Echinacea

Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra echinacea to make up the missed dose.

Avoid coffee, tea, cola, energy drinks, or other products that contain caffeine. Taking echinacea with caffeinated products can increase caffeine side effects such as headache, increased heart rate, and feeling jittery.

Do not take echinacea without medical advice if you are using a medication to treat any of the following conditions:

• any type of infection (including HIV, malaria, or tuberculosis);

• anxiety or depression;

• asthma or allergies;

• cancer;

• erectile dysfunction;

• heartburn or gastroesophageal reflux disease (GERD);

• high blood pressure, high cholesterol, or a heart condition;

• migraine headaches;

• psoriasis, rheumatoid arthritis, or other autoimmune disorders;

• a psychiatric disorder; or

• seizures.

This list is not complete. Other drugs may interact with echinacea, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

Avoid coffee, tea, cola, energy drinks, or other products that contain caffeine. Taking echinacea with caffeinated products can increase caffeine side effects such as headache, increased heart rate, and feeling jittery.

Do not take echinacea without medical advice if you are using a medication to treat any of the following conditions:

• any type of infection (including HIV, malaria, or tuberculosis);
• anxiety or depression;
• asthma or allergies;
• cancer;
• erectile dysfunction;
• heartburn or gastroesophageal reflux disease (GERD);
• high blood pressure, high cholesterol, or a heart condition;
• migraine headaches;
• psoriasis, rheumatoid arthritis, or other autoimmune disorders;
• a psychiatric disorder; or
• seizures.

This list is not complete. Other drugs may interact with echinacea, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this product guide.

There is limited evidence that echinacea is effective in shortening the duration of symptoms of upper respiratory tract infections, but a lack of effectiveness for its use in prevention. Echinacea is hypothesized to be an immunomodulator. There is also interest in its potential use in cancer therapy, but clinical trials are lacking. The variation in available commercial products and lack of consistency in clinical trials make specific recommendations difficult.

Many commercial preparations are available containing components derived from different plant parts as well as from different species and varieties. Recommended dosing (all administered 3 times daily) include the following: 300 mg dry powdered extract (standardized to 3.5% echinacoside), 0.25 to 1.25 mL liquid extract (1:1 in 45% alcohol), 1 to 2 mL tincture (1:5 in 45% alcohol), 2 to 3 mL expressed juice of E. purpurea , and 0.5 to 1 g dried root or tea. Echinacea use for more than 8 weeks at a time should be avoided because of the potential for immune suppression. Intravenous (IV) use is not recommended.

Limited clinical evidence, expert opinion, and long-term traditional use suggest that oral echinacea is safe for use during pregnancy at normal dosages. Direct evidence for safety during lactation is lacking. Use with caution.

Little is known about the toxicity of echinacea. Animal studies generally indicate low toxicity.

Echinacea is a popular herbal remedy in the United States. The plant was used in traditional medicine by American Indians and quickly adopted by settlers. During the 1800s, claims for the curative properties of the plant ranged from blood purification to treatment of dizziness and rattlesnake bites. During the early part of the 20th century, extracts of the plant were used as anti-infectives; however, the use of these products fell out of favor after the discovery of modern antibiotics. The plant and its extracts continue to be used topically for wound healing and internally to stimulate the immune system. 5 , 6