EC31) has been taken by mouth once daily for 28 days.

• To treat the common cold in adults, experts often suggest 500-1,000 milligrams of echinacea three times daily for 5-7 days (with 900 milligrams daily shown to have more benefit than 450 milligrams daily); a dose of 6-9 milliliters of echinacea juice in divided doses daily for 5-7 days; a dose of 0.75-1.5 milliliters of tincture, gargled then swallowed, 2-5 times daily for 5-7 days (with the daily dose equivalent to 900 milligrams of dried echinacea root); and for echinacea tea, typically two teaspoons (four grams of powdered echinacea herb) simmered in boiling water for 10 minutes, daily for 5-7 days. Eight doses of five milliliters of Echinacea purpurea extract (Echinilin®), diluted with half a glass of water, have been taken by mouth on the first day of cold symptoms, with three doses taken on days 2-7. Echinilin® (Echinacea purpurea extract) has been taken by mouth in four-milliliter doses for seven days. Echinaforce® (6.78 milligrams of Echinacea purpurea extract) and a 7X concentration (48.27 milligrams) have been taken by mouth. Twenty drops of Echinaguard® (Echinacea purpurea sap) have been taken by mouth in water every two hours for the first day, then three times daily for up to 10 days. Echinacea pallida root has been taken by mouth as 90 drops daily over 8-10 days. Five to six cups of Echinacea Plus® tea (equivalent to 1.275 milligrams of dried herb and root per tea bag) have been taken by mouth on the first day and reduced by one cup daily for the next five days. A dose of 900 milligrams of Pascotox® (Echinacea pallida root) has been taken by mouth daily for 8-10 days. A dose of 450 milligrams or 900 milligrams of Echinacea purpurea root has been taken by mouth. A dose of one milliliter of Echinacea angustifolia or Echinacea purpurea root extract in 30% alcohol has been taken by mouth twice daily for 12 weeks. The pressed juice of Echinacea purpurea (Echinacin® EC31) has been taken by mouth for 28 days. A mixture of unrefined Echinacea purpurea herb (25%) and root (25%) plus Echinacea angustifolia root (50%) has been taken by mouth in one-gram doses six times on the first day of symptoms, then three times daily on each additional day of illness, for up to 10 days. Echinacea tablets containing 675 milligrams of Echinacea purpurea and 600 milligrams of Echinacea angustifolia root extracts have been taken by mouth as two tablets four times daily for one day, followed by one tablet four times daily for four days.

• To treat eye inflammation, 150 milligrams of Echinacea purpurea have been taken by mouth twice daily as an add-on therapy.

• To promote wound healing, experts often suggest using a 15% pressed herb juice applied to the skin daily.

• For cancer, 60 milligrams per meter squared of Echinacin® have been injected into the muscle on days 3-10 after cyclophosphamide therapy, then twice weekly. A solution containing two milligrams of an echinacea polysaccharide has been given through the vein once daily, starting three days before chemotherapy and continuing for 10 days. In general, injectable forms of echinacea are no longer approved for use in Germany and are not available commercially, due to reports of severe reactions.

Children (under 18 years old)

• Note: Increased risk of rash has been reported after the use of echinacea for cold symptom treatment in children aged 2-11 years.

• For treatment of the common cold or ear infection, there is no proven safe or effective dose for echinacea in children.

• To treat whooping cough in children 14 years and younger, 1-2 milliliters of squeezed aqueous extract (0.1 grams per two milliliters) has been injected into the muscle twice daily for 3-21 days. However, safety information on injecting echinacea into the muscle is limited, and so this method of administration should be used with caution. Echinacea preparations given through intravenous feeding tubes are no longer approved for use in Germany and are not available commercially, due to reports of severe reactions.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

• Avoid in people who are allergic or sensitive to echinacea, its parts, or any members of the Asteraceae or Compositae family (such as chrysanthemums, daisies, marigolds, and ragweed).

• People who have asthma or atopy (tendency for allergic asthma, eye and skin allergies, food allergy, or hay fever) may be more likely to have allergic reactions after taking echinacea by mouth or applying it to the skin. Hives, itching, low blood pressure, lung spasm, rash, severe allergic reaction, shock, skin redness, and swelling under the skin have been reported with echinacea use.

• Increased risk of rash has been reported after the use of echinacea for cold symptom treatment in children aged 2-11 years.

Side Effects and Warnings

• In general, echinacea has been well tolerated, with few side effects reported. Rash and upset stomach are the most common side effects.

• Studies have reported that endotoxin contaminations have been found in certain samples of Esberitox®, a combination product containing echinacea.

• Echinacea is thought to be possibly safe when used in children and in pregnant women when taken as directed. However, more safety information is needed.

• Echinacea may alter bleeding. Caution is advised in people with bleeding disorders or those taking drugs that may alter bleeding. Dosing adjustments may be necessary.

• Use cautiously long-term. Long-term echinacea may cause reduced white blood cell count. Echinacea may cause a blood disorder in which blood clots form in small blood vessels, leading to a low platelet count.

• Use cautiously in injectable form, especially for people who have diabetes, due to possible changes in blood sugar.

• Use tinctures cautiously in alcoholics and in people who are taking agents that may affect the immune system, agents that may affect the liver's processing of drugs, agents that may be toxic to the liver, amoxicillin, corticosteroids, disulfiram, kava, or metronidazole.

• Use cautiously in children with colds. Echinacea may increase the risk of eye infection in these children.

• Use cautiously in people who have or are at risk of liver disorders or those taking a large amount of echinacea. Echinacea may cause liver damage.

• Use cautiously in people who have abnormally high iron levels, abnormal white blood cell count, arthritis or other joint diseases, atopy (tendency for allergic asthma, eye and skin allergies, food allergy, or hay fever), autoimmune diseases, cancer, chronic headaches or migraines, collagen disease, heart disease, HIV/AIDS, kidney disease, mental disorders (anxiety or nervousness), multiple sclerosis, skin disorders, sleep disorders, stomach problems, or tuberculosis.

• Use cautiously in pregnant or breastfeeding women, or women who are trying to become pregnant. Many tinctures contain high levels of alcohol and should be avoided during pregnancy.

• Avoid in people who are allergic or sensitive to echinacea, its parts, or any members of the Asteraceae or Compositae family (such as chrysanthemums, daisies, marigolds, and ragweed).

• Avoid using in combination with anesthesia or in people who are preparing to undergo transplant surgery.

• Echinacea may also cause anxiety and nervousness, a bad taste, bronchitis, changes in blood cells, changes in heart rate, changes in sperm motility, constipation, diarrhea, dizziness, dry mouth, dry throat, fatigue, headache, heartburn, joint pain, kidney failure, mild drowsiness, mild nausea, mouth irritation, numb tongue, pemphigus vulgaris (autoimmune disease causing blistering, sore skin), sleep problems, stomach pain, and vomiting.

Pregnancy and Breastfeeding

• Research suggests that echinacea is one of the most commonly used herbal supplements in women before and during pregnancy. However, safety information is limited on the use of echinacea in breastfeeding women, pregnant women, or women who are trying to become pregnant.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

• Echinacea may interact with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

• Echinacea may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be altered in the blood and may cause potentially serious adverse reactions. People using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

• Echinacea may interact with agents that are cleared from the body by the kidney, agents that may affect the immune system, agents that may be toxic to the liver, agents that may increase light sensitivity, agents that may treat muscle spasms, agents that may treat retroviral infections (HIV/AIDS), anesthesia, antibiotics, anticancer agents, anti-inflammatories, antiviral agents, caffeine, cardiac glycosides, corticosteroids, disulfiram (Antabuse®), econazole nitrate (Spectazole®), metronidazole (Flagyl®), p-glycoprotein-regulated agents, and steroids.

Interactions with Herbs and Dietary Supplements

• Echinacea may interact with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

• Echinacea may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these herbs or supplements may be altered in the blood and may cause potentially serious adverse reactions. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

• Echinacea may interact with anesthesia, antibacterials, anticancer herbs and supplements, anti-inflammatory herbs and supplements, antioxidants, antivirals, astragalus, caffeine-containing herbs and supplements, cardiac glycosides, glycyrrhiza, herbs and supplements that are cleared from the body by the kidney, herbs and supplements that may affect the immune system, herbs and supplements that may be toxic to the liver, herbs and supplements that may increase light sensitivity, herbs and supplements that may treat muscle spasms, kava, p-glycoprotein-regulated agents, and vitamins.

Author Information

• This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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