What is it?
Echinacea is an herb. Several species of the echinacea plant are used to make medicine from its leaves, flower, and root.
Echinacea is widely used to fight infections, especially the common cold and other upper respiratory infections. Some people take echinacea at the first sign of a cold, hoping they will be able to keep the cold from developing. Other people take echinacea after cold symptoms have started, hoping they can make symptoms less severe. The people who use echinacea to treat symptoms have the right idea. Research to date shows that echinacea probably modestly reduces cold symptoms, but it’s not clear whether it helps prevent colds from developing.
Echinacea is also used against many other infections including the flu, urinary tract infections, vaginal yeast infections, genital herpes, bloodstream infections (septicemia), gum disease, tonsillitis, streptococcus infections, syphilis, typhoid, malaria, and diphtheria.
Other uses not related to infection include chronic fatigue syndrome (CFS), rheumatism, migraines, acid indigestion, pain, dizziness, rattlesnake bites, and attention deficit-hyperactivity disorder (ADHD).
Sometimes people apply echinacea to their skin to treat boils, abscesses, skin wounds, ulcers, burns, eczema, psoriasis, UV radiation skin damage, herpes simplex, bee stings, and hemorrhoids.
Echinacea species are native to North America and were used as traditional herbal remedies by the Great Plains Indian tribes. Later, settlers followed the Indians’ example and began using echinacea for medicinal purposes as well. For a time, echinacea enjoyed official status as a result of being listed in the US National Formulary from 1916-1950. However, use of echinacea fell out of favor in the United States with the discovery of antibiotics and due to the lack of scientific evidence supporting its use. But now, people are becoming interested in echinacea again because some antibiotics don’t work as well as they used to against certain bacteria.
Commercially available echinacea products come in many forms including tablets, juice, and tea.
There are concerns about the quality of some echinacea products on the market. Echinacea products are frequently mislabeled, and some may not even contain echinacea, despite label claims. Don’t be fooled by the term “standardized.” It doesn’t necessarily indicate accurate labeling. Also, some echinacea products have been contaminated with selenium, arsenic, and lead.
How effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for ECHINACEA are as follows:
Possibly effective for...
- Common cold. Many scientific studies show that taking some echinacea products when cold symptoms are first noticed can modestly reduce symptoms of the common cold in adults. But other scientific studies show no benefit. The problem is that scientific studies have used different types of echinacea plants and different methods of preparation. Since the studies have not been consistent, it is not surprising that different studies show different results. If it helps for treating a cold, the benefit will likely be modest at best. It also isn’t clear whether echinacea can help PREVENT colds. Any benefit is likely to be modest.
- Vaginal yeast infections. Taking echinacea and applying a medicated cream to the skin seems to lower the recurrence rate of infection to about 16% compared to 60.5% with econazole alone.
Possibly ineffective for...
- Ear infection. Early research suggests that taking a liquid echinacea extract does not prevent ear infections in children who are prone to ear infections. The risk of ear infection was actually increased by 1.59 times in children receiving echinacea.
Insufficient evidence to rate effectiveness for...
- Anxiety. Early research suggests that taking 40 mg of echinacea daily for one week reduces anxiety. It does not seem to reduce anxiety when taken at a lower dose.
- Exercise performance. Early research shows that taking 8 grams of echinacea daily for 28 days improves breathing capacity during exercise in healthy men.
- Gingivitis. Early research suggests that applying a patch in the mouth or using a mouth rinse containing Centella asiatica, Echinacea purpurea, and Sambucus nigra for 14 days improves gingivitis in people with long-term gum disease.
- Genital herpes (Herpes simplex virus, HSV). Evidence on the effect of echinacea for the treatment of HSV is unclear. Some research shows that taking a specific echinacea extract (Echinaforce by Bioforce AG) 800 mg twice daily for 6 months does not seem to prevent or reduce the frequency or duration of recurrent genital herpes. However, other research shows that taking a combination product containing echinacea (Esberitox) 3-5 times daily reduces itchiness, tension, and pain in most people with HSV.
- Human papilloma virus (HPV). Early research shows that taking a combination product containing echinacea, Andrographis paniculata, grapefruit, papaya, Tabebuia, and Uncaria (Erbavita) daily for one month reduces the recurrence of anal warts in people who had surgical removal of anal warts.
- Influenza (flu). Taking echinacea by mouth might slightly reduce some symptoms of the flu. However, there is not enough evidence to know if echinacea can treat or prevent the flu.
- Low white blood cell count (Leukopenia). Administering a part of echinacea through the vein (intravenously) might reduce white blood cell loss caused by chemotherapy. In early research, taking 275 mg of echinacea by mouth twice daily for two weeks also reduced blood cell damage caused by radiation. In other research, taking 50 drops of an echinacea product (Esberitox N) three times daily in between chemoradiation treatments improved blood cell numbers in people who had received chemotherapy for 6 months or less, but not in people who had received chemotherapy for longer periods of time.
- Tonsillitis. Early research shows that spraying a specific product containing sage and echinacea every two hours up to 10 times daily for up to five days improved sore throat symptoms as well as commonly used drug sprays in people with tonsillitis. Other early research suggests that taking 50 drops of a product containing echinacea (Esberitox) three times daily for two weeks, along with an antibiotic, reduced sore throat and increased overall well-being in people with tonsillitis.
- Eye inflammation (Uveitis). Early research suggests that taking 150 mg of an echinacea product (Iridium, SOOFT, Montegiorgio, Ageoli, Italy) twice daily, in addition to eye drops and a steroid used to treat inflammation, for four weeks, does not improve vision any more than eye drops and steroids alone in people with eye inflammation.
- Warts. Early research suggests that taking 60 mg of echinacea by mouth daily for up to 3 months does not clear warts on the skin.
- Urinary tract infections (UTIs).
- Migraine headaches.
- Chronic fatigue syndrome (CFS).
- Bee stings.
- Attention deficit-hyperactivity disorder (ADHD).
- Other conditions.
More evidence is needed to rate echinacea for these uses.
Echinacea seems to activate chemicals in the body that decrease inflammation, which might reduce cold and flu symptoms.
Laboratory research suggests that echinacea can stimulate the body’s immune system, but there is no evidence that this occurs in people.
Echinacea also seems to contain some chemicals that can attack yeast and other kinds of fungi directly.
Echinacea is LIKELY SAFE for most people when used short-term. There is not enough information to know if echinacea is safe for long-term use. Some side effects have been reported such as fever, nausea, vomiting, unpleasant taste, stomach pain, diarrhea, sore throat, dry mouth, headache, numbness of the tongue, dizziness, insomnia, disorientation, and joint and muscle aches.
Echinacea is POSSIBLY SAFE in children. It seems to be safe in most children ages 2-11 years. However, about 7% of these children may experience a rash that could be due to an allergic reaction. There is some concern that allergic reactions to echinacea could be more severe in some children. For this reason, some regulatory organizations have recommended against giving echinacea to children under 12 years of age.
Echinacea is most likely to cause allergic reactions in children and adults who are allergic to ragweed, mums, marigolds, or daisies. If you have allergies, be sure to check with your healthcare provider before taking echinacea.
Applying echinacea to the skin can cause redness, itchiness, or a rash.
Special precautions & warnings:
Pregnancy or breast-feeding: Not enough is known about the use of echinacea during pregnancy and breast-feeding. Stay on the safe side and avoid use.
“Auto-immune disorders” such as such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), a skin disorder called pemphigus vulgaris, or others: Echinacea might have an effect on the immune system that could make these conditions worse. Don’t take echinacea if you have an auto-immune disorder.
An inherited tendency toward allergies (atopy): People with this condition are more likely to develop an allergic reaction to echinacea. It’s best to avoid exposure to echinacea if you have this condition.
Be cautious with this combination.
The body breaks down caffeine to get rid of it. Echinacea might decrease how quickly the body breaks down caffeine. Taking echinacea along with caffeine might cause too much caffeine in the bloodstream and increase the risk of side effects. Common side effects include jitteriness, headache, and fast heartbeat.
Etoposide is changed and broken down by the body. Echinacea might change how the body breaks down some medications. Taking echinacea along with etoposide might increase the side effects of etoposide. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the body.
Medications changed by the body (Cytochrome P450 3A4 (CYP3A4) substrates)
Some medications are changed and broken down by the body. Echinacea might change how the body breaks down some medications. Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the body.
Some medications changed by the body include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and many others.
Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Some medications are changed and broken down by the liver. Echinacea might decrease how quickly the liver breaks down some medications. Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the liver.
Some of the medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others
Medications that decrease the immune system (Immunosuppressants)
Echinacea can increase the activity of the immune system. Taking echinacea along with some medications that decrease the immune system might decrease these medications' effectiveness.
Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.
Be watchful with this combination.
Taking midazolam (Versed) with echinacea increases how much midazolam (Versed) the body absorbs. This might increase the effects and side effects of midazolam (Versed), but more information is needed.
Warfarin (Coumadin) is used to slow blood clotting. The body breaks down warfarin (Coumadin) to get rid of it. Echinacea might increase the breakdown and decrease the effectiveness of warfarin (Coumadin). Decreasing the effectiveness of warfarin (Coumadin) might increase the risk of clotting. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.
There are no known interactions with herbs and supplements.
There are no known interactions with foods.
The following doses have been studied in scientific research:
For treatment of upper respiratory infections including the common cold and influenza, a wide variety of doses have been used depending on how the echinacea is prepared. These preparations include:
- A tablet containing 6.78 mg of Echinacea purpurea crude extract based on 95% herb and 5% root (Echinaforce, Bioforce AG): two tablets given 3 times daily.
- Freeze-dried echinacea juice extract capsules: 100 mg three times daily.
- Echinacea purpurea herb juice: a daily dose of 6-9 mL for up to a maximum of 8 weeks. Echinacea purpurea herb juice has also been used in a dose of 20 drops every 2 hours for the first day followed by 20 drops three times daily until cold or flu symptoms improve.
- An echinacea pallida root tincture equivalent to 900 mg herb daily.
- An echinacea herbal compound tea (Echinacea Plus, Traditional Medicinals), consisting of leaves, flowers, and stems of Echinacea purpurea and Echinacea angustifolia plus dried extract of Echinacea purpurea root, has been used by drinking 5-6 cups of tea on the first day of symptoms and titrating down to 1 cup per day over the next 5 days. The tea is prepared by pouring 8 ounces of boiling water over one tea bag and steeping, covered, for 10-15 minutes.
- Echinacea liquid (Echinagard): 20 drops every 2 hours for the first day of symptoms, then 3 times daily for up to 10 days.
- A tablet containing 100 mg of a proprietary Echinacea angustifolia root extract (Monoselect Echinacea, PharmExtracta, Italy): 2 tablets daily for 15 days, then 1 tablet daily for 15 days, then 1 tablet every other day for 60 days to help prevent colds and the flu.
- Echinacea purpurea liquid: 0.9 mL 3 times daily for 4 months to help prevent colds.
American Cone Flower, Black Sampson, Black Susans, Brauneria Angustifolia, Brauneria Pallida, Comb Flower, Coneflower, Echinacea Angustifolia, Echinacea Pallida, Echinacea Purpurea, Echinaceawurzel, Échinacée, Échinacée Angustifolia, Échinacée Pallida, Échinacée Pourpre, Échinacée Purpurea, Equinácea, Fleur à Hérisson, Hedgehog, Igelkopfwurzel, Indian Head, Kansas Snakeroot, Narrow-Leaved Purple Cone Flower, Pale Coneflower, Purple Cone Flower, Purpursonnenhutkraut, Purpursonnenhutwurzel, Racine d'echininacea, Red Sunflower, Rock-Up-Hat, Roter Sonnenhut, Rudbeckie Pourpre, Schmallblaettrige Kegelblumenwurzel, Schmallblaettriger Sonnenhut, Scurvy Root, Snakeroot, Sonnenhutwurzel.
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).
To see all references for the Echinacea page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/981.html.
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