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From the National Institutes of HealthNational Institutes of Health

Echinacea


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 can help treat a cold, but it won’t prevent one.

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. Keep in mind that TREATING a common cold is different than PREVENTING a common cold. Taking echinacea does not seem to PREVENT a cold from starting.
  • 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...

  • Genital herpes (Herpes simplex virus, HSV). Taking a specific echinacea extract (Echinaforce by Bioforce AG) 800 mg twice daily for 6 months does not seem to prevent or reduce frequency or duration of recurrent genital herpes.

Insufficient evidence to rate effectiveness for...

  • Urinary tract infections (UTIs).
  • Migraine headaches.
  • Chronic fatigue syndrome (CFS).
  • Eczema.
  • Hayfever.
  • Allergies.
  • Bee stings.
  • Attention deficit-hyperactivity disorder (ADHD).
  • Influenza (flu).
  • Other conditions.
More evidence is needed to rate echinacea for these uses.

How does it work?

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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.

Are there safety concerns?

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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 aged 2-11 when used for up to 10 days. But some children might develop a rash.

Echinacea can cause allergic reactions, especially in people 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.

Are there interactions with medications?

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Moderate

Be cautious with this combination.

Caffeine
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.

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.

Minor

Be watchful with this combination.

Midazolam (Versed)
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.

Are there interactions with herbs and supplements?

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There are no known interactions with herbs and supplements.

Are there interactions with foods?

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There are no known interactions with foods.

What dose is used?

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The following doses have been studied in scientific research:

BY MOUTH:

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.

Other names

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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.

Methodology

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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).

References

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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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Last reviewed - 12/09/2011

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Page last updated: 27 September 2012