Echinacea

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, PolinaceaT, 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 50mg/mL of the extract of the upper plant parts of Echinacea purpurea and roots of Echinacea angustifolia, 50mg/mL of propolis, and 10mg/mL of vitamin C; Cold-X? (Vitamin C 100mg, Echinacea purpurea root extract 20.1mg, eucalyptus leaf extract 12.3mg, fennel seed extract 10.3mg); Kan Jang? (Adhatoda vasica, Echinacea purpurea, and Eleutherococcus senticosus); Esberitox? liquid (ethanolic-aqueous extracts of herba Thuja occidentalis 2mg, radix Echinacea 7.5mg, and radix Baptisia tinctoria 10mg); Esberitox? tablets (vitamin C 20mg, Thuja occidentalis 2mg, radix Echinacea 7.5mg, and radix Baptisia tinctoria 10mg); the transmucosal herbal periodontal patch, provided by Izun Pharmaceuticals (New York, NY) (plant extracts from Centella asiatica (gotu kola), Echinacea purpurea, and Sambucus nigra (elderberry)); 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) that originated in eastern North America. Of the nine identified species, only 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 percent 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 and rash caused by echinacea in children.
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.
Echinacea use has been discouraged in people who have autoimmune disease. However, more research is needed before further conclusions can be made.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Taking echinacea by mouth is often suggested as a treatment for the common cold. Echinacea may help reduce the length and severity of the common cold. Much research has focused on the potential benefits of echinacea for this purpose. Although most studies report positive effects, some recent high-quality trials found negative results in adults and children. More research is needed before a firm conclusion can be made.

 B


Taking echinacea by mouth is often suggested as a treatment for the common cold. Echinacea may help reduce the length and severity of the common cold. Much research has focused on the potential benefits of echinacea for this purpose. Although most studies report positive effects, some recent high-quality trials found negative results in adults and children. More research is needed before a firm conclusion can be made.

 B


Early study suggests that echinacea may help reduce anxiety. Although results are promising, more research is needed in this area.

 C


Early study suggests that echinacea may help reduce anxiety. Although results are promising, more research is needed in this area.

 C


Early study suggests that taking a single dose of echinacea by mouth may lack effect on blood pressure. At this time, evidence showing benefit on blood pressure is lacking. More research is needed in this area.

 C


Early study suggests that taking a single dose of echinacea by mouth may lack effect on blood pressure. At this time, evidence showing benefit on blood pressure is lacking. More research is needed in this area.

 C


At this time, there is not enough evidence to support the use of echinacea for any type of cancer. Evidence of benefit is lacking and more study is needed.

 C


At this time, there is not enough evidence to support the use of echinacea for any type of cancer. Evidence of benefit is lacking and more study is needed.

 C


There is conflicting evidence on the effectiveness of echinacea for preventing the common cold. Although some studies report that echinacea may have this benefit, other results suggest that effects of echinacea are lacking. More studies are needed in this area.

 C


There is conflicting evidence on the effectiveness of echinacea for preventing the common cold. Although some studies report that echinacea may have this benefit, other results suggest that effects of echinacea are lacking. More studies are needed in this area.

 C


Early research suggests that echinacea may lack benefit in treating symptoms of the common cold in children. This may be due to parents not recognizing symptoms soon enough to begin treatment, or due to the dose of echinacea for use in children not being clear. It is also possible that echinacea is more effective in adults than children due to differences such as whether illness is caused by viral or bacterial infection, different viruses, different sites of infection, etc. Rash has been reported with echinacea use in children. More research is needed before a conclusion may be made.

 C


Early research suggests that echinacea may lack benefit in treating symptoms of the common cold in children. This may be due to parents not recognizing symptoms soon enough to begin treatment, or due to the dose of echinacea for use in children not being clear. It is also possible that echinacea is more effective in adults than children due to differences such as whether illness is caused by viral or bacterial infection, different viruses, different sites of infection, etc. Rash has been reported with echinacea use in children. More research is needed before a conclusion may be made.

 C


Limited research suggests that using echinacea to treat colds in children who tend to have ear infections may increase the risk of acute ear infection. More studies are needed before a conclusion may be made.

 C


Limited research suggests that using echinacea to treat colds in children who tend to have ear infections may increase the risk of acute ear infection. More studies are needed before a conclusion may be made.

 C


Early research suggests that taking echinacea by mouth may increase red blood cell production and oxygen intake in healthy men. These effects may be linked to improved athletic performance. However, more studies are needed before conclusions may be made.

 C


Early research suggests that taking echinacea by mouth may increase red blood cell production and oxygen intake in healthy men. These effects may be linked to improved athletic performance. However, more studies are needed before conclusions may be made.

 C


Early study reports that taking echinacea by mouth may help treat mild eye inflammation. More research is needed to confirm these findings.

 C


Early study reports that taking echinacea by mouth may help treat mild eye inflammation. More research is needed to confirm these findings.

 C


A combination therapy containing echinacea has been used to reduce inflammation after stomach and intestine surgery. Limited results suggest that this may reduce the duration of complications related to stomach and intestine inflammation. However, further details are lacking at this time.

 C


A combination therapy containing echinacea has been used to reduce inflammation after stomach and intestine surgery. Limited results suggest that this may reduce the duration of complications related to stomach and intestine inflammation. However, further details are lacking at this time.

 C


Taking echinacea by mouth has been studied for the treatment of recurrent genital herpes. Esberitox?, a German combination product containing echinacea, has been studied for herpes treatment. However, early research found a lack of benefit. More studies are needed in this area.

 C


Taking echinacea by mouth has been studied for the treatment of recurrent genital herpes. Esberitox?, a German combination product containing echinacea, has been studied for herpes treatment. However, early research found a lack of benefit. More studies are needed in this area.

 C


Early research suggests that herbal patches containing echinacea may help improve gum health in people who have gum disease. However, the effect of echinacea alone is still unclear. Further study is needed before a conclusion may be made.

 C


Early research suggests that herbal patches containing echinacea may help improve gum health in people who have gum disease. However, the effect of echinacea alone is still unclear. Further study is needed before a conclusion may be made.

 C


Research suggests that Esberitox? may treat herpes infection of the mouth. However, more research is needed before conclusions can be made.

 C


Research suggests that Esberitox? may treat herpes infection of the mouth. However, more research is needed before conclusions can be made.

 C


A study found that Erbavita?, a combination therapy containing echinacea, may reduce anal warts after surgery, compared to a lack of treatment. However, the effect of echinacea alone is unclear. More studies are needed before a conclusion may be made.

 C


A study found that Erbavita?, a combination therapy containing echinacea, may reduce anal warts after surgery, compared to a lack of treatment. However, the effect of echinacea alone is unclear. More studies are needed before a conclusion may be made.

 C


Echinacea has been studied alone and in combination therapies for immune system stimulation. It has been studied in people undergoing chemotherapy for cancer. However, evidence of benefit is unclear. More research is needed in this area before conclusions can be made.

 C


Echinacea has been studied alone and in combination therapies for immune system stimulation. It has been studied in people undergoing chemotherapy for cancer. However, evidence of benefit is unclear. More research is needed in this area before conclusions can be made.

 C


Esberitox? has been studied for middle ear and tonsil inflammation. Echinacea has been used together with the antibiotic erythromycin. This combination may help improve symptoms, recovery time, and well-being of people with tonsil inflammation. However, the effect of echinacea alone is unclear at this time. More research is needed before a conclusion may be made.

 C


Esberitox? has been studied for middle ear and tonsil inflammation. Echinacea has been used together with the antibiotic erythromycin. This combination may help improve symptoms, recovery time, and well-being of people with tonsil inflammation. However, the effect of echinacea alone is unclear at this time. More research is needed before a conclusion may be made.

 C


Esberitox? N has been studied for its potential effects on immune cell activity. The herbal supplement was shown to affect the immune system and natural resistance in people with lymphoma. However, the effects of echinacea alone are unclear. More research is needed before a conclusion may be made.

 C


Esberitox? N has been studied for its potential effects on immune cell activity. The herbal supplement was shown to affect the immune system and natural resistance in people with lymphoma. However, the effects of echinacea alone are unclear. More research is needed before a conclusion may be made.

 C


Early studies have found conflicting results for the use of echinacea in treating low white blood cell count caused by radiation. The combination product Esberitox?, which contains echinacea, and the dry extract product Echinacea? have both been studied. More research is needed in this area.

 C


Early studies have found conflicting results for the use of echinacea in treating low white blood cell count caused by radiation. The combination product Esberitox?, which contains echinacea, and the dry extract product Echinacea? have both been studied. More research is needed in this area.

 C


Echinacea has been used to treat skin wounds. Esberitox? has been studied for skin conditions. Further research is needed before a conclusion may be made.

 C


Echinacea has been used to treat skin wounds. Esberitox? has been studied for skin conditions. Further research is needed before a conclusion may be made.

 C


A throat spray containing echinacea and sage may be as effective as other sprays for sore throat relief. However, more studies are needed in this area.

 C


A throat spray containing echinacea and sage may be as effective as other sprays for sore throat relief. However, more studies are needed in this area.

 C


Early research reports that the herbal product Esberitox? N may improve response to the hepatitis B vaccine. However, the effect of echinacea alone is unclear at this time. More studies are needed before a conclusion may be made.

 C


Early research reports that the herbal product Esberitox? N may improve response to the hepatitis B vaccine. However, the effect of echinacea alone is unclear at this time. More studies are needed before a conclusion may be made.

 C


Some research suggests that using echinacea together with Spectazole?, a prescription cream, may result in less frequent vaginal yeast infections. Studies also suggest that that echinacea extract may block yeast growth. Although not well studied in humans, PolinaceaT, which contains echinacea root extract, may stimulate the immune system. More research is needed.

 C


Some research suggests that using echinacea together with Spectazole?, a prescription cream, may result in less frequent vaginal yeast infections. Studies also suggest that that echinacea extract may block yeast growth. Although not well studied in humans, PolinaceaT, which contains echinacea root extract, may stimulate the immune system. More research is needed.

 C


Early study suggests that echinacea may lack an effect in the prevention and treatment of warts on the skin. More well-designed research is needed in this area.

 C


Early study suggests that echinacea may lack an effect in the prevention and treatment of warts on the skin. More well-designed research is needed in this area.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. 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 healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
To treat anxiety, 20-40 milligrams of echinacea have been taken by mouth daily for seven days.
To improve exercise performance, five 400 milligram doses of echinacea have been taken by mouth four times daily for 28 days. A dose of 8,000 milligrams of echinacea has been taken by mouth once 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? (5 milliliters each) have been taken by mouth in a single day at onset of two symptoms of common cold, followed by three doses of 5 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 dose 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 dose 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 176-300 milligrams of Echinacea purpurea or 300 milligrams of Echinacea angustifolia have been taken by mouth three times daily for 1-8 weeks before a virus challenge, followed by continuation of treatment for five or seven days. 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. A dose of 4 milliliters of echinacea juice has been taken by mouth twice daily for eight weeks. Pressed juice of Echinacea purpurea (Echinacin? EC31) has been taken by mouth once daily for 28 days. A dose of 2,400 milligrams (0.9 milliliters) of Echinaforce? has been taken by mouth daily in three divided doses, then increased to 4,000 milligrams daily in five divided doses for a total of four months. A dose of 200 milligrams of Polinacea? has been taken by mouth daily for 15 days, then reduced to 100 milligrams daily for 15 days, then finally reduced to 100 milligrams every other day for 60 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 daily in divided doses 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 daily dose equivalent to 900 milligrams of dried echinacea root); and for echinacea tea, typically 2 teaspoons (4 grams of powdered echinacea herb) simmered in boiling water for 10 minutes, taken daily for 5-7 days. Eight doses of 5 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? has also been taken by mouth in 4 milliliter doses for seven days. Echinaforce? (6.78 milligrams of Echinacea purpurea extract) and a 7X concentration (48.27 milligrams) has been taken by mouth. Twenty drops of Echinaguard? (Echinacea purpurea sap) has 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 1 milliliter of Echinacea angustifolia or Echinacea purpurea root extract in 30 percent 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 1 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 in two tablet doses four times daily for one day, followed by one tablet doses four times daily for four days.
To treat mild 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 percent pressed herb juice applied to the skin daily.
For cancer, 300 milligrams per meter squared of cyclophosphamide have been given through an intravenous (IV) tube every 28 days, 60 milligrams per meter squared of Echinacin? have been injected into the muscle, and 30 milligrams per meter squared of thymostimulin have been injected into the muscle on days 3-10 after cyclophosphamide, then twice weekly. A solution containing 2 milligrams of an echinacea polysaccharide has been given through IV 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, as severe reactions have been reported.

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.

Interactions

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, anti-platelet drugs such as clopidogrel (Plavix?), and non-steroidal 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 increased in the blood, and may cause increased effects or 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 kidneys, agents that affect the immune system, agents toxic to the liver, agents that increase light sensitivity, agents that treat muscle spasms, agents that treat retroviral infections (HIV), anesthesia, antibiotics, anticancer agents, anti-inflammatories, antiviral agents, anxiety agents, caffeine, cardiac glycosides, corticosteroids, dental agents, disulfiram (Antabuse?), econazole nitrate (Spectazole?), metronidazole (Flagyl?), P-glycoprotein-regulated agents, and steroids.

Attribution

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).

Bibliography

Barrett B, Brown R, Rakel D, et al. Placebo effects and the common cold: a randomized controlled trial. Ann.Fam.Med 2011;9(4):312-322.
Bensch K, Tiralongo J, Schmidt K, et al. Investigations into the antiadhesive activity of herbal extracts against Campylobacter jejuni. Phytother.Res 2011;25(8):1125-1132.
Bright-Gbebry M, Makambi KH, Rohan JP, et al. Use of multivitamins, folic acid and herbal supplements among breast cancer survivors: the black women's health study. BMC.Complement Altern.Med 2011;11:30.
De Hert S, Imberger G, Carlisle J, et al. Preoperative evaluation of the adult patient undergoing non-cardiac surgery: guidelines from the European Society of Anaesthesiology. Eur.J Anaesthesiol. 2011;28(10):684-722.
Fonseca BL, dos Santos BC, Martins P, et al. Neuroprotective effects of a new skin care formulation following ultraviolet exposure. Cell Prolif. 2012;45(1):48-52.
He SM, Chan E, and Zhou SF. ADME properties of herbal medicines in humans: evidence, challenges and strategies. Curr.Pharm.Des 2011;17(4):357-407.
Hudson JB. Applications of the phytomedicine Echinacea purpurea (Purple Coneflower) in infectious diseases. J Biomed.Biotechnol. 2012;2012:769896.
Isbaniah F, Wiyono WH, Yunus F, et al. Echinacea purpurea along with zinc, selenium and vitamin C to alleviate exacerbations of chronic obstructive pulmonary disease: results from a randomized controlled trial. J Clin.Pharm.Ther 2011;36(5):568-576.
Kowalsky PE. Common interactions with herbal supplements and prescription drugs. AACN.Adv.Crit Care 2011;22(2):101-106.
Kumar A, Rinwa P, and Chhabra M. Pharmacotherapeutics of Echinacea purpurea: Gardening shelf to Clinic. J Pharm Educ Res 2011;2(2):45-54.
Ma H, Carpenter CL, Sullivan-Halley J, et al. The roles of herbal remedies in survival and quality of life among long-term breast cancer survivors--results of a prospective study. BMC.Cancer 2011;11:222.
Molto J, Valle M, Miranda C, et al. Herb-drug interaction between Echinacea purpurea and darunavir-ritonavir in HIV-infected patients. Antimicrob.Agents Chemother. 2011;55(1):326-330.
Sharma M, Schoop R, Suter A, et al. The potential use of Echinacea in acne: control of Propionibacterium acnes growth and inflammation. Phytother.Res 2011;25(4):517-521.
Smith CA, Collins CT, and Crowther CA. Aromatherapy for pain management in labour. Cochrane Database.Syst.Rev. 2011;(7):CD009215.
Walsh NP, Gleeson M, Pyne DB, et al. Position statement. Part two: Maintaining immune health. Exerc.Immunol.Rev. 2011;17:64-103.