Echinacea

Common names: Echinacea also is known as American coneflower, black susans, comb flower, echinacea, hedgehog, Indian head, Kansas snakeroot, narrow-leaved purple coneflower, purple coneflower, scurvy root, and snakeroot.

Efficacy rating:

ÒÒÒ...Positive clinical trials

Safety rating:

What is Echinacea?

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There are at least 9 species of echinacea. The ones most commonly studied are E. purpurea, E. pallida, and E. angustifolia. Echinacea is a member of the Asteraceae (sunflowers, daisies) family.

Echinacea is native to Kansas, Nebraska, and Missouri. There has been confusion regarding the identification of echinacea. Because of this confusion, it should be recognized that much of the early research conducted on this plant (in particular with European E. angustifolia) probably was conducted on E. pallida. At least 6 synonyms have been documented for these plants.

Echinacea products have been found to be adulterated with another member of the family Compositae, Parthenium integrifolium L. This plant has no pharmacologic activity.

What is Echinacea used for?

Echinacea is a popular herbal remedy in the central US, an area to which it is indigenous. The plant was used in traditional medicine by the American Indians and quickly adopted by the settlers. During the 1800s, claims for the curative properties of the plant ranged from a blood purifier to a treatment for 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.

A small but growing body of evidence is developing to support the traditional uses of echinacea topically as a wound-healing agent and internally as an immunostimulant. Most of the research during the past 10 years has focused on the immunostimulant properties of this plant. There is some evidence that echinacea (E. purpurea and E. pallida) is effective in shortening the duration of symptoms of URIs (upper respiratory infections), including the common cold, but it has not been shown to be effective as a preventative. The variation in available products makes specific recommendations difficult to determine. A 1993 review of all studies of echinacea revealed that echinacea may have an effect on the immune system, but that there is insufficient evidence to provide specific recommendations. Although test results are encouraging, they are too preliminary to draw conclusions about the appropriate therapeutic uses of echinacea extracts. Similarly, there are no well-controlled studies that have evaluated the effects of OTC Echinacea supplements.

What is the dosage of Echinacea?

Echinacea clinical trials for prevention or treatment of cold symptoms primarily have been run on the fresh pressed juice of the herb, which is preserved with 22% alcohol. Typical daily doses are 5 to 10 mL of the juice. Echinacin (Madaus, EC31) and Echinagard are fresh juice prepared from the herb. Extracts of the root are available, including Echinaforce and Echinacea Plus. These have been given at doses corresponding to 1 g of the crude herb or root 3 times/day.

Is Echinacea safe?

Childhood, chronic diseases such as diabetes, bronchial asthma, allergy, or autoimmune deficiency, tuberculosis, leukemia, collagenous disease, multiple sclerosis, polyarthritis, HIV infection, organ transplantation, pneumonia, or fungal infections, other infections not involving the respiratory tract, known inflammatory GI disease or impairment of resorption, acute influenza, chronic diseases of the respiratory tract; patients taking any immunosuppressants including corticosteroids, antibiotics, or cytostatic therapy; pregnancy or lactation; fever; hypersensitivity to plants of the Asteraceae/Compositae family; and any type of acute infection.

Information regarding safety and efficacy in pregnancy and lactation is lacking. Best avoided during pregnancy, but a small prospective cohort study found no increased risk for malformations or other adverse outcomes.

None well documented.

Side effects are rare. Patients with allergies, specifically allergies to daisy-type plants (Asteraceae family) might be more susceptible to reactions. Nausea and other mild GI effects have been reported in clinical trials. Because of the potential immune stimulating property of echinacea, patients who are immunocompromised should not take echinacea.

Little is known about the toxicity of echinacea.

References

Copyright © 2006 Wolters Kluwer Health

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