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Echinacea

 

Natural Standard Monograph, Copyright © 2014 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified health care professional before making decisions about therapies and/or health conditions.

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 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

 

Uses based on scientific evidence 

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 professional.

Grade* 

Common cold (treatment in adults) 

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 

Anxiety 

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

C 

Blood pressure control 

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 

Cancer (general) 

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 

Common cold (prevention in adults and children) 

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 

Common cold (treatment in children) 

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 

Ear infection 

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 

Exercise performance 

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 

Eye inflammation 

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

C 

Gastrointestinal inflammation (stomach and intestine inflammation) 

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 

Genital herpes 

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 

Gum disease 

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 

Herpes (cold sores) 

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

C 

Human papillomavirus (HPV) 

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 

Immune stimulant 

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 

Inflammation (head and neck) 

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 

Lymphoma (cancer of the immune system) 

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 

Radiation side effects 

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 

Skin wounds 

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 

Sore throat 

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 

Vaccine adjunct (increase response to vaccine) 

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 

Vaginal yeast infections 

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, Polinacea™, which contains echinacea root extract, may stimulate the immune system. More research is needed.

C 

Warts 

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 against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

For full grading rationale, click here.

Uses based on tradition or 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, ADHD, antioxidant, bacterial infection (staph, strep), bee stings, boils, bronchitis, catarrh (inflammation of nose and airways), diphtheria (bacterial infection of nose and throat), dizziness, eczema (itchy inflamed skin), flu, heart disease, hemorrhoids, HIV infection, indigestion, 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 (severe blood infection), sexually transmitted disease, snakebites, stomachache, sun protection, typhoid (infection causing diarrhea and rash), urinary disorders, urinary tract infection, whooping cough.


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 professional before starting a new therapy. Consult a healthcare professional 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

  • Echinacea is likely safe when taken by mouth or applied to the skin in suggested doses for up to eight weeks.
  • Echinacea is thought to be possibly safe when used in children and in pregnant women if taken as directed. However, more safety information is needed.
  • Use cautiously in people who have heart disease. Echinacea may cause abnormal or irregular heartbeat.
  • Caution is advised in people who are taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Use cautiously in people who have skin disorders. Echinacea may cause burning sensations, hives, itching, rashes, and skin redness.
  • Use cautiously when used in injectable form, especially for people who have diabetes, according to experts.
  • Use cautiously in people who are taking agents that may affect the immune system, agents that may affect the liver's processing of drugs, amoxicillin, corticosteroids, or kava.
  • Use tinctures cautiously in pregnant women and alcoholics, and in people who are taking disulfiram or metronidazole.
  • Use cautiously in people who have or are at risk of liver disorders or are taking a large amount of echinacea. Echinacea may cause liver damage.
  • Use cautiously in people who are taking agents that may be toxic to the liver (including anabolic steroids, amiodarone, methotrexate, and ketoconazole). Echinacea may cause liver inflammation.
  • Use cautiously in children who have colds. Echinacea may increase the risk of ear infection.
  • Use cautiously when used 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 people who have abnormally high iron levels, abnormal white blood cell count, AIDs, 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, HIV, kidney disease, mental disorders (anxiety or nervousness), multiple sclerosis, sleep disorders, stomach problems, and tuberculosis.
  • 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.
  • Avoid using in people who are preparing to undergo transplant surgery.
  • Echinacea may also cause anxiety and nervousness, bad taste, bronchitis, constipation, diarrhea, dizziness, dry throat, dry mouth, 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, sperm motility, stomach pain, upset stomach, 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 professional 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, 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.

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 other herbs or supplements may become too high in the blood. 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, astralagus, caffeine-containing herbs and supplements, cardiac glycosides, dental herbs and supplements, glycyrrhiza, herbs and supplements that are cleared from the body by the kidneys, herbs and supplements that affect the immune system, herbs and supplements toxic to the liver, herbs and supplements that increase light sensitivity, herbs and supplements that treat anxiety, herbs and supplements that treat muscle spasms, kava, P-glycoprotein-regulated agents, and vitamins.

Authors

Selected References

Natural Standard developed the above evidence-based information based on a 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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Hudson JB. Applications of the phytomedicine Echinacea purpurea (Purple Coneflower) in infectious diseases. J Biomed.Biotechnol. 2012;2012:769896.
  8. 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.
  9. Kowalsky PE. Common interactions with herbal supplements and prescription drugs. AACN.Adv.Crit Care 2011;22(2):101-106.
  10. Kumar A, Rinwa P, and Chhabra M. Pharmacotherapeutics of Echinacea purpurea: Gardening shelf to Clinic. J Pharm Educ Res 2011;2(2):45-54.
  11. 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.
  12. 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.
  13. 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.
  14. Smith CA, Collins CT, and Crowther CA. Aromatherapy for pain management in labour. Cochrane Database.Syst.Rev. 2011;(7):CD009215.
  15. Walsh NP, Gleeson M, Pyne DB, et al. Position statement. Part two: Maintaining immune health. Exerc.Immunol.Rev. 2011;17:64-103.
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