Background

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.

Safety Safety definitions

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 & 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.

Effectiveness

Dosing & administration

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.

Interactions with pharmaceuticals

Caffeine

Interaction Rating=Moderate Be cautious with this combination.

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.

Darunavir (Prezista)

Interaction Rating=Minor Be watchful with this combination.

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)

Interaction Rating=Minor Be watchful with this combination.

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.

Etoposide (VePesid)

Interaction Rating=Moderate Be cautious with this combination.

Echinacea might decrease how quickly the body breaks down etoposide. Taking echinacea along with etoposide might increase the side effects of etoposide.

Etravirine (Intelence)

Interaction Rating=Minor Be watchful with this combination.

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)

Interaction Rating=Minor Be watchful with this combination.

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.

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

Interaction Rating=Moderate Be cautious with this combination.

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 3A4 (CYP3A4) substrates)

Interaction Rating=Moderate Be cautious with this combination.

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)

Interaction Rating=Moderate Be cautious with this combination.

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.

Midazolam (Versed)

Interaction Rating=Minor Be watchful with this combination.

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)

Interaction Rating=Minor Be watchful with this combination.

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.

Interactions with herbs & supplements

There are no known interactions with herbs and supplements.

Interactions with foods

There are no known interactions with foods.