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echinacea


What Is It?
Health Benefits
Forms
Dosage Information
Guidelines for Use
General Interaction
Possible Side Effects
Cautions
References
Evidence Based Rating Scale

What Is It?

One of the most popular herbal remedies in the western world, Echinacea was commonly used by Native Americans for treating a variety of conditions. Medical practitioners in the United States started using Echinacea in the 1800's. In the early 1900's German clinicians and researchers started integrating it into their practices and studying its effects. For most of the 20th century, this native plant was used more in Europe than in the U.S. In more recent history, however it continues to be one of the top selling herbs in both Europe and the U.S.

Active ingredients from the plant are thought to fight colds, flu, and other infections. There are nine species of this Herb, commonly called the purple coneflower, but just three (Echinacea angustifolia, E. pallida, and E. purpurea) are used medicinally. Other names for Echinacea include comb flower, and red sunflower. Various parts of the plant (flowers, leaves, stems, or roots) from a variety of species appear in literally hundreds of commercial preparations. Depending on the species and plant part used, the herb will stimulate the immune system and combat bacteria, viruses, and other disease-causing microbes. (1)

Health Benefits 

Both safe and powerful, Echinacea stimulates various immune system cells that are key weapons against infection. The herb also helps boost the cells' production of a virus-fighting substance called Interferon, and has been shown to have anti-inflammatory effects. (1) One interesting study showed that Echinacea Extract produced different effects on bronchial cells depending on whether the cells were infected with the cold virus. Cold symptoms are actually produced by the body’s inflammation response to the virus rather than by a direct action of the virus. In cells infected with the cold virus, the release of the inflammatory chemicals stimulated by the virus was reversed by the two different types of Echinacea extract studied. In contrast, in healthy cells, Echinacea extract caused increased release of these same inflammatory substances. (2) Thus, taking Echinacea for extended periods when healthy may be counter-productive. This is also why Echinacea is not recommended for those suffering from auto-immune disorders.

Specifically, Echinacea may help to:  

 Prevent the onset of colds and other respiratory illness. For many years doctors recommended that people take Echinacea continuously for 3 - 6 weeks during cold season to ward off illness. In one study of 430 children aged 1 to 5, an herbal preparation containing a combination of Echinacea, propolis, and vitamin C reduced the number of respiratory tract infections by 55%. (3) However, a recent review of studies indicated that while early use of aerial parts of Echinacea purpurea may be beneficial in treating colds, studies have been inconsistent for other species and for prevention. (4) More large-scale studies are needed to recommend specific Echinacea preparations for the prevention of colds.

 Reduce duration of colds, flu, and sore throat. If started with the onset of the sneezing, aches, congestion, or fever common to colds or flu, Echinacea may cause these symptoms to be less severe and to subside more quickly. (5-7) However not all Echinacea extracts provide this benefit. A review of 16 studies found that Echinacea purpurea preparations made from the aerial parts of the plant were more effective for the early treatment of colds. (4) Proprietary preparations have also proven effective in stimulating the immune system and fighting colds. (8, 9) However, a study with 437 volunteers taking an extract of Echinacea angustifolia demonstrated no efficacy in preventing or treating colds. (10) Ask a doctor familiar with the use of herbs for recommendations regarding the most efficacious preparation for treatment of a particular symptom profile.  

 Fight recurrent respiratory infections, such as bronchitis, sinusitis, strep throat, and earache. The herb's immune-boosting properties make it particularly helpful for fighting chronic upper respiratory infections in adults and children. In a study of 524 children between the ages of 2 and 11 conducted during the winter months of 2000 – 2002, researchers found that the children who took Echinacea after the occurrence of the first upper respiratory tract infection experienced 28% fewer recurrent infections. (11) For best results, take Echinacea at the first sign of illness. In a recent laboratory study, scientists measured the effects of a standardized extract of Echinacea purpurea on infectious respiratory agents such as Group A Strep (the usual cause of “strep throat”), and Haemophilus—another common respiratory bacteria. The extract reduced the inflammatory response of bronchial cells and inactivated the bacteria. Even with other types of bacteria that were less inhibited, inflammation was reduced supporting a role for Echinacea in controlling symptoms of bacterial respiratory infections. (12)

 Combat vaginal yeast, Candida overgrowth, and urinary tract infections. As an immune-booster, Echinacea can be particularly helpful for fighting these recurrent infections. (13) For yeast infections, the herb seems to stimulate white blood cells to destroy the yeast. Urinary tract infections can be helped by consuming extra fluids, including immune-boosting Echinacea tea.

 Promote healing of skin wounds and inflammations, including canker sores, burns, and cuts and scrapes. As a natural Antibiotic and infection fighter, Echinacea promotes the healing of all kinds of skin irritations, including burns, cuts and scrapes, boils, abscesses, and canker sores. (14)  It can be applied topically to a wound or taken internally to strengthen the immune system.

 Treat chronic fatigue syndrome. Echinacea is currently being studied as a possible treatment for chronic fatigue syndrome, a condition marked by profound and persistent exhaustion. One theory holds that this mysterious disorder represents the body's response to a past viral infection that managed to permanently weaken the immune system. By bolstering the immune system and fighting any further viral (or bacterial) presence, Echinacea may help those who suffer from this disorder. In laboratory tests, Echinacea enhanced the immune function of cells from patients with HIV and with chronic fatigue syndrome. (15)

 Build immunity during cancer treatments and possibly protect against certain forms of cancer. Although not a traditional use of this plant, since researchers discovered its immune-enhancing properties, some people have started integrating Echinacea into their cancer treatment plan. Rotating Echinacea with extracts of medicinal mushrooms may help to strengthen overall immunity during cancer treatments. Also, studies in mice have shown that regular supplementation with Echinacea may help to prevent the immune related disorders associated with aging. (16) Since mice and humans share 97% of their genetic code, researchers are excited about the potential of applying these research findings to humans. (17) However, in a recent study in Russia, Echinacea purpurea had no effect on metastases in mice with lung carcinoma and even stimulated tumor growth. In contrast, in the same study, another complex isolated from Echinacea increased the antitumor and antimetastatic activity of the chemotherapeutic agent cyclophosphamide. (18) The article is in Russian and little more is known about the methodology of the study. Much more research is needed to fully define Echinacea’s possible role in fighting cancer in humans.

 

Note: Echinacea has also been found to be useful for a number of other disorders. For information on these additional ailments, see our Dosage Recommendations Chart for Echinacea.

Forms 

  • Tincture
  • tablet
  • softgel
  • lozenge
  • liquid
  • dried herb/tea
  • capsule  

Dosage Information 

Special tips:  

For maximum effect, take Echinacea in liquid form--either as a fresh-pressed juice (standardized to contain 2.4% beta-1, 2-fructofuranosides) or as an alcohol-based tincture (containing a 5:1 concentration of the herb), which can be mixed with water or tea. This gets the medicine directly to where it needs to act. Good quality Echinacea has a numbing effect on the throat. Many medicinal herb companies take advantage of this fact, packaging Echinacea in small spray bottles. 

If unable to tolerate the liquid form, try standardized extracts in pill form. Look for pills containing at least 3.5% echinacosides, the active ingredient.

The various Echinacea products available--capsules, tablets, juice, extract--commonly contain Echinacea made from either a single or mixed species. Check the label carefully to ensure that the species--and the plant part--you need is present in the product you select. Use the following as a guide:

  • For long-term use as a general immune-booster: Take supplements made from the whole plant (the roots and leaves) of E. angustifolia. To get the maximum benefit, alternate Echinacea (200 mg twice a day) with other immune-enhancing herbs such as goldenseal, astragalus, pau d'arco, or maitake, reishi, and/or shiitake mushrooms. Pick two of these other herbs, use each one for a week, and then return to Echinacea every third week. This practice may be good for chronic fatigue sufferers and for those who want to boost immunity during cancer treatments.
  • For cold and flu prevention: Take 200 mg a day, preferably from supplements made from the above-ground part of E. purpurea and the root of E. pallida. Or try rotating Echinacea in three-week cycles with astragalus (500 mg a day), a Chinese herb that acts on the immune system in a way similar to Echinacea.

  • For sore throat: To decrease the symptoms, a high dose is necessary: Take 200 mg four or five times a day. For immediate sore throat relief, add 1 teaspoon Echinacea tincture to 1/2 cup warm water, gargle, and swallow four or five time a day until the pain subsides. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida.

  • For chronic bronchitis: Take 200 mg twice a day. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida.

  • For earache: Take 200 mg three times a day. Use in a cycle of three weeks on, one week off for recurrent infections. Dosages are generally calculated based on a 150 lb. adult; children's dosages should be adjusted accordingly. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida.

  • For vaginal yeast infections: Take 200 mg three times a day or 20-90 drops of a tincture (1-3mL). Use in a cycle of three weeks on, one week off for recurrent infections. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida.

  • For urinary tract infections: Drink 1 cup of Echinacea tea several times a day. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida. To make the tea, use 2 teaspoons Echinacea for each 8-ounce cup of very hot (not boiling) water. Steep for 15 minutes and strain. Sweeten to taste with honey, if desired.

  • For skin wounds and Inflammation: Add 3 drops of liquid extract to 1 teaspoon of water and apply to the wound. Or take 200 mg three times a day to prevent infection. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida.

  • For canker sores: Take 200 mg three times a day at the first sign of a sore. Begin taking Echinacea at the higher dose and reduce the dosage as the sore heals. For prevention, take 200 mg each morning for three weeks of each month. Select supplements made from the above-ground part of E. purpurea and the root of E. pallida.

Be sure to check out our Dosage Recommendations Chart for Echinacea, which lists therapeutic dosages for specific ailments at a glance.  

Guidelines for Use 

  • Use Echinacea alone for no longer than three weeks, followed by a one-week rest period before you start taking it again. With continuous use, the herb's immunity-enhancing effects begin to decrease. Starting and stopping Echinacea, or rotating it with goldenseal and the other herbs mentioned above, may maximize its effectiveness.

  • Although Echinacea can be taken with or without food, some people experience nausea or loose stools when taking on an empty stomach. 

General Interaction 

  • Echinacea may interact with aromatase inhibitors such as anastrozole (Arimidex), which is used in the treatment of breast cancer. (19)

  • When combined with caffeine, Echinacea may increase blood concentration of caffeine. (20)

  • Echinacea inhibits the enzyme in the liver that metabolizes drugs such as acetaminophen, warfarin, diazepam, amitryptiline, and numerous others. Taking Echinacea with these drugs could increase their concentration levels in the blood leading to potential overdose. (20) 

Possible Side Effects 

  • People who are allergic to flowers in the daisy family, which also includes ragweed, chrysanthemums, and marigolds, may be allergic to Echinacea as well.

  • Echinacea has been associated with clinically significant ocular side effects including dry eye, retinal hemorrhages, and transient vision loss. (21) 

Cautions 

  • Echinacea is not a replacement for antibiotics or other infection-fighting drugs, but it can be used to complement them.

  • Because Echinacea stimulates the immune system, theoretically it could worsen the conditions of lupus, multiple sclerosis, rheumatoid arthritis, and other autoimmune disorders, although no cases have been reported. Consult a doctor before taking the herb if any of these disorders are present.

  • Don't take Echinacea for progressive infections such as tuberculosis.

References

1. Echinacea. Altern Med Rev. 2001 Aug;6(4):411-4.
2. Sharma M, Arnason JT, Burt A, Hudson JB. Echinacea extracts modulate the pattern of chemokine and cytokine secretion in rhinovirus-infected and uninfected epithelial cells. Phytother Res. 2006 Feb;20(2):147-52.
3. Cohen HA, Varsano I, Kahan E, Sarrell EM, Uziel Y. Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med. 2004 Mar;158(3):217-21.
4. Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold.
Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000530.
5. Melchart D, Linde K, Worku F, et al.
Immunomodulation with Echinacea—a systematic review of controlled clinical trials. Phytomedicine 1994;1:245–54.
6 Hoheisel O, Sandberg M, Bertram S, et al. Echinacea shortens the course of the common cold: a double-blind, Placebo-controlled clinical trial. Eur J Clin Res 1997;9:261–8.
7. Grimm W, Müller HH. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory tract infections. Am J Med 1999;106:138–43.
8. 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.
9. Naser B, Lund B, Henneicke-von Zepelin HH, Kohler G, Lehmacher W, Scaglione F A randomized, double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold. Phytomedicine. 2005 Nov;12(10):715-22.
10. Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med. 2005 Jul 28;353(4):341-8.
11. Weber W, Taylor JA, Stoep AV, Weiss NS, Standish LJ, Calabrese C. Echinacea purpurea for Prevention of Upper Respiratory Tract Infections in Children. J Altern Complement Med. 2005 Dec;11(6):1021-6
12. Sharma SM, Anderson M, Schoop SR, Hudson JB. Bactericidal and anti-inflammatory properties of a standardized Echinacea extract (Echinaforce): dual actions against respiratory bacteria. Phytomedicine. 2010 Jul;17(8-9):563-8. Epub 2009 Dec 29.
13. Coeugniet E, Kuhnast R. Recurrent candidiasis. Adjuvant immunotherapy with different formulations of Echinacea. Therapiwoche 1986;36:3352–8 [in German].
14. Speroni E, Govoni P, Guizzardi S, Renzulli C, Guerra MC. Anti-inflammatory and cicatrizing activity of Echinacea pallida Nutt. root extract. J Ethnopharmacol. 2002 Feb;79(2):265-72.
15. See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacology. 1997 Jan;35(3):229-35.
16. Brousseau M, Miller SC. Enhancement of natural killer cells and increased survival of aging mice fed daily Echinacea root extract from youth. Biogerontology. 2005;6(3):157-63.
17. Miller SC. Echinacea: a miracle herb against aging and cancer? Evidence in vivo in mice. Evid Based Complement Alternat Med. 2005 Sep;2(3):309-14.
18. Razina TG, Lopatina KA, Zueva AM, Gur'ev AM, Krylova SG, Amosova EN.
Effect of Echinacea purpurea tincture and its polysaccharide complex on the efficacy of cytostatic therapy of transferred tumors. Eksp Klin Farmakol. 2007 May-Jun;70(3):33-5.
19. Malekzadeh F, Rose C, Ingvar C, Jernstrom H. Natural remedies and Hormone preparations--potential risk for breast cancer patients. A study surveys the use of agents which possibly counteract with the treatment. Lakartidningen. 2005 Oct 31-Nov 6;102(44):3226-8, 3230-1.
20. Gorski JC, Huang S, Zaheer NA, et al. The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo.Clin Pharmacol Ther 2003;73 (Abstract PDII-A-8):P94.
21. Fraunfelder FW. Ocular side effects from herbal medicines and nutritional supplements. Am J Ophthalmol. 2004 Oct;138(4):639-47.
22. Barrett B. Medicinal properties of Echinacea: a critical review. Phytomedicine. 2003;10:66-86.


Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

Condition

Rating

Explanation

 

Bronchitis

   

Large studies have shown benefit in reducing the frequency of illness in children. (11)

Burns   Date Published: 04/18/2005
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