Echinacea

Updated | 2018-10-29


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Echinacea


Overview

Botanical Name: Echinacea


Order: Asterales


Family: Asteraceae


Various North American species in the genus Echinacea are used for manufacturing herbal supplements containing Echinacea.



Evidence

Strong:

-

Good:

-

Promising:

  • Gingivitis, mouthwashes and patches containing Echinacea [1-3]
  • T-Cell Increase (Immune Stimulant) [4-11]

Conflicting (Unclear):

  • Common Cold, there is a possibility of a placebo effect [Barrett et al. 2011]; however, a blend of Echinacea / Thuja species / Baptista species may be more effective in relieving colds [12-25]
  • Upper Respiratory Tract Infections (URTIs), Echinacea blends with zinc / selenium / vitamin C; Thuja species / Baptista species; Malabar nut / Siberian ginseng; or propolis / vitamin C may be more effective [26-37]

Limited Evidence:

  • Anal Warts, an oral supplement of Echinacea / Uncaria species / Tabebuja species / papaya / grapefruit / Andrographis paniculata [38]
  • Autoimmune Eye Inflammation [39]
  • Chemotherapy Induced Leukopenia (Low White Blood Cell Count) [40]
  • Flu [41-42]
  • Oral Anti-Bacterial (for Bad Breath), an oral supplement of Echinacea / sage / lavender / mastic gum or only Echinacea [43-44]
  • Skin Reddening from Mosquito Bite, an ointment consisting of Echinacea / Ledum palustre / witch hazel / Urtica urens [45]
  • Warts, an oral supplement of Echinacea / zinc / probiotics / methionine [46-47]
  • Sore Throat, an oral supplement of Echinacea / sage [48]

No Evidence:

  • Ear Infection in Children [49]
  • Genital Herpes [50]

No Clinical Research:

All other conditions.


Side Effects
Side effects may include:
  • Allergic Reactions (and severe allergic reactions in rare cases)
  • Difficulty Breathing
  • Dizziness
  • Gastrointestinal Upset
  • Headache
  • Itching
  • Rashes
Precautions and Adverse Events:
  • Avoid or contact a licensed healthcare practitioner, if you have allergies to plants in the family Asteraceae (ragweed, chamomile, etc.), collagenosis, rheumatoid arthritis, lupus, leukemia, multiple sclerosis (MS), tuberculosis (TB), HIV infection, AIDS, other auto-immune disorders (Echinacea appears to be an immune-stimulant).
  • In some cases Echinacea may cause erythema nodosum (inflammation of the fat cells under the skin), hypereosinophilia (increase eosinophil, a type of white blood cell), severe allergic reactions, decrease blood pressure.
  • There have been reports of Echinacea causing hypersensitive allergic responses such as swelling of the face, asthma, urticaria (hives), anaphylaxis, angioedema, swollen tongue, inflammation of the liver.
  • Use Echinacea when necessary; long-term use of Echinacea may cause it be less effective.
  • In isolated cases, topical application of Echinacea has caused erythema (reddening of the skin), exanthema (widespread rashes), pruritus (itching).
  • A report of long-term use of Echinacea may have caused leukopenia.
  • Echinacea may have caused a case of autoimmune hepatitis.
  • Taking Echinacea intravenously may worsen diabetes.
[51-63]


Pregnant or Nursing

Taking Echinacea during pregnancy and breast-feeding may not cause adverse events. However, in general, there is not enough information on the use of supplements containing Echinacea during pregnancy and breast-feeding, so consult a licensed healthcare practitioner before use or avoid use. A pregnant woman experienced taste disturbances while taking Echinacea. [51-63]



Interactions

Major

-

Moderate

  • Drugs changed by Cytochrome P450s (CYPs) in the liver
  • Azathioprine
  • Basiliximab
  • Corticosteroids
  • Cyclosporine (Ciclosprin)
  • Daclizumab
  • Drugs to Prevent Organ Transplant Rejection
  • Etoposide (and potentially other chemotherapeutic drugs changed in the liver); an interaction decreased the amount of platelets in the blood
  • Immunosuppressant Drugs
  • Muromonab
  • Mycophenolic Acid
  • Mycophenolate Mofetil (pro-drug of mycophenolic acid)
  • Sirolimus
  • Tacrolimus
[64-71]

Potential

  • Caffeine
  • Midazolam
  • Echinacea may NOT interact with Darunavir, Digoxin, Indinavir, Lopinavir, Ritonavir, Warfarin
[64-71]


Dosage

Echinacea is not a "drug", so the best doses have not been thoroughly established. Make sure to follow the specific product instructions and take as directed on the label, or consult a licensed healthcare practitioner before use.



Compounds
Echinacea compounds


References

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The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J. 2002 Nov;4(11 Suppl):919-22. 6. Brush J, Mendenhall E, Guggenheim A, Chan T, Connelly E, Soumyanath A, Buresh R, Barrett R, Zwickey H. The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD69 expression and immune cell activation in humans. Phytother Res. 2006 Aug;20(8):687-95. 7. Goel V, Lovlin R, Chang C, Slama JV, Barton R, Gahler R, Bauer R, Goonewardene L, Basu TK. A proprietary extract from the echinacea plant (Echinacea purpurea) enhances systemic immune response during a common cold. Phytother Res. 2005 Aug;19(8):689-94. 8. 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):138-49. 9. Melchart D, Linde K, Worku F, Sarkady L, Holzmann M, Jurcic K, Wagner H. Results of five randomized studies on the immunomodulatory activity of preparations of Echinacea. J Altern Complement Med. 1995 Summer;1(2):145-60. 10. Schwarz E, Metzler J, Diedrich JP, Freudenstein J, Bode C, Bode JC. Oral administration of freshly expressed juice of Echinacea purpurea herbs fail to stimulate the nonspecific immune response in healthy young men: results of a double-blind, placebo-controlled crossover study. J Immunother. 2002 Sep-Oct;25(5):413-20. 11. Zwickey H, Brush J, Iacullo CM, Connelly E, Gregory WL, Soumyanath A, Buresh R. The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD25 expression in humans: a pilot study. Phytother Res. 2007 Nov;21(11):1109-12. 12. Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D'Alessio D. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2002 Dec 17;137(12):939-46. 13. 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The "-" means there is no information.