ECHINACEA: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

Overview

Echinacea (E. angustifolia, E. purpurea, E. pallida.) are plants related to sunflowers and ragweed. The leaf, flower, and root are used as medicine.

Echinacea species are native to areas east of the Rocky Mountains in the United States. Echinacea seems to activate chemicals in the body that decrease inflammation. It might also increase the body's immune system.

Echinacea is most commonly used for the common cold and other infections, but there is no good scientific evidence to support most of these uses. There is also no good evidence to support using echinacea for COVID-19.

Uses & Effectiveness ?

Possibly Effective for

Common cold. Taking echinacea by mouth while still healthy might help prevent some colds in adults, but the benefit is probably small. Taking echinacea after catching a cold doesn't seem to improve symptoms. It isn't clear if echinacea is helpful in children.

There is interest in using echinacea for a number of other purposes, but there isn't enough reliable information to say whether it might be helpful.

Side Effects

When taken by mouth: Echinacea is likely safe for most people in the short-term. Various echinacea products have been used safely for up to 10 days. Some products, such as Echinaforce (A. Vogel Bioforce AG), have been used safely for up to 6 months.

The most common side effects are stomach pain, constipation, diarrhea, heartburn, vomiting, and rash. Allergic reactions might occur in some people, especially in people who are allergic to ragweed, mums, marigolds, or daisies.

When applied to the skin: Echinacea is possibly safe when used short-term. A cream (Linola Plus Cream) containing echinacea has been used safely for up to 12 weeks. Applying echinacea to the skin might cause redness, itchiness, or a rash.

Special Precautions and Warnings

Pregnancy: Echinacea is possibly safe when taken by mouth for up to 7 days when pregnant. There isn't enough reliable information to know if using echinacea for longer than 7 days is safe.

Breast-feeding: There isn't enough reliable information to know if echinacea is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: Echinacea is possibly safe when taken by mouth or applied to the skin for up to 10 days. Taking echinacea by mouth seems to be safe in most children ages 2-11 years, but rashes due to an allergic reaction can occur. There is some concern that allergic reactions to echinacea could be more severe in some children.

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.

"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.

Interactions ?

Moderate Interaction

Be cautious with this combination

Caffeine interacts with ECHINACEA
Echinacea might decrease how quickly the body breaks down caffeine. Taking echinacea along with caffeine might increase levels of caffeine and increase the risk of side effects from caffeine, such as jitteriness, headache, and fast heartbeat.
Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with ECHINACEA
Some medications are changed and broken down by the liver. Echinacea might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interacts with ECHINACEA
Some medications are changed and broken down by the liver. Echinacea might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.
Medications that decrease the immune system (Immunosuppressants) interacts with ECHINACEA
Echinacea can increase the activity of the immune system. Some medications, such as those used after a transplant, decrease the activity of the immune system. Taking echinacea along with these medications might decrease the effects of these medications.
Etoposide (VePesid) interacts with ECHINACEA
Echinacea might decrease how quickly the body breaks down etoposide. Taking echinacea along with etoposide might increase the side effects of etoposide.

Minor Interaction

Be watchful with this combination

Midazolam (Versed) interacts with ECHINACEA
Echinacea seems to affect how quickly the body breaks down midazolam. Taking midazolam with echinacea might increase the side effects or decrease the effects of midazolam.
Warfarin (Coumadin) interacts with ECHINACEA
Warfarin is used to slow blood clotting. Echinacea might increase the breakdown of warfarin and decrease how well warfarin works. This might increase your risk of having a clot. Be sure to have your blood checked regularly. The dose of your warfarin might need to be changed.
Darunavir (Prezista) interacts with ECHINACEA
Echinacea might affect how quickly the body breaks down darunavir. Taking echinacea along with darunavir might increase the risk of side effects or decrease the effects of darunavir. But it's not clear if this is a big concern.
Docetaxel (Taxotere) interacts with ECHINACEA
Echinacea might affect how quickly the body breaks down docetaxel. Taking echinacea along with docetaxel might increase the risk of side effects or decrease the effects of docetaxel. But it's not clear if this is a big concern.
Etravirine (Intelence) interacts with ECHINACEA
Echinacea might affect how quickly the body breaks down etravirine. Taking echinacea along with etravirine might increase the side effects or decrease the effects of etravirine. But it's not clear if this is a big concern.
Lopinavir / Ritonavir (Kaletra) interacts with ECHINACEA
Echinacea might affect how quickly the body breaks down lopinavir / ritonavir. Taking echinacea along with lopinavir / ritonavir might increase the side effects or decrease the effects of lopinavir / ritonavir. But it's not clear if this is a big concern.

Dosing

Echinacea is available in many different types of products, including supplements, liquids, creams, mouthwashes, and throat sprays. Doses vary widely depending on the type of product used. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

View References

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Shah SA, Sander S, White CM, et al. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis 2007;7:473-80. View abstract.

Soon SL, Crawford RI. Recurrent erythema nodosum associated with echinacea herbal therapy. J Am Acad Dermatol 2001;44:298-9. View abstract.

Sperber SJ, Shah LP, Gilbert RD, et al. Echinacea purpurea for prevention of experimental rhinovirus colds. Clin Infect Dis 2004;38:1367-71. View abstract.

Speroni E, Govoni P, Guizzardi S, et al. Anti-inflammatory and cicatrizing activity of Echinacea pallida Nutt. root extract. J Ethnopharmacol 2002;79:265-72. View abstract.

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ECHINACEA - Uses, Side Effects, and More

Overview

Uses & Effectiveness ?

Possibly Effective for

Side Effects

Special Precautions and Warnings

Interactions ?

Moderate Interaction

Caffeine interacts with ECHINACEA

Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates) interacts with ECHINACEA

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interacts with ECHINACEA

Medications that decrease the immune system (Immunosuppressants) interacts with ECHINACEA

Etoposide (VePesid) interacts with ECHINACEA

Minor Interaction

Midazolam (Versed) interacts with ECHINACEA

Warfarin (Coumadin) interacts with ECHINACEA

Darunavir (Prezista) interacts with ECHINACEA

Docetaxel (Taxotere) interacts with ECHINACEA

Etravirine (Intelence) interacts with ECHINACEA

Lopinavir / Ritonavir (Kaletra) interacts with ECHINACEA

Dosing

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