Echinacea

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What is it?

Echinacea is an herb that is native to areas east of the Rocky Mountains in the United States. It is now widely cultivated for medicinal use. The leaves, flower, and root of several species of the echinacea plant are used to make medicine.

Echinacea is most commonly used for the common cold and other infections, but there is no good scientific evidence to support most of these uses.

Coronavirus disease 2019 (COVID-19): Some experts warn that echinacea may interfere with the body’s response against COVID-19. There is no strong data to support this warning. But there is also no good data to support using echinacea for COVID-19. Follow healthy lifestyle choices and proven prevention methods instead.

It is effective?
Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

Possibly Effective for …

  • Common cold. Taking echinacea by mouth while still healthy may help prevent some colds. But the benefit is probably small. Taking echinacea after catching a cold doesn’t seem to help improve symptoms.

Insufficient Evidence to Make a Determination for …

  • Anxiety. Early research shows that taking 40 mg of a specific echinacea extract (ExtractumPharma ZRT) one or two times per day for 7 days reduces anxiety. But taking less than 40 mg per day does not seem to be effective.
  • Athletic performance. Early research shows that taking echinacea 2 grams four times daily for 28 days increases oxygen intake during exercise tests in healthy men. But high doses of echinacea (8 grams or 16 grams) taken daily along with other ingredients don’t seem to improve oxygen intake in athletes.
  • Eczema (atopic dermatitis). Early research shows that applying an echinacea cream (Linola Plus Cream) for 12 weeks can help reduce symptoms of mild eczema such as redness, swelling, itchiness, and dryness. It might take up to 12 weeks for the echinacea cream to show benefit. It’s not clear if the echinacea cream works as well as steroid eczema creams.
  • Genital herpes. Early research shows that taking an echinacea extract twice daily for 6 months does not seem to prevent genital herpes or make it less frequent or severe.
  • Flu (influenza). Early research shows that taking an echinacea product daily for 15 days might improve the response to the flu vaccine in people with breathing problems such as bronchitis or asthma. It is unknown if echinacea has any benefit in people who are not vaccinated.
  • Ear infection (otitis media). Early research shows that taking a specific liquid echinacea extract three times daily for 3 days at the first sign of a common cold does not prevent an ear infection in children 1-5 years-old with a history of ear infections. In fact, ear infections actually seemed to increase.
  • Warts. Early research shows that taking echinacea by mouth daily for up to 3 months does not help to clear warts on the skin.
  • A mild form of gum disease (gingivitis).
  • A sexually transmitted infection that can lead to genital warts or cancer (human papillomavirus or HPV).
  • Attention deficit-hyperactivity disorder (ADHD).
  • Burns.
  • Chronic fatigue syndrome (CFS).
  • Cold sores (herpes labialis).
  • HIV/AIDS.
  • Malaria.
  • Migraine.
  • Rheumatoid arthritis (RA).
  • Swelling (inflammation) of the tonsils (tonsillitis).
  • Upper airway infection.
  • Urinary tract infections (UTIs).
  • Vaginal yeast infections.
  • Water warts.
  • Other conditions.

More evidence is needed to rate echinacea for these uses.

How does it work?
Echinacea seems to activate chemicals in the body that decrease inflammation, and it might also increase the body’s immune system.

Is there concern for the safety of its use?
When taken by mouth: Echinacea is LIKELY SAFE for most people in the short-term. Various liquid and solid forms of Echinacea have been used safely for up to 10 days. There are also some products, such as Echinaforce (A. Vogel Bioforce AG) that have been used safely for up to 6 months.

Some side effects have been reported such as fever, nausea, vomiting, bad taste, stomach pain, diarrhea, sore throat, dry mouth, and headache. In rare cases, echinacea has been reported to cause serious allergic reactions and liver damage.

When applied to the skin: Echinacea is POSSIBLY SAFE short-term. A cream (Linola Plus Cream) containing echinacea has been used safely for up to 12 weeks. In some people, applying echinacea to the skin may cause redness, itchiness, or a rash.

Echinacea is most likely to cause allergic reactions in children and adults who are allergic to ragweed, mums, marigolds, or daisies. If you have allergies, be sure to check with your healthcare provider before taking echinacea.

Special Precautions & Warnings:

Pregnancy: Echinacea is POSSIBLY SAFE when taken by mouth for up to 7 days. But until this is confirmed, it is best to stay on the safe side and avoid use.

Breast-feeding: There isn’t enough reliable information to know if echinacea is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: Echinacea is POSSIBLY SAFE when taken by mouth or applied to the skin for up to 10 days. Taking echinacea by mouth seems to be safe in most children ages 2-11 years, although rashes due to an allergic reaction can occur. There is some concern that allergic reactions to echinacea could be more severe in some children. For this reason, some regulatory organizations have recommended against giving echinacea to children under 12 years of age.

An inherited tendency toward allergies (atopy): People with this condition are more likely to develop an allergic reaction to echinacea. It’s best to avoid exposure to echinacea if you have this condition.

“Auto-immune disorders” such as such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), a skin disorder called pemphigus vulgaris, or others: Echinacea might have an effect on the immune system that could make these conditions worse. Don’t take echinacea if you have an auto-immune disorder.

Are there any drug interactions?

Caffeine

Interaction Rating=Moderate Be cautious with this combination.

The body breaks down caffeine to get rid of it. Echinacea might decrease how quickly the body breaks down caffeine. Taking echinacea along with caffeine might cause too much caffeine in the bloodstream and increase the risk of side effects. Common side effects include jitteriness, headache, and fast heartbeat.

Medications changed by the body (Cytochrome P450 3A4 (CYP3A4) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the body.
Echinacea might change how the body breaks down some medications. Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the body.
Some medications changed by the body include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and many others.

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver.
Echinacea might decrease how quickly the liver breaks down some medications.
Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the liver.
Some of the medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

Medications that decrease the immune system (Immunosuppressants)

Interaction Rating=Moderate Be cautious with this combination.

Echinacea can increase the immune system. Taking echinacea along with some medications that decrease the immune system might decrease the effectiveness of medications that decrease the immune system.
Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Midazolam (Versed)

Interaction Rating=Minor Be watchful with this combination.

Taking midazolam with echinacea increases how much midazolam the body absorbs. This might increase the effects and side effects of midazolam, but more information is needed.

Are there any interactions with herbs and supplements?
There are no known interactions with herbs and supplements.

Are there any interactions with food?
There are no known interactions with foods.

What dose is used?
BY MOUTH:

  • For the common cold: For prevention, a specific echinacea extract (Echinaforce, A. Vogel Bioforce AG) 0.9 mL three times daily (total dose: 2400 mg daily) for 4 months, with an increase to 0.9 mL five times daily (total dose: 4000 mg daily) at the first sign of a cold, has been used.

By what other names is the product known?
American Cone Flower, Black Sampson, Black Susans, Brauneria Angustifolia, Brauneria Pallida, Brauneria Purpurea, Comb Flower, Coneflower, Echinacea Angustifolia, Echinacea Pallida, Echinacea Purpurea, Echinacea Serotine, Echinacea Speciose, Echinaceawurzel, Échinacée, Échinacée Angustifolia, Échinacée Pallida, Échinacée Pourpre, Échinacée Purpurea, Equinácea, Fleur À Hérisson, Hedgehog, Helichroa Purpurea, Igelkopfwurzel, Indian Head, Kansas Snakeroot, Narrow-Leaved Echinacea, Narrow-Leaved Purple Coneflower, Narrow-Leaved Purple Cone Flower, Pale Coneflower, Pale Flower Echinacea, Pale Purple Coneflower, Purple Coneflower, Purple Cone Flower, Purpursonnenhutkraut, Purpursonnenhutwurzel, Racine D’echininacea, Red Sunflower, Rock-Up-Hat, Roter Sonnenhut, Rudbeckia Purpurea, Rudbeckie Pourpre, Schmallblaettrige Kegelblumenwurzel, Schmallblaettriger Sonnenhut, Scurvy Root, Snakeroot, Sonnenhutwurzel.

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