Echinacea (Echinacea purpurea)
Be aware that the U.S. Food and Drug Administration does not strictly
regulate herbs and dietary supplements. There is no guarantee of strength,
purity or safety of products containing or claiming to contain Echinacea.
Decisions to use herbs or supplements should be carefully considered. Individuals
using prescription drugs should discuss taking herbs or supplements with
a pharmacist or health care professional before starting.
Scientists have studied Echinacea for the following health problems:
Common cold treatment
Although multiple low-quality studies have previously suggested that taking
Echinacea orally when cold symptoms first begin may reduce the length and
severity of the symptoms, a clinical trial reported in July 2005 did not
demonstrate any clinical benefit. The sum of the evidence cannot support
Echinacea as a treatment for the common cold.
Common cold prevention
Studies have found that taking Echinacea is not helpful for preventing the
common cold. Most experts do not recommend chronic use of Echinacea for
preventing the common cold.
Respiratory tract infections
Study results of Echinacea for preventing or treating respiratory tract
infections are mixed. Further research is needed before a conclusion can
Echinacea has also been studied as a treatment for the toxic effects of cancer
X-ray therapy (radiation-induced leukopenia), for skin wound healing and
for genital herpes, but there are no clear answers in these areas. Early
evidence suggests that when Echinacea is used at the same time as the
prescription cream econazole nitrate (Spectazole), vaginal yeast infections
(Candida) may occur less frequently.
Echinacea has been suggested for many other uses, based on tradition or
on scientific theories. However, these uses have not been thoroughly studied
in humans, and there is limited scientific evidence about safety or
effectiveness. Some of these suggested uses are for conditions that are
potentially very serious and even life-threatening. You should consult a
health care professional before taking Echinacea for any unproven use.
Urinary tract infections
Whooping cough (pertussis)
People with allergies to plants in the Asteraceae or Compositae
family (ragweed, chrysanthemums, marigolds, daisies) are more likely to have
allergic reactions to Echinacea. Multiple cases of anaphylactic shock (severe
allergic reaction) and allergic rashes have been reported; these problems
may occur more commonly in people with asthma or other allergies. Echinacea
injections have caused severe reactions and are not recommended.
Few side effects have been reported from Echinacea at the recommended doses.
The most common complaints include stomach discomfort and nausea, although
these are unusual. Rarely, skin rash, drowsiness, headaches, dizziness or
muscle aches may occur. There have been several cases of hepatitis (liver
inflammation) in people taking echinacea, although it is not clear that echinacea
was the cause.
Some natural medicine experts discourage the use of Echinacea by people with
conditions affecting the immune system, such as AIDS or HIV, some types of
cancer, multiple sclerosis, tuberculosis and rheumatologic diseases (rheumatoid
arthritis, lupus, etc.). However, there are no specific studies or reports
in this area, and the risks of Echinacea use with these conditions are not
Long-term use of Echinacea may cause low white blood cell counts (leucopenia).
Pregnancy And Breast-Feeding
Echinacea cannot be recommended during pregnancy or breast-feeding. Many
experts believe that oral Echinacea is safe, but currently there is not enough
information. Pregnant women should absolutely avoid tinctures because of
the high alcohol content (15 percent to 90 percent).
Interactions with drugs, supplements and other herbs have not been thoroughly
studied. The interactions listed below have been reported in scientific
publications. If you are taking prescription drugs, speak with a health care
professional or pharmacist before using herbs or dietary supplements.
Interactions With Drugs
People taking amoxicillin may want to avoid Echinacea based on one published
case of a life-threatening reaction, although the details of this case are
not very clear. The high alcohol content in some echinacea tinctures may
lead to vomiting if used with the drugs disulfiram (Antabuse) or metronidazole
(Flagyl). Because Echinacea is believed to affect the immune system, people
taking immunosuppressants, such as corticosteroids, drugs for rheumatologic
diseases (rheumatoid arthritis, lupus, etc.) or drugs to prevent rejection
of transplanted organs, should consult a health care professional or pharmacist
before using Echinacea. Examples of such drugs are azathioprine, cyclosporine
and prednisone. People should use caution when taking Echinacea with
acetaminophen (Tylenol) because liver and kidney damage may occur.
Echinacea may affect the way that certain drugs are broken down by the liver.
Interactions With Herbs And Dietary Supplements
Very few interactions between Echinacea and herbs and supplements have been
reported. Echinacea is sometimes sold in combination with goldenseal
(Hydrastis canadensis), and goldenseal may reduce the body's ability
to absorb vitamin B. Echinacea may affect the way that certain herbs and
supplements are broken down by the liver.
The doses listed below are based on scientific research, publications
or traditional use. Because most herbs and supplements have not been thoroughly
studied or monitored, safety and effectiveness may not be proven. Brands
may be made differently, with variable ingredients even within the same brand.
Combination products often contain small amounts of each ingredient, and
may not be effective. The appropriate dosing should be discussed with a health
care professional before starting therapy; always read the recommendations
on a product's label. The dosing for unproven uses should be approached
cautiously, because scientific information is limited in these areas.
In general, experts suggest using Echinacea for no longer than eight weeks.
There is limited scientific information about use for longer periods of time.
For The Common Cold
Adults (Aged 18 Or Older)
Capsules (of powdered herb): A dose of 500 to 1,000 milligrams three
times per day for five to seven days has been taken by mouth.
Expressed juice: A dose of six to nine milliliters per day, divided
into two or three doses, for five to seven days has been taken by mouth.
Tincture: A dose of 0.75 to 1.5 milliliters (1:5) has been gargled
and swallowed two to five times per day for five to seven days.
Tea: A tea made by simmering two teaspoons of coarsely powdered herb
(four grams of Echinacea) in one cup of boiling water for 10 minutes has
been consumed daily for five to seven days.
Children (Younger Than 18): The dosing and safety of Echinacea
have not been studied thoroughly in children. Discuss doses with a health
care professional before your child starts therapy. Some natural medicine
practitioners recommend basing children's doses on weight; take the child's
weight in pounds, divide by 150, then multiply that number by the recommended
adult dose (that will give the child's dose). However, there is no scientific
support or safety data for this formula.
For Other Conditions
Echinacea is also available in preparations for the skin (called topical
preparations), but no specific doses have been shown to be safe or effective.
Although Echinacea has been suggested for many conditions, it has been most
studied as a treatment for the common cold. Study results of Echinacea for
reducing the length and severity of symptoms if taken at the first sign of
a cold are mixed. Echinacea has not been proven effective for any other health
conditions. It should be avoided by pregnant women and by individuals taking
amoxicillin. Remember that tinctures can contain large amounts of alcohol
and may cause nausea or vomiting if taken with the drugs disulfiram (Antabuse)
or metronidazole (Flagyl). Echinacea should be used in recommended doses
for no longer than eight weeks. Consult a health care professional immediately
if you experience side effects.
The information in this monograph was prepared by the professional staff
at Natural Standard, based on thorough systematic review of scientific evidence.
The material was reviewed by the Faculty of the Harvard Medical School with
final editing approved by Natural Standard.
Standard: An organization that produces scientifically based reviews
of complementary and alternative medicine (CAM) topics
for Complementary and Alternative Medicine (NCCAM): A division of the
U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Echinacea
Natural Standard reviewed more than 525 articles to prepare the professional
monograph from which this version was created.
Some of the more recent studies are listed below:
Barrett B. Medicinal properties of Echinacea: a critical review. Phytomedicine
Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with
unrefined Echinacea: a randomized,double-blind, placebo-controlled trial.
Ann Intern Med 2002;Dec 17, 137(12):939-946. Comment in: Ann Intern Med 2002;Dec
17, 137(12):1001-1002. Thorax 2003; Mar, 58(3):230. Summary for patients
in: Ann Intern Med 2002;Dec 17, 137(12):118.
Barrett B, Vohmann M, Calabrese C. Echinacea for upper respiratory tract
infection. J Fam Pract 1999;48(8):628-635.
Bielory L. Adverse reactions to complementary and alternative medicine: ragweed's
cousin, the coneflower (echinacea), is "a problem more than a sneeze". Ann
Allergy Asthma Immunol 2002;Jan, 88(1):7-9. Comment in: Ann Allergy Asthma
Immunol 2002;Jan, 88(1):42-51.
Brinkeborn RM, Shah DV, Degenring FH. Echinaforce and other Echinacea fresh
plant preparations in the treatment of the common cold: a randomized, placebo
controlled, double-blind clinical trial. Phytomed 1999;6(1):1-6.
Cohen HA, Varsano I, Kahan E, et al. Effectiveness of an herbal preparation
containing echinacea, propolis, and vitamin C in preventing respiratory tract
infections in children: a randomized,double-blind, placebo-controlled,
multicenter study. Arch Pediatr Adolesc Med 2004;Mar, 158(3):217-221.
Del Mar CB, Glasziou P, BMJ Publishing Group. Upper respiratory tract infection.
Am Fam Physician 2002;Dec 1, 66(11):2143-2144.
Dorn M, Knick E, Lewith G. Placebo-controlled, double blind study of
Echinaceae pallidae radix in upper respiratory tract infections.
Compliment Ther Med 1997;5:40-42.
Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure
to Echinacea: a prospective controlled study. Arch Intern Med
Giles JT, Palat CT III, Chien SH, et al. Evaluation of Echinacea for treatment
of the common cold. Pharmacother 2000;20(6):690-697.
Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea
preparation (Echinilin) for the treatment of the common cold: a randomized,
double-blind, placebo-controlled trial. J Clin Pharm Ther 2004;Feb, 29(1):75-83.
Grimm W, Muller HH. A randomized controlled trial of the effect of fluid
extract of Echinacea purpurea on the incidence and severity of colds
and respiratory infections. Am J Med 1999;106(2):138-143.
Henneicke-von Zepelin H, Hentschel C, et al. Efficacy and safety of a fixed
combination phytomedicine in the treatment of the common cold (acute viral
respiratory tract infection): results of a randomised, double blind, placebo
controlled, multicentre study. Curr Med Res Opin 1999;15(3):214-227.
Hoheisel O, Sandberg M, Bertram S, et al. Echinagard treatment shortens the
course of the common cold: a double blind, placebo controlled clinical trial.
Eur J Clin Res 1997;9:261-269.
Kemp DE, Franco KN. Possible leukopenia associated with long-term use of
echinacea. J Am Board Fam Pract 2002;Sep-Oct, 15(5):417-419.
Kim LS, Waters RF, Burkholder PM. Immunological activity of larch arabinogalactan
and Echinacea: a preliminary, randomized, double-blind, placebo-controlled
trial. Altern Med Rev 2002;Apr, 7(2):138-149.
Lindenmuth GF, Lindenmuth EB. The efficacy of Echinacea compound herbal tea
preparation on the severity and duration of upper respiratory and flu symptoms:
a randomized, double-blind placebo-controlled study. J Altern Complement
Med 2000; 6(4):327-334.
Melchart D, Clemm C, Weber B, et al. Polysaccharides isolated from Echinacea
purpurea herb cell cultures to counteract undesired effects of chemotherapy:
a pilot study. Phytother Res 2002;Mar, 16(2):138-142.
Melchart D, Linde K, Fischer P, et al. Echinacea for preventing and treating
the common cold. Cochrane Database Syst Rev 2000;(2):CD000530.
Melchart D, Walther E, Linde K, et al. Echinacea root extracts for the prevention
of upper respiratory tract infections: a double-blind, placebo-controlled
randomized trial. Arch Fam Med 1998;7(6):541-545.
Mullins R. Allergic reactions to Echinacea. J Allergy Clin Immunol 2000;105(1
Mullins RJ, Heddle R. Adverse reactions associated with Echinacea: the Australian
experience. Ann Allergy Asthma Immunol 2002;Jan, 88(1):42-51. Comment in:
Ann Allergy Asthma Immunol 2002;Jan, 88(1):7-9.
Paulsen E. Contact sensitization from Compositae-containing herbal
remedies and cosmetics. Contact Dermatitis 2002;Oct, 47(4):189-198.
Scaglione F, Lund B. Efficacy in the treatment of the common cold of a
preparation containing an echinacea extract. Internat J Immunother
Soon SL, Crawford RI. Recurrent erythema nodosum associated with Echinacea
herbal therapy. J Am Acad Dermatol 2001;44(2):298-299.
Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative controlled
study of Andrographis paniculata fixed combination, Kan Jang and an
Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory
disease in children. Phytother Res 2004;Jan, 18(1):47-53.
Sperber SJ, Shah LP, Gilbert RD, et al. Echinacea purpurea for prevention
of experimental rhinovirus colds. Clin Infect Dis 2004;May 15, 38(10):1367-1371.
Epub 2004;Apr 26.
Turner RB, Bauer R, Woelkart K, et al. An evaluation of Echinacea
angustifolia in experimental rhinovirus infections. N Engl J Med 2005;Jul
Vonau B, Chard S, Mandalia S, et al. Does the extract of the plant Echinacea
purpurea influence the clinical course of recurrent genital herpes? Int
J STD AIDS 2001;12(3):154-158.
Yale SH, Liu K. Echinacea purpurea therapy for the treatment of the
common cold: a randomized, double-blind, placebo-controlled clinical trial.
Last updated August 01, 2005