Echinacea is a drought-tolerant plant that possesses several health benefits. Taking a daily Echinacea supplement has been scientifically proven to boost the immune system and reduce the severity of a cold. In addition, Echinacea can help to heal wounds and with the symptoms of urinary tract infections.
The entire Echinacea plant has medicinal parts. Not only has it been proven to help with colds, it can also help with a cough, bronchitis, fever, and inflammation of the mouth. Echinacea should not be used by pregnant women, by people who have tuberculosis, multiple sclerosis, AIDS or HIV infection and people who have diabetes. Several drugs interact with Echinacea – consult your doctor before beginning a regimen. Echinacea can be found in capsule and liquid form.
The medicinal parts are, depending on varieties, the roots, leaves, or the whole plant in various stages of development.
Flower and Fruit
The flower heads are large and solitary on terminal peduncles with spreading ray florets. The bracts are in a number of rows. The bracts are leafy, rigid, thorny tipped, and longer than the conical erect disc florets. The reddish or occasionally white florets are conspicuous. The lingual florets are usually sterile and 3 cm long. The pappus is small or absent.
Leaves, Stem, and Root
Echinacea is usually a perennial herb and grows up to 45 cm in height. The leaves are large, solitary, opposite or alternate, and are smooth-margined. They are 7 to 20 cm long and have a rough surface. The leaves are entire-margined and are on slender petioles. A transverse section of the rhizome shows a thin bark and a yellowish, porous wood, which is flecked with black.
The taste is slightly sweet then bitter leaving a tingling sensation on the tongue. The odor is faintly aromatic.
Echinacea purpurea and Echinaceae pallida grow in the middle or eastern U.S. and is cultivated in Europe.
Echinacea purpurea herb consists of the fresh, above-ground parts, harvested at flowering time. The root consists of the fresh or dried underground part, gathered in autumn. Echinacea pallida herb consists of the fresh or dried above-ground parts, collected at the time of flowering. Echinacea angustifolia herb and root consist of the fresh or dried roots, or above-ground parts collected at the time of flowering.
Not to be Confused With
The herbs and roots of Echinacea purpurea, Echinacea angustifolia, and Echinacea pallida have different medicinal properties. Some Echinacea species may be confused with or adulterated with Parthenium integrifoium.
Black Sampson, Hedgehog, Purple Coneflower, Red Sunflower, Rudbeckia, Sampson Root
Actions & Pharmacology
Compounds: Echinacea Purpurea Herb
Water-soluble immunostimulating polysaccharides (4-O-methylglucuronylarabinoxylans, acidic arabinorhamno-galactans)
Volatile oil (under 0.08-0.32%): components including germacrene alcohol, borneol, bornylacetate, pentadeca-8-en-2-on, germacrene D, caryophyllene, caryophyllene epoxide
Flavonoids: ferulic acid derivatives including cichoriic acid, cichoriic acid methyl ester, 2-O- caffeoyl-3-O-feruloyl-tartaric acid, 2,3-O-diferuloyl tartaric acid 2-O-caffeoyl tartaric acid
Alkamides: including undeca-2E,4Z-dien-8,10-diin acid- and dodeca-2E,4E-8Z,10E/Z- tetraen acid isobutylamide
Polyenes: trideca-1,11-dien-3,5,7,9,-tetraine, trideca-1-en-3,5,7,9,11-pentaine, trideca-8,10,12-trien-2,4,6-triine, pontica epoxide
Compounds: Echinacea Purpurea Root
Water-soluble immunostimulating polysaccharides
Water-soluble immunostimulating glycoproteins
Volatile oil (0.2%): components including caryophyllene, humules, caryophyllene epoxide, dodeca-2,4-dien-1-yl-isovalerate, germacrene D, palmitic acid, linolenic acid
Caffeic and ferulic acid derivatives (0.6-2.1%): including cichoriic acid, cichoriic acid methyl ester, 2-O- caffeoyl tartaric acid
Alkamides (0.01-0.04%): including undeca-2E,4Z-dien-8,10-diinacetyl- and dodeca-2E,4E-8Z,10E/Z-tetracetyliso-butyl-amide
Polyynes (0.01mg/%): including trideca-1-en-3,5,7,9,11-pentain, trideca-1,11-dien-3,5,7,9,-tetraine, trideca-8,10,12-trien-2,4,6-triine, pontica epoxide
Effective pyrrolizidine alkaloids: tussilagine, isotussilagine
Compounds: Echinacea Pallida Herb
Volatile oil (0.1%): including 1,8-pentadecadien
Flavonoids: in particular rutin
Caffeic acid derivatives: Cichoriic acid, chlorogenic acid, isochlorogenic acid, verbascoside
Alkamides: including dodeca-2E,4E-8Z,10E-tetracetyliso- butylamide
Compounds: Echinacea Pallida Root
Water-soluble immunostimulating polysaccharides (arabino- rhamnogalactans)
Volatile oil (0.2 - 2%): chief components include pentadeca-8Z-en-2-on, pentadeca-1,8Z-dien, 1-pentadecan
Caffeic acid derivatives: echinacoside
Alkamides: including isomeric dodeca-2E,4E-8Z,10E/Z-tetraenic acid-isobutylamide
Polyynes: including trideca-1-en-3,5,7,9,11-pentain, pontica epoxide
Compounds: Echinacea Angustifolia Herb
Volatile oil (under 0.1%): typical components consist of epishyobunol, beta-farnesene, alpha- and beta-pinenes, myrcene, carvomenthene, caryophyllene
Caffeic acid derivatives: cichoriic acid, chlorogenic acid, isochlorogenic acid, verbascoside, echinacoside
Alkamides: including dodeca-2E,4E-8Z,10E-tetracetyl-isobutylamide
Polyynes: including trideca-1-en-3,5,7,9,11-pentaine, pontica epoxide
Compounds: Echinacea Angustifolia Root
Volatile oil (under 1%): components include dodeca-2,4-dien-1-ylisovalerate, as well as palmitic acid, linolenic acid
Caffeic acid derivatives (0.3 to 1.3%): echinacoside, cynarin
Alkamides (0.01%): including dodeca-2E,4E-8Z,10E/Z- tetracetyl isobutylamide
Polyynes: including trideca-1-en-3,5,7,9,11-pentaine, pontica epoxide, in dehydrated roots only traces
Effects: All Varieties
Echinacea activity is directed toward the nonspecific cellular immune system. The herb has demonstrated antibacterial, anti-inflammatory, metabolic, immune-system enhancement, infertility, wound healing, antineoplastic, and antiseptic properties, depending on the type of plant species. The main active principles of the immunostimulating, antibacterial, and virostatic drug are the alkamides, glycoproteins, caffeic acid derivatives (cichoriic acid and echinosides), and polysaccharides. Echinacea preparations are commonly given in Europe for the prophylaxis or treatment of bacterial and viral infections and as an adjunct to treatment of more severe infections. Echinacea extracts are commonly used to treat upper respiratory infections, influenza-like infections, and are reported to significantly reduce the symptoms accompanying the common cold. When taken soon after an exposure, extracts may lessen the severity and lead to earlier resolution (Gruber & DerMarderosian, 1996). The herb is also used as an adjuvant therapy for frequently recurring infections of the urinary tract.
Antibacterial Effects: Echinacea angustifolia, as a part of a combination herbal treatment known as Mercurius cyanatus complex, was tested in vitro using serial dilution against 105 clinical microorganisms. The bactericidal activity was approximately that of vancomycin (Vestweber et al, 1995). It is difficult to assess the results since the product was a combination of several herbs. Alcoholic extracts of Echinacea purpurea increased phagocytic, metabolic, and bactericidal activities of peritoneal macrophages (Bukovsky et al, 1993; Bukovsky et al, 1993a).
Anti-inflammatory Effects: Polyunsaturated alkamides in Echinacea angustifolia exert anti-inflammatory effects through inhibition of cyclooxygenase and 5-lipoxygenase (Muller-Jakic, 1994). The polysaccharide fraction of Echinacea angustifolia exerts anti-inflammatory effects (Tubaro, 1987), and the polysaccharide from Echinacea purpurea induces an acute phase reaction. The acute phase reaction occurs with enhancing the spontaneous motility of PMN and increasing the ability of these cells to kill bacteria such as staphylococci. (Roesler, 1991). Echinacea extracts have been used to treat arthritis. A few combination products may decrease inflammation and itching after insect bite.
Collagen-Protecting Effects: The caffeic acid derivatives exert a protective effect on the free-radical-induced degradation of Type III collagen. Collagen degradation was inhibited the greatest by echinacoside and chicoriic acid, then cynarine and chlorogenic acid (Facino, 1995). A fibroblast-populated collagen lattice was used to study the influence of Echinacea extracts on the collagen-contracting ability of mouse fibroblasts. Collagen gel contraction was inhibited by herb and root extracts (added at the time of gel preparation) dose dependently. Inhibition of collagen gel contraction parallels the inhibition of morphological changes in the wound (Zoutewelle & van Wijk, 1990).
Cytokine Stimulation Effects: Arabinogalactan, a highly purified polysaccharide from plant cell cultures of Echinacea purpurea, is effective in activating macrophage cytotoxicity actions against tumor cells and microorganisms (Leishmania enriettii). This polysaccharide induces macrophages to produce TNF-alpha, interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10) and interferon-beta. The component also induces a slight increase in T-cell proliferation (Burger, 1997; Luettig, 1989; Roesler, 1991). Extracts of Echinacea purpurea stimulate cell-mediated immunity through the production of lymphokines by lymphocytes (Coeugniet, 1987). Echinacea purpurea herb has shown some short-term viral resistance against influenza, herpes, and vesicular stomatitis viruses, which has been credited to an interferon-like effect (Wacker, 1978).
Immunostimulating Effects: Ethanolic root extracts of the Echinacea purpurea, Echinacea pallida, and Echinacea angustifolia were shown to cause a 23% increase of the phagocytosis rate in granulocyte smears in vitro (Jurcic, 1989; Melchart 1995). Confirmed by the carbon clearance test and granulocyte tests, the ethanolic root extracts significantly enhance phagocytosis (Bauer, 1988). The ethanolic extracts of aerial parts of Echinacea angustifolia and Echinacea purpurea exert immunostimulatory effects also through metabolic and bactericidal activities of peritoneal macrophages. The ethanolic extracts of both Echinacea plants also increase the total weight of the spleen (Bukovsky, 1993).
Echinacea purpurea extract was tested in vitro. A stimulation of lymphokines by lymphocytes and a stimulation in the transformation test was seen. The potential was for increased cell-mediated immunity (Coeugniet & Elek, 1987). Echinacea extract, at concentrations of greater than or equal to 0.1 mcg/km, significantly enhanced killer cell and peripheral blood mononuclear cells (PBMC) function in vitro. An extract of Echinacea purpurea was evaluated on its ability to stimulate cellular immune function by PBMC from normal subjects, patients with chronic fatigue syndrome, and patients with AIDS (See et al, 1997). Extracts of Echinacea purpurea increased the in vitro phagocytosis of Candida albicans by granulocytes and monocytes from healthy donors by 30% to 45%. Chemotactic granulocyte migration (Boyden Chamber) was increased by 45%. There was no effect on intracellular killing of bacteria and yeasts and in vitro transformation of lymphocytes was not induced (Wildfeuer & Mayerhofer, 1994). Significant immunostimulating actions were demonstrated in water-soluble polysaccharide fractions (heteroglycans) from Echinacea purpurea and Echinacea angustifolia. (Wagner et al, 1985; Wagner et al, 1984).
Infertility: Echinacea purpurea (8.1 mg/mL) inhibited sperm motility and velocity after 24 hours of contact with 100 donor sperm. Echinacea inhibited the action of hyaluronidase, an enzyme located at the head of the sperm responsible for assisting the sperm to penetrate cumulus cell layers around the oocyte, possibly preventing sperm from successfully fertilizing the oocytes (Ondrizek et al, 1999).
Immunostimulation and Cold/Flu Prevention
A major 2006 Cochrane Collaboration review of the literature on Echinacea analyzed and pooled the results of randomized controlled clinical trials to date that have compared the effectiveness of the herb (mono-preparations as opposed to blends) with a placebo, no treatment, or another treatment for preventing or treating the common cold. The review found 16 such trials, involving a total of 22 comparisons—19 of Echinacea compared to a placebo, two to no treatment at all, and one to another herbal preparation. All but one trial was double-blind. In terms of preventing the common cold, two trials found no effect in this regard with Echinacea taken for 8 to 12 weeks. and none of the three trials that compared Echinacea's effectiveness over placebo showed benefit from taking Echinacea. Most of the trials, however, looked at whether Echinacea taken after cold symptoms begin could shorten the duration of the cold, or decrease the severity of the symptoms any better than a placebo could. In this regard, some Echinacea preparations showed better effectiveness over a placebo for this purpose (in adults). Specifically, a significant effect of Echinacea over placebo was identified in nine of the trials that made this comparison (plus a trend toward effectiveness in one). In terms of actually treating a cold, six of the comparisons showed no effectiveness for Echnicacea over placebo. Echinacea preparations differ widely in the clinical trials—there are more than 200 different ones that use various different types (species) and parts of the plant (root, herb, or both) as well as many methods of extracting the active ingredient. Some, evidence points to effectiveness for early treatment of colds when aerial (above-ground) parts of the herb are used. Rigorous and well-designed clinical trials have yet to be performed that conclusively show that Echinacea has preventive properties (Linde, 2006).
A 2005 structured review of evidence for Echinacea in treating the common cold similarly found little evidence to justify its therapeutic effectiveness. At the time, 322 articles were identified. Nine were placebo-controlled clinical trials, but only two met 11 criteria designed to measure quality (essential elements to provide valid results, such as double-blinding, lack of a quantifiable analysis, compliance testing, and randomized assignment to treatment), and the authors of these two studies themselves deemed the findings for Echinacea to treat the common cold unconvincing (Caruso, 2005).
One 2005 study that set out to test Echinacea in a very controlled setting, using a chemically well-defined preparation, a clearly defined illness, and early exposure to the herb in the development of a cold ultimately did not find the herb to have a clinically significant effect on the infection or course of illness. No statistically significant effects of the chemically defined extracts of Echinacea angustifolia root—three different preparations made with either supercritical carbon dioxide, 60% alcohol, or 20% alcohol) from a single lot of the herb root—were observed on rates of infection or severity of symptoms in the volunteers. The participants were given a cold virus (rhinovirus type 39) and kept in a sequestered environment for 5 days. In all, 437 participants (from six different cohorts) were randomly assigned to either a prevention or treatment group with one of the extracts or a placebo, and 399 (mean age 20.8) were actually “given” (infected with) the cold virus and then isolated in individual hotel rooms for the rest of the study. In addition to having no significant impact on the participants' clinical course of disease, the Echinacea extract had no significant impact on the amount of virus (quantitative-virus titer in the volunteer's body), the volume of nasal secretions produced, or nasal-lavage specimen measurements of key immune system cells (polymorphonuclear leukocyte or interleukin-8 concentrations) (Turner, 2005).
Somewhat different results were obtained in another 2005 study. Echinilin, a formulation prepared from freshly harvested Echinacea purpurea plants and standardized on the basis of three known active components (alkamides, cichoric acid, and polysaccharides) was found to be effective for the treatment of common cold. For a 7-day period, volunteers took either Echinilin or placebo at the onset of their cold, with 8 doses (5 mL/dose) on day 1 and 3 doses on subsequent days. Fasting blood samples were obtained before and during their colds. Those in the Echinacea group experienced a more significant decrease in total daily symptomatic score, suggesting that Echinilin, by enhancing the non-specific immune response and eliciting free radical scavenging properties, may have led to faster resolution of the cold symptoms (Goel et al, 2005).
An earlier study of 282 subjects showed that the same preparation, Echilin, produced lower daily symptom scores than placebo. The subjects, who were aged 18-65 years with a history of two or more colds in the previous year, but otherwise in good health, were randomly assigned to take Echinacea or placebo at the onset of the first symptom related to cold, consuming 10 doses the first day and four doses daily on subsequent days for 7 days. Total daily symptom scores were lower by 23.1% in the Echinacea group than in placebo (p<0.01). Throughout the treatment period, the response rate to treatments was greater in patients treated with Echinacea (Goel et al, 2004).
In contrast, symptoms and duration of the common cold were not mitigated in a 2004 randomized, double-blind, placebo-controlled clinical trial. In all, 128 individuals (volunteers from a community) were given either 100 mg Echinacea purpurea or a placebo 3 times daily within 24 hours of cold symptoms starting (as reported by the participants), and until cold symptoms ceased or at 14 days—whichever came first. The herb was given in the form of freeze-dried pressed juice from the plant's aerial parts. No statistically significant differences were observed between the Echinacea and placebo groups for the total or mean symptoms scores, which were based on participant-recorded daily record of such symptoms as sneezing, nasal discharge, headache, hoarseness, muscle aches, cough, and sore or scratchy throat. The authors note that relatively few numbers of participants enrolled (Yale, 2004).
Echinacea was deemed ineffective in reducing symptoms or severity of acute upper respiratory tract (URI) infection in children (age 2 to 11 years), but potentially effective in reducing subsequent URI in this treatment-efficacy trial—a secondary analysis of data from a randomized, double-blind, placebo-controlled study. Echinacea purpurea (reconstituted dried juice of above-ground portion of the plant) was used. In all, 524 children were monitored for URI over the course of 4 months. In these children, the use of Echinacea for the first URI was linked to a 28% decreased risk of a second URI (p=0.01) (Weber, 2005).
The ability of Echinacea purpurea to prevent infection with rhinovirus type 39 (RV-39) was tested in a randomized, double-blind, placebo-controlled clinical trial. Forty-eight previously health adults administered Echinacea or placebo, 2.5 mL 3 times per day, for 7 days before and 7 days after intranasal inoculation with RV-39. A total of 92% of the Echinacea recipients and 82% of the placebo recipients were infected. Colds developed in 58% of patients in the Echinacea group and 82% in the placebo group, which was not significantly different (p=0.114) (Sperber et al, 2004).
A 2000 study that used Echinacea Plus, an herbal tea preparation containing Echinacea purpurea and Echinacea angustifolia, decreased the duration of symptoms of cold or flu when taken at early onset of symptoms. The trial was double-blind, placebo-controlled, and involved 95 subjects ages 24 to 62 years. Symptom relief, number of days of symptoms, and number of days before noticeable symptom change were significantly improved in the Echinacea Plus group compared to the placebo group (p<0.001 for all 3 results). No significant adverse reactions were reported. Subjects in this study were primarily health care women, thus limiting the ability to generalize these results (Lindenmuth & Lindenmuth, 2000).
Echinacea demonstrated safe and effective symptom relief for viral respiratory tract infections in a double-blind, placebo-controlled, multicenter study. Herbal Echinacea's total efficacy over placebo was significant (p=0.0497) with symptom relief response time reduced with treatment (p=0.022). Although common colds will resolve spontaneously, the achieved goal was symptom relief (Henneicke-von Zepelin et al, 1999).
Echinacea concentrate and Echinaforce® exhibited low risk, effective, symptomatic relief in a placebo-controlled, double-blind, study involving 246 subjects with the common cold. Subjects were randomized into one of four groups: Echinaforce (n=55), Echinacea concentrate (n=64), Echinacea purpurea (n=63), and placebo (n=64) with instructions to take 2 tablets 3 times daily with onset of cold symptoms. Treatment was not to exceed 7 days. Reduction in the complaint index of 12 primary symptoms associated with the common cold was significantly higher in the Echinacea concentrate (p=0.003) and Echinaforce (p=0.02) groups than in the placebo group (Brinkeborn, 1999).
A randomized, placebo-controlled, double-blind trial evaluated the effect of a fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. The fluid extract, given 4 mL twice daily for 8 weeks, did not significantly decrease the incidence, duration, or severity of colds and respiratory infections compared to placebo. (Melchart et al, 1998).
Echinagard® effectively shortened the course of acute, uncomplicated upper respiratory infections (URI) in a double-blind, placebo-controlled study involving 120 patients randomized to either Echinagard (n=60) or placebo (n=60). Significant rapid recovery was demonstrated in the group taking Echinagard versus placebo (p<0.0001) with median improvement reported in 4 days versus 8 days. No distinguishing adverse events were reported (Hoheisel et al, 1997).
Overall, a statistically significant decrease in infections was observed when a “susceptible” group (members had experienced flu within last 12 months) was compared to the entire population (p<0.05) in a placebo-controlled, double-blind clinical trial of Resistan®. The Resistan group experienced 15% fewer primary and 27% fewer secondary infections as compared with the placebo group. In the subgroup of “susceptible” subjects, there was a 20% decrease in infections compared to the placebo group. The study also showed that Echinacea products taken at the onset of upper respiratory symptoms may reduce the duration of the illness by 25% to 33%. Evaluation on days 6 to 8 demonstrated a significant reduction in all seven symptoms in the placebo group (Schulz & Haensel, 1996).
Echinacea did not improve symptoms of upper respiratory tract infections (URI) in children in a large, double-blind, placebo-controlled trial. Parents were asked to rate symptoms and adverse events. Complete information existed for a total of 608 URIs that occurred during the 4-month study period. No significant differences were noted between placebo and Echinacea for the primary study outcome (Taylor et al, 2003).
Echinacea did not reduce symptom severity or duration of the common cold in a randomized, double-blind, placebo-controlled community-based trial. One hundred and forty-two participants with early cold symptoms completed this trial. Participants were randomly assigned to receive encapsulated Echinacea or placebo. The mean duration difference was -0.52 day (95% CI, - 1.09 to 0.22 days) between the placebo group (5.75 days) and Echinacea group (6.27 days). There was no significant difference in symptom severity between the Echinacea and placebo groups. Adverse effects were not different between the two groups (Barrett et al, 2002).
Treatment with the plant and root extract of Echinacea purpurea had no significant benefit in patients with recurrent genital herpes (Vonau et al, 2001).
Indications & Usage
Echinacea Purpurea Herb
Approved by Commission E:
- Common cold
- Fevers and colds
- Infections of the urinary tract
- Inflammation of the mouth and pharynx
- Tendency to infection
- Wounds and burns
Echinacea purpurea herb is used internally as supportive therapy for colds and chronic infections of the respiratory tract and lower urinary tract, and for influenza-like infections. It can also be applied locally to poorly healing superficial wounds.
Echinacea Purpurea Root
Echinacea purpurea root is used for acute and chronic respiratory tract infections (of viral and bacterial origin); increased susceptibility to infection due to temporarily lowered resistance, treatment of leukopenia following radio and cytostatic therapy and in support of anti-infectious chemotherapy.
Echinacea Pallida Root
Approved by Commission E:
- Fevers and colds
Echinacea pallida root is used as a supportive therapy for influenza-like infections.
Echinacea Angustifolia Herb and Root
In folk medicine, Native Americans use the drug externally for burns, swelling of the lymph nodes, and insect bites. The drug is used internally for pain associated with headaches and stomach aches, measles, coughs and gonorrhea. The drug has also been used for rattlesnake bites. Today the drug is used for prophylaxis and treatment of “flu,” sepsis, and mild to moderate cold infections. Externally, the drug is used for treatment of poorly healing wounds and inflammatory conditions such as abscesses and leg ulcers.
Because of a possible activation of autoimmune aggressions and other overreactive immune responses, the drug should not be administered in the presence of tuberculosis, multiple sclerosis, leukosis, collagenosis, AIDS or HIV infection, and other autoimmune diseases. Diabetes may worsen in diabetic patient receiving Echinacea intravenously (Bisset, 1994), and parenteral administration should not be used in patients with tendencies to allergies, especially allergies to members of the composite family (Asteraceae).
Not be used during pregnancy. However, in a prospective study, no statistically significant difference was demonstrated between neonatal malformations in women using Echinacea during pregnancy in comparison with those who did not use the herb. The dosage of Echinacea used by the women varied from 250 to 1000 mg daily for tablet or capsule forms and 5 to 30 drops/day of tincture, with alcohol content between 25% to 45% (Gallo et al, 2000).
Precautions & Adverse Reactions
All Varieties and Forms
An extensive review of the safety and efficacy of Echinacea found no toxicity in both adults and children in acute as well as long-term administration (Parnham, 1996). When used parenterally, dose-dependent, short-term fever reactions, nausea, and vomiting can occur (Bisset, 1994). Hypersensitivity reactions with anaphylaxis have been reported (Mullins, 1998). Dizziness, headache, skin irritation, or allergic reactions are possible; rashes, itching, occasional swelling of the face, breathing difficulties, dizziness and a drop in blood pressure have been observed after administration of preparations containing Echinacea.
Erythema, exanthema, and pruritus have been reported in isolated cases following topical application of Echinacea (Fachinfo Resistan, 1996; Taylor et al, 2003).
In an analysis of the Australian Adverse Drug Reactions Advisory Committee's database of events of IgE-mediated hypersensitivity reactions, 51 reports were found to be related to Echinacea use. Twenty-six reactions, including urticaria, angioedema, asthma, and anaphylaxis were concluded by the investigators to be IgE-mediated reactions to Echinacea. More than half of the affected patients had a history of asthma, allergic rhinitis, rhinoconjunctivitis, or atopic dermatitis. Four persons required hospitalization due to their reactions and no deaths occurred. In 94% of patients, the symptoms appeared within 24 hours of Echinacea ingestion. Eighty percent of the patients included were female and the median age was 32 years (Mullins & Heddle, 2002).
High concentrations of Echinacea had adverse effects on oocytes in animal models (Ondrizek, 1999).
Concurrent use may result in decreased effectiveness of basiliximab. Clinical Management: Concomitant use of echinacea and basiliximab should be avoided due to the antagonistic effect an immunostimulant such as Echinacea may have on basiliximab, an immunosuppressant.
Concurrent use may result in decreased effectiveness of azathioprine. Clinical Management: Since reduced azathioprine effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and azathioprine.
Concurrent use may result in decreased effectiveness of corticosteroids. Clinical Management: Since reduced corticosteroid effectiveness may be life-threatening, avoid concomitant use of Echinacea and corticosteroids
Concurrent use may result in decreased effectiveness of cyclosporine. Clinical Management: Since reduced cyclosporine effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and cyclosporine.
Concurrent use may result in decreased effectiveness of daclizumab. Clinical Management: Since reduced daclizumab effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and daclizumab.
Concurrent use may result in decreased effectiveness of muromonab. Clinical Management: Since reduced muromonab effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and muromonab.
Concurrent may result in decreased effectiveness of mycophenolic acid. Clinical Management: Echinacea may reduce the effectiveness of mycophenolic acid, and their concomitant use should be avoided.
Concurrent use may result in decreased effectiveness of mycophenolate mofetil. Clinical Management: Since reduced mycophenolate mofetil effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and mycophenolate mofetil.
Concurrent use may result in decreased effectiveness of sirolimus. Clinical Management: Since reduced sirolimus effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and sirolimus.
Concurrent use may result in decreased effectiveness of tacrolimus. Clinical Management: Since reduced tacrolimus effectiveness may be life-threatening in organ transplantation, avoid concomitant use of Echinacea and tacrolimus.
Echinacea inhibited cytochrome P450 3A4 in vitro (Budzinski et al, 2000); caution is advised if Echinacea is administered with drugs metabolized by this enzyme.
In one study, using a polysaccharide fraction from Echinacea purpurea intravenously, a moderate acceleration in the erythrocyte sedimentation rate was noted (Roesler et al, 1991).
In tests of Echinacea purpurea, toxic cellular effects were seen only at very high, clinically irrelevant concentrations. Administration of very high doses may produce a depressant action (Coeugniet & Elek, 1987).
Echinacea Purpurea Herb
Mode of Administration
Pressed juice and galenic preparations for internal and external use.
The pressed juice is prepared in a concentration of 2.5:1 and is stabilized with 22% alcohol. Other complicated methods of preparation are known.
When used internally, the recommended dosage is 6 to 9 ml of the expressed juice. The recommended dosage for parenteral administration should be individualized, depending on the seriousness of the condition as well as the specific nature of the respective preparation. Parenteral application requires a gradation of dosage, especially for children. The manufacturer is required to show this information for the respective preparation. When used externally, semi-solid preparations containing at least 15% pressed juice are used for a maximum of 8 weeks.
Echinacea Purpurea Root
Mode of Administration
Comminuted drug for decoctions and galenic preparations.
When using the tincture, 30 to 60 drops should be taken three times a day.
Echinacea should be protected from light sources, and, if possible be uncomminuted.
Echinacea Pallida Herb and Root
Mode of Administration
As a liquid preparation for oral use.
A 1:5 tincture is made using 50% (V/V) ethanol and native dried extract (50% ethanol in a 7 to 11:1 proportion)
The daily dose is 900 mg of drug. The drug should be used for a maximum of 8 weeks.
Protect from light sources. If possible, store uncomminuted.
Echinacea Angustifolia Herb and Root
Mode of Administration
Since the efficacy in the claimed areas of application has not been documented, therapeutic application cannot be recommended. Because of the risks, the use of parenteral preparations is not justified.
- Capsule – 100 mg, 125 mg, 167 mg, 200 mg, 250 mg, 380 mg 390 mg, 400 mg, 430 mg, 450 mg, 500 mg
- Liquid – 120 mg/5mL
The root tea is prepared using 1/2 teaspoonful of comminuted drug with boiling water. Strain after 10 minutes.
For colds, drink 1 cup freshly made tea several times daily.
Protect from light sources. If possible, store uncomminuted.