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What is Echinacea
Echinacea is a name commonly used to describe herbs derived from the aerial and root portions of several different Echinacea spp., including Echinacea purpurea, Echinacea pallida, and Echinacea angustifolia.
Echinacea purpurea, or purple coneflower, has been cultivated in the US for hundreds of years; the Plains Indian tribes used Echinacea purpurea root as a poultice for wounds, insect stings, and snakebites.
In the US, echinacea was commonly used as an anti-infective prior to the discovery of antibiotics.
In past studies, the poor botanical identification of Echinacea spp. has led some to believe that all Echinacea spp. are interchangeable.
However, earlier pharmacologic studies of E. angustifolia have been now been identified as studies of E. pallida, and thus information supporting the clinical use of E. angustifolia is lacking.
Clinical data does not support prophylactic use of echinacea in adults;however, in children, echinacea may prevent subsequent upper respiratory tract infections. In one study, the use of a common non-alcoholic extract available in Germany (Echinacin® Saft) reduced the risk of subsequent infection by 28% (P=0.01, 95% CI 8—44%) over a 4-month period.
Clinical studies in adults are conflicting; some studies demonstrate efficacy in the alleviation of symptoms and in shortening the duration of upper respiratory infections, while others demonstrate no effect over placebo or a control group.
Recently, a clinical trial in experimental rhinovirus infection found that 300 mg three times daily of Echinacea angustifolia is not effective in alleviating the symptoms or shortening the duration of infection.
Data on the use of echinacea in children for the treatment of upper respiratory infections are negative.
One randomized study in children 2—11 years of age has found Echinacea purpurea to be ineffective in shortening the duration or reducing the severity of upper respiratory infection vs. placebo; the incidence of rash in the treatment group was higher than with placebo.
One reason for the conflicting findings in echinacea studies is that many of the studies have lacked statistical power or consistent methodology, including lack of comparable doses or preparations of echinacea.
The great variability in herb composition among available studies makes comparisons of products, and thus the study results, difficult. However, a 2005 Cochrane’s review indicates that aerial parts of Echinacea purpurea may be effective in providing symptomatic relief and shortening the duration of upper respiratory infections in adults if initiated early in the infection.
The review also indicates that while other preparations of echinacea may be effective, evidence of such efficacy is lacking.
Similarly, Germany’s Commission E has approved only 2 Echinacea spp. oral formulations for clinical use. Echinacea purpurea (fresh plant juice from the aerial portions of the herb) and Echinacea pallida (hydroalcoholic extracts of the root) are recommended for oral use for supportive therapy of colds and influenza-like infections of the respiratory tract.
Clinical data suggest that oral hydroalcoholic extracts of the root of Echinacea purpurea will likely also be approved for use in the German Commission E monographs in the future.
Topical preparations of Echinacea purpurea are recommended by the Commission E for the external treatment of poorly healing wounds and chronic ulcerations.
Esberitox N(TM) is a popular commercial brand of echinacea in Germany, and contains a blend of E. purpurea, E. pallida, and other active herbs.
Many oral preparations of echinacea are currently available in the US, including many non-standardized products.
Indications
- common cold
- pharyngitis
For the supportive treatment of the common cold†, pharyngitis†, or mild influenza-type illnesses
Side Effects
- abdominal pain
- anaphylactic shock
- angioedema
- arthralgia
- bronchospasm
- chills
- confusion
- constipation
- contact dermatitis
- diaphoresis
- diarrhea
- dizziness
- dysgeusia
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- erythema multiforme
- erythema nodosum
- fatigue
- fever
- headache
- hepatitis
- infertility
- insomnia
- lymphadenopathy
- myalgia
- myasthenia
- nausea
- oral ulceration
- pruritus
- rash
- thrombotic thrombocytopenic purpura (TTP)
- urticaria
- vomiting
- xerostomia
Monitoring Parameters
- laboratory monitoring not necessary
Contraindications
- acquired immunodeficiency syndrome (AIDS)
- asthma
- atopy
- autoimmune disease
- breast-feeding
- children
- chronic obstructive pulmonary disease (COPD)
- corticosteroid therapy
- diabetes mellitus
- eczema
- fever
- geriatric
- hepatic disease
- human immunodeficiency virus (HIV) infection
- immunosuppression
- infants
- infection
- infertility
- multiple sclerosis
- neoplastic disease
- organ transplant
- pregnancy
- pulmonary disease
- renal disease
- renal failure
- renal impairment
- rheumatoid arthritis
- surgery
- systemic lupus erythematosus (SLE)
- tuberculosis
Interactions
- Acetaminophen; Aspirin, ASA; Caffeine
- Acetaminophen; Butalbital; Caffeine
- Acetaminophen; Butalbital; Caffeine; Codeine
- Acetaminophen; Caffeine
- Acetaminophen; Caffeine; Dihydrocodeine
- Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
- Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
- Aldesleukin, IL-2
- Alemtuzumab
- Alfentanil
- Alkylating agents
- Altretamine
- Antithymocyte Globulin
- Antitumor antibiotics
- Aspirin, ASA; Butalbital; Caffeine
- Aspirin, ASA; Butalbital; Caffeine; Codeine
- Aspirin, ASA; Caffeine; Dihydrocodeine
- Aspirin, ASA; Caffeine; Orphenadrine
- Azathioprine
- Basiliximab
- Bexarotene
- Bortezomib
- Caffeine
- Caffeine; Ergotamine
- Carmustine, BCNU
- Cetuximab
- Chlorambucil
- Cisapride
- Clofarabine
- Corticosteroids
- Cyclophosphamide
- Cyclosporine
- Daclizumab
- Denileukin Diftitox
- Estramustine
- Ethanol
- Everolimus
- Folate analogs
- Hydroxyurea
- Ibritumomab Tiuxetan
- Imatinib
- Lomustine, CCNU
- Melphalan
- Midazolam
- Mitoxantrone
- Muromonab-CD3
- Mycophenolate
- Natural Antineoplastics
- Nimodipine
- Non-nucleoside reverse transcriptase inhibitors
- Nucleoside reverse transcriptase inhibitors
- Protease inhibitors
- Purine analogs
- Rituximab
- Rituximab; Hyaluronidase
- Sirolimus
- Tacrolimus
- Theophylline, Aminophylline
- Tositumomab
- Tretinoin, ATRA
- Warfarin
