Scientific Name: Echinacea
Other Names: American Coneflower, Black Sampson, Comb Flower, Echinacea angustifolia, Echinacea pallida, Echinacea purpurea, Hedgehog, Indian Head, Purple Coneflower, Rudbeckia, Sampson Head, Scurvy Root, Snakeroot

Who is this for?

Uses

Echinacea acts as a stimulant to the immune system by several methods which include increasing the production of specific types of white blood cells and strengthening human cell walls so bacteria and viruses have a harder time getting into cells. It is probably best known as a preventative and treatment for upper respiratory infections, such as colds and the flu. A number of human studies have been conducted to evaluate echinacea’s effectiveness for these conditions, but they are inconsistent – with some finding significant antiviral effects and others finding no differences between echinacea and placebo (inactive sugar pills). Additionally, study results are difficult to compare because the studies used a wide range of products, strengths, doses, and treatment methods. In general, however, when they are taken as soon as symptoms begin, echinacea products may reduce the length of time that cold or flu symptoms last. Taking echinacea may also lessen the severity of upper respiratory viral infections, but it does not seem to prevent them.

Echinacea’s immune-enhancing effects have also been studied extensively for cancer and AIDS patients. In Europe, intravenous (IV) echinacea used to be available for add-on therapy in the treatment of some types of cancer. It is no longer used much, though, due to side effects that are associated with its use. Additionally, no clear conclusions about echinacea’s true effectiveness have been reached in studies. Some researchers feel that stimulating immune function actually may cause cancers and AIDS to progress faster; while others find a disease-treating effect from using echinacea. Some preliminary evidence from other clinical studies appears to show that echinacea may have antiviral and antifungal effects, possibly adding to its infection-fighting ability. Until more evidence is available, however, echinacea cannot be recommended for any of these serious conditions.

Topically, echinacea may have anti-infective and anti-inflammatory effects, so it has been applied to treat skin conditions such as eczema and psoriasis. It is included in other topical products used to relieve conditions as diverse as hemorrhoids and insect bites. Some early evidence from animal studies shows that topical echinacea preparations may also protect skin from damage due to sunlight.

Individuals with autoimmune conditions should not take echinacea due to its possible effects on the immune system. Autoimmune conditions include:

• Crohn's disease
• Multiple Sclerosis
• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
• Type 1 diabetes

Precautions

One published study found no side effects for either the mother or the baby when echinacea was taken by women in early stages of pregnancy. However, very little information is available on how echinacea might affect a developing fetus, an infant, or a small child. Therefore, its use is not recommended during pregnancy, while breast-feeding, or in early childhood.

Echinacea belongs to the same family of plants that also includes chrysanthemums, daisies, and ragweed. Individuals who are sensitive to any of these types of plants may also be sensitive to echinacea.

What side effects should I watch for?

Study participants who took oral echinacea reported only occasional, mild gastrointestinal side effects including diarrhea and nausea. In some studies, rashes were also more often associated with taking echinacea than with taking placebo (inactive sugar pills).

Oral Echinacea angustifolia (narrow-leaved coneflower) may cause a bitter taste or tingling feeling in the mouth.

In a recent study of children between the ages of 2 years and 11 years, children taking oral echinacea developed rashes about 2.5 times more often than children taking placebo (inactive sugar pills).

Topical application of echinacea may result in itching, especially in individuals who are allergic to ragweed or other members of the daisy family of plants.

Injectable forms of echinacea have been associated with:

• Chills
• Muscle weakness
• Pain or itching at the site of injection

What interactions should I watch for?

Because it can enhance immune system function, echinacea may interfere with the effects of drugs used to suppress the immune system after organ transplants or in other conditions. Taking echinacea is not recommended for patients who take drugs such as:

• azathioprine (Imuran)
• CellCept
• cyclosporine (Neoral, Sandimmune)
• Prograf
• Rapamune
• Zenapak

Because it is broken down by certain enzymes in the liver, echinacea may possibly interfere with the use of prescription drugs that are processed by the same enzymes. Some of these drugs are:

• Allergy drugs such as fexofenadine
• Antifungal drugs such as itraconazole and ketoconazole
• Cancer drugs such as etoposide, paclitaxel, vinblastine, or vincristine
• Drugs for high cholesterol such as lovastatin
• midazolam (Versed)
• Oral contraceptives

Results from a very small study of healthy individuals show that echinacea may delay the body’s breakdown of caffeine. Results of this potential interaction are unknown, however.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how echinacea interacts with drugs, other herbals, and foods and the severity of those interactions, please use our Drug Interactions Checker to check for possible interactions.

Should I take it?

Several species of echinacea are known, but only three – Echinacea angustifolia, Echinacea pallida, and Echinacea purpurea — are commonly used in medicine. Echinacea species originated as wildflowers on the plains areas of the United States and Canada, but they are now cultivated in Europe and parts of Asia, as well as in North America. Native people used them for multiple medical conditions, including treating poisonous snake and insect bites. During the 1800s, echinacea was an essential part of U.S. medicine, and its use spread to Germany in the last few years of that century. Echinacea compounds were used widely as antibiotics until better synthetic antibiotic medicines became available in the middle of the 20th century. In recent years, echinacea has regained popularity, possibly because no drugs are available to treat colds.

German homeopathic physicians were the first to grow echinacea in fields, rather than collecting the wild plants. The rediscovery of echinacea’s medicinal uses may have put its wild populations at risk, since current demand far exceeds the supply available from commercial growers. Unauthorized harvesting of wild echinacea means that some of the lesser-known species may be close to extinction. Several echinacea species have been put on the federal list of endangered plants.

All species of echinacea have basic similarities. They all grow as perennial plants consisting of a sturdy stem that supports a large daisy-like flower. In varying shades of reddish purple, the flowers have raised centers that are covered with spiky points, giving them a “hedgehog” appearance. Both the stems and the leaves are covered with fuzz. Different echinacea species can be distinguished by the shape of the leaves, the height of the plants, and the color and size of the flower. Echinacea angustifolia (narrow-leaved coneflower) has a sharply bitter taste that produces a tingling sensation when it comes in contact with tissue inside the mouth.

Various parts of Echinacea species are used in medicine. Most often the roots, which can be as long as 20 inches, are taken from plants that are at least 3 years old. Flowers, leaves and stems may be cut during the summer while 2-year-old to 3-year-old plants are in full bloom. Often called “aerial” (above ground) parts, they are dried for use as teas or extracts. Sometimes, freshly cut plants are crushed to make juice. Fresh echinacea may contain some chemicals that are not present after the plant has been dried. Some sources recommend that fresh echinacea juice be refrigerated to delay the loss of active components.

Dosage and Administration

Echinacea products to be taken by mouth come in many various forms: fresh and dried “aerial parts” (flowers, leaves, and stems), fresh and dried roots, tablets, capsules, juice, lozenges, teas, extracts, and tinctures. Often, different species of echinacea are mixed into one product. Accidental or deliberate contamination with other plants is fairly common. Doses vary greatly depending on the condition being treated and the product being used. Individuals who decide to take echinacea should follow the directions on the package that is purchased.

For topical application, echinacea is available in creams, lotions, mouthwashes, ointments, toothpastes, and skin washes. Occasionally, it is added to cosmetics as an unproven anti-aging ingredient. Typically, echinacea preparations may be applied as often as needed. However, the directions on the package that is purchased should be followed.

Neither intravenous nor injectable echinacea is available in the United States.

Summary

Even though they are not proven to be effective, echinacea products are among the most widely used herbals in the world. They are taken by mouth to enhance immune system response and to lessen the duration and symptoms of colds and flu. When applied to the skin, they are used to relieve conditions such as eczema, insect bites, and psoriasis.

Risks

Ecinacea’s potential to increase immune function may worsen autoimmune conditions such as multiple sclerosis and type 1 diabetes. Individuals with autoimmune diseases should not use echinacea. Pregnant and breast-feeding women and small children should also avoid its use.

Side Effects

Side effects reported from taking echinacea by mouth include nausea and diarrhea. Some individuals may develop an allergic reaction from taking echinacea, applying topical forms, or handling the plant.

Interactions

Echinacea may interact with drugs that suppress the immune system and with several other drugs that are processed by the body in the same way that echinacea is processed. It may interfere with the breakdown of caffeine. Individuals who are not sure whether a drug they take will interact with echinacea should ask a doctor or pharmacist before beginning to use echinacea. All non-prescription and herbal products should be mentioned as well as prescription medications.

Last Revised September 13, 2006

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Last Revised September 13, 2006

Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.

In general, herbal products are not subject to review or approval by the U.S. Food and Drug Administration (FDA). They are not required to be standardized, meaning that the amounts of active ingredients or contaminants they contain may vary between brands or between different batches of the same brand. Not all of the risks, side effects, or interactions associated with the use of herbal products are known because few reliable studies of their use in humans have been done.

This information is provided for your education only. Please share this information with your healthcare provider and be sure that you talk to your doctor and pharmacist about all the prescription and non-prescription medicines you take before you begin to use any herbal product.

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