Skip to main content


Scientific Name(s): Echinacea angustifolia DC, Echinacea pallida (Nutt.) Britton, Echinacea purpurea (L.) Moench
Common Name(s): American coneflower, Black Sampson, Black Susan, Comb flower, Echinacea, Echinaceawurzel, Hedgehog, Igelkopfwurzel, Indian head, Kansas snakeroot, Narrow-leaved purple coneflower, Purple coneflower, Purpursonnenhutkraut, Racine d'echininacea, Radix Echinaceae, Rock-up-hat, Roter sonnenhut, Scurvy root, Snakeroot, Sonnenhutwurzel

Medically reviewed by Last updated on Oct 24, 2022.

Clinical Overview


Use of echinacea as prophylaxis for upper respiratory tract infections has been reported, but evidence of efficacy is limited. Traditionally, echinacea has been used to prevent and treat the common cold; however, quality clinical trial data are lacking. Anxiolytic and immunomodulatory effects have been investigated. Specific recommendations for use for any indication are unreliable due to variations in composition of commercial echinacea products and inconsistent clinical trial results.


A major limitation reported in meta-analyses of available trial data is the lack of standardization of echinacea preparations, making dosing recommendations difficult. Commercial preparations contain echinacea components derived from different plant parts, species, and varieties. Long-term use of echinacea or use for longer than 10 days for acute infections in otherwise healthy individuals is not recommended. Parenteral use is not recommended.


Avoid use in individuals with known hypersensitivity to plants of the Asteraceae/Compositae family. Echinacea is also contraindicated in individuals with an autoimmune disease, rheumatoid arthritis, systemic lupus erythematosus, leukosis, multiple sclerosis, tuberculosis, and HIV infection.


Information regarding safety and efficacy in pregnancy and lactation is lacking. Limited clinical evidence, expert opinion, and long-term traditional use suggest that oral echinacea is safe during pregnancy at typical dosages. Echinacea should be used with caution during lactation.


Specific case reports of interactions are limited, with one report describing an interaction with etoposide. Data regarding echinacea's effects on the CYP-450 enzyme system are conflicting. Interactions with clozapine, etoposide phosphate, nimodipine, selpercatinib, and ubrogepant are possible.

Adverse Reactions

Adverse reactions with echinacea are rare. The most commonly reported reactions are allergy, GI upset, and rash. A case report of leukopenia, possibly caused by long-term echinacea use, has been published. Because of conflicting data, echinacea should not be used in any condition potentially affected by immune stimulation or suppression, such as HIV, tuberculosis, multiple sclerosis, and use of immunosuppressive agents. Use with caution in patients with hepatic impairment.


There is little evidence regarding toxicity with echinacea, despite its widespread use. Echinacea has not been associated with acute or chronic toxic effects. However, individuals with hepatic impairment should use echinacea with caution, as case reports of hepatotoxicity exist.

Scientific Family

  • Asteraceae/Compositae (sunflower)


Echinacea is a member of the Compositae family (also called the Asteraceae family), which is native to eastern and central North America. "Kansas snakeroot" or "snakeroot" should not be confused with white snakeroot (Ageratina altissima).USDA 2020 There are at least 9 species of echinacea, with E. purpurea, E. pallida, and E. angustifolia most commonly used for medicinal purposes.Ross 2001, USDA 2020 Because of the difficulty in identifying echinacea species, much of the early European research, particularly regarding E. angustifolia, may have actually been conducted on E. pallida.WHO 1999

Echinacea species are perennial herbs that grow up to 1.2 m in height. The plant has narrow leaves and stout stems that blossom into large, solitary flower heads with lavender or purple florets and central rigid bracts. The traditional Radix Echinaceae preparation consists of the fresh or dried roots (either single taproots or fibrous roots) of E. angustifolia.WHO 1999 When chewed, the root has a pungent taste and causes tingling of the lips and tongue.Ross 2001, WHO 1999 Additional plant parts used include fresh or dried flowering tops and fresh pressed juice from the flowering tops of E. purpurea.


Echinacea is a popular herbal remedy in the United States. The plant was used in traditional medicine by American Indians and was quickly adopted by settlers. During the 1800s, claims of curative properties of the plant ranged from blood purification to treatment of dizziness and rattlesnake bites. During the early 20th century, extracts of echinacea were used as anti-infectives; however, 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.Barnes 2005, Ross 2001, WHO 1999


The chemical constituents of echinacea are well described. Biologically active constituents include a volatile oil (containing pentadecadiene, pentadecene, ketoalkynes, and ketoalkenes), alkamides (mainly a mixture of isobutylamides), polyalkenes, polyalkynes, caffeic acid derivatives, and polysaccharides.Barnes 2005, Duke 1992, Ross 2001, WHO 1999 It has been reported that the alkamides found in echinacea are available following oral administration, but that caffeic acid derivatives are not.Barnes 2005

Toxic pyrrolizidine alkaloids (isotussilagine and tussilagine) have been identified at low levels.Duke 2002, WHO 1999

Uses and Pharmacology

Data comparisons and pooling are difficult due to trial methodology concerns, including variations in plant species, plant parts, preparations, and dosages, as well as high dropout rates and a lack of intention-to-treat analyses.(Karsch-Volk 2014, Wolsko 2005)


In vitro data

Effects of an ethanol extract of E. purpurea on adipogenesis (ie, insulin-induced adipocyte differentiation of 3T3-L1 preadipocytes) were observed in vitro, suggesting a potential role in the treatment or prevention of obesity or diabetes.(Shin 2014)

Alcoholic liver disease

Animal data

Chicoric acid extracted from E. purpurea was protective against alcohol-induced hepatic steatosis in mice.(Landmann 2014)

Anti-inflammatory effects

Animal and in vitro data

Antihyaluronidase activity,(Facino 1993) inhibition of prostaglandins,(Guiotto 2008, Hinz 2007) and reduction in proinflammatory mediators in vitro(Moazami 2015) and in rodents(Dogan 2014) have been demonstrated. When injected intravenously (IV) and applied topically, echinacea inhibited induced inflammation in rodents.(Tubaro 1987)

Antitussive/Bronchodilatory effects

Animal data

Extracts of the flowering parts of echinacea demonstrated antitussive and bronchodilatory effects in rodents.(Capek 2015)


Animal and in vitro data

Root extracts from 3 echinacea species (E. purpurea, E. angustifolia, and E. pallida) produced concentration- and time-dependent induction of apoptosis in human pancreatic and colon cancer cell lines.(Chicca 2007) In mice, 8 weeks of echinacea therapy prolonged mean survival age and suppressed thymic lymphoma enlargement; other experiments demonstrated elevated natural killer cell levels and prolonged survival times in leukemic mice.(Currier 2001, Miller 2005) In a study in rats, coadministration of cadmium and echinacea led to increased concentrations of cadmium in certain organs and in blood.(Zitkevicius 2007) In an in vitro study, typical constituents of echinacea species applied topically were effective in the prevention and/or treatment of skin damage caused by ultraviolet/ultraviolet B radiation. Another study suggested radioprotection following oral administration of echinacea.(Joksić 2009)

Clinical data

In a trial investigating the effects of an IV administered polysaccharide fraction of echinacea in 15 patients with advanced gastric cancer, increases in median number of leukocytes occurred; however, differences from a historical control group were not considered clinically relevant.(Melchart 2002) Another study of 23 patients with tumors showed no effect on cytokines or leukocytes after use of an E. angustifolia preparation.(Elsässer-Beile 1996)

CNS effects

Animal data

Anxiolytic activity of echinacea has been demonstrated in limited animal studies.(Hájos 2012, Haller 2010, Sarris 2013)

Clinical data

An open-label study investigated anxiolytic activity of E. angustifolia extract in healthy individuals (N=33) with elevated anxiety scores. The study did not include a placebo group; participants were randomized to receive 1 or 2 capsules (each capsule containing 20 mg of extract) daily for 1 week. Only the higher dose resulted in a reduction in anxiety scores during treatment and for 2 weeks after.(Haller 2013) The observed effect may be due to lipophilic alkylamide constituents interacting with cannabinoid receptors.(Sarris 2013) A double-blind, randomized, placebo-controlled study enrolled 108 physically healthy adults 18 to 65 years of age with symptoms of mild to moderate anxiety to explore the effects of E. anugustifolia standardized extract on anxiety, positive and negative affect symptoms, insomnia, and quality of life (QOL). Recruitment occurred between May and June 2020 in Australia, and the extract was administered at a low (40 mg/day) and high (80 mg/day) dose. At week 6, all groups demonstrated significant improvement in anxiety total scores (by 31% to 35%) as well as psychological and somatic sub-scale scores from baseline with no differences observed between groups. Negative affect scores were also significantly improved in all groups; however, significant increases in positive affect scores were only seen in the echinacea groups compared to baseline (P≤0.001 each dose). Compared to placebo, positive and negative affect changes were significant in the echinacea low- and high-dose groups (P=0.001 and P=0.041, respectively). In the QOL scores, both echinacea groups demonstrated better emotional well-being than placebo (P=0.043 and 0.046, respectively, for the low and high dose). Additionally, the high-dose group was found to have better social functioning (P=0.043) and general health (P=0.049) scores than placebo. No significant differences were observed among the groups for insomnia. Mild digestive complaints were reported more frequently in the echinacea high-dose group (n=4); 1 participant from each echinacea group withdrew from the study due to mild digestive complaints.(Lopresti 2021)

Dental applications

Clinical data

According to a prospective, cross-sectional survey (N=250) analyzing use of 31 complementary and alternative medicine (CAM) remedies for dental or mouth issues, echinacea was recommended by 36% of German dentists and maxillofacial surgeons. As would be expected, perceived effectiveness was rated higher among CAM proponents than opponents.(Baatsch 2017)

Immunomodulatory effects

Many studies investigating the immunomodulatory properties of various echinacea species, extracts, and plant parts have been conducted. Reviews of the literature generally show agreement that echinacea extracts exert effects on markers of the immune system.(Barnes 2005, Barrett 2003)

Animal and in vitro data

In a study evaluating the effects of oral echinacea hydroethanolic extract on the dog immune system, appreciable immunostimulatory activity was suggested; further studies are needed to confirm findings. In vitro and animal studies are ongoing.(Fonseca 2014, Torkan 2015)

Clinical data

Clinical studies have been conducted largely in healthy adults(Brush 2006, Coeugniet 1987, Dapas 2014, Guiotto 2008, Hall 2007, Ritchie 2011, Schwarz 2005) or to investigate echinacea's potential in preventing or treating specific infections (see Infections/Common cold section).(Barnes 2005, Barrett 2003) Effects such as enhanced macrophage function, stimulation of cytokine production (including certain interleukins and tumor necrosis factor alpha), enhanced natural killer cell function, and increased mean circulating total white blood cell counts have been demonstrated; however, the impact of these effects on clinical outcomes has not been established.(Barnes 2005, Barrett 2003, Walsh 2011) Reviews note that overt stimulation of immune functions is not without the potential for harm(Barnes 2005, Barrett 2003); a case report exists of potential activation of autoimmune disease (Sjogren syndrome) with echinacea use.(Logan 2003)

Infections/Common cold

Animal and in vitro data

Antifungal, antibacterial, and antiviral (herpes simplex virus, HIV, and influenza) properties have been studied in vitro(Barnes 2005, Birt 2008, Cruz 2014, Sharma 2009, Sharma 2011); however, widespread traditional use of echinacea for infections, especially for the common cold, as well as the availability of clinical trial data make animal data largely irrelevant.(Karsch-Volk 2014)

Clinical data

According to a Cochrane review of quality clinical trials (conducted up to mid 2013) evaluating echinacea products in the treatment of the common cold, only 1 of 7 studies showed a reduction in duration of infection.(Karsch-Volk 2014) A pooled analysis was not conducted because of the strong clinical heterogeneity of the studies, making definitive statements regarding effects difficult.(Karsch-Volk 2014, Shah 2007) A placebo effect was reported in a clinical study (N=719) that used echinacea to treat new-onset common cold.(Barrett 2011) In another clinical study (N=90), risk of acute otitis media was possibly increased in echinacea-treated otitis-prone children.(Wahl 2008) Efficacy as well as safety and tolerability of echinacea have been studied in children with upper respiratory infections, with equivocal results.(Saunders 2007, Taylor 2003)

Published reviews of echinacea for infection prevention should be considered separately from those evaluating its role in infection treatment, as prophylactic administration occurs prior to symptom onset and for a longer duration.(Karsch-Volk 2014, Schapowal 2015) A Cochrane review of quality clinical trials (N=4,631; including trials published up to mid 2013) evaluating echinacea products in the prevention of upper respiratory tract infections due to the common cold showed a nonsignificant trend in favor of echinacea as prophylaxis; the effect size was of limited clinical relevance (10% to 20% relative risk [RR] reduction).(Karsch-Volk 2014) In a meta-analysis of 6 clinical studies (N=2,458), 4 evaluating echinacea and 2 evaluating other supplements, the risk for recurrent respiratory infections was reduced with echinacea (RR, 0.649; 95% CI, 0.545 to 0.774; P<0.0001).(Schapowal 2015)

In a clinical trial investigating the effect of an echinacea extract on the severity and recurrence of genital herpes, no difference was observed compared with placebo.(Vonau 2001)

Performance enhancement

Animal data

The literature includes limited studies evaluating the effects of echinacea on exercise enhancement in animals; however, studies demonstrating anti-inflammatory and antioxidant effects have led to supplementation of horse feed with echinacea products.(Williams 2008)

Clinical data

Studies in athletes did not demonstrate enhanced performance or change in hemoglobin concentration with echinacea 8,000 mg daily over 6 weeks.(Baumann 2014, Bellar 2014, Stevenson 2016)

According to a consensus statement, evidence is lacking to support use of echinacea in athletes to maintain immune health.(Walsh 2011)


A major limitation reported in meta-analyses of available trial data was the lack of standardization among echinacea preparations, making dosing recommendations difficult. Many products lacked active echinacea chemical compounds or were contaminated with other chemical entities.Barnes 2005, Karsch-Volk 2014

Parenteral use is not recommended; evidence of safety and effectiveness is lacking.Karsch-Volk 2014, Melchart 2002

Long-term use or use for longer than 10 days for acute infections in otherwise healthy individuals is not recommended.Bradley 1992

Pregnancy / Lactation

Information regarding safety and efficacy in pregnancy and lactation is lacking.

A prospective cohort study (N=206) found no increased risk of fetal malformations with the use of echinacea during the first trimesterGallo 2000; however, the study was limited by small sample size, allowance of detection of common malformations only, and lack of standardization of preparations.Barnes 2005, Holst 2011

Evidence regarding safety of echinacea use during lactation is lacking. A case report documented breast milk concentrations that were similar to serum levels 1 to 4 hours after consumption.Amer 2015, Sachs 2013

Despite the Complete German Commission E Monographs statement that oral echinacea is safe for use during lactation at recommended dosages,Blumenthal 1998, Blumenthal 2000 echinacea should be used with caution during lactation; high-quality clinical studies are needed to determine safety.Amer 2015, Perri 2006, Sachs 2013


Data regarding effects on the CYP-450 enzyme system are conflicting.(Colombo 2014, Gorski 2004, Haefeli 2014, Hansen 2008)

In 2 small studies, no impact of echinacea on docetaxel(Goey 2013) or etravirine(Moltó 2012) pharmacokinetics was found; however, a case report describes an interaction with etoposide.(Bossaer 2012) Due to upregulation of CYP1A2 (caffeine) and CYP3A4 (midazolam), effects on therapeutic agents such as amitriptyline, haloperidol and olanzapine, theophylline and zileuton, efavirenz and nevirapine, tamoxifen, and etoposide have been suggested.(Awortwe 2015, Grappe 2014) Echinacea was less active in inhibiting CYP2C8 enzyme activity (metabolism of antihyperglycemic agents) than were 2 of the 6 other plants tested (ie, cranberry, saw palmetto).(Albassam 2015)

Clozapine: CYP3A4 inducers (weak) may decrease the serum concentration of clozapine. Monitor therapy.(Clozaril September 2015, Jerling 1994, Joos 1998, Junghan 1993, Langbehn 2000, Miller 1991, Muller 1988, Peritogiannis 2007, Raitasuo 1994, Tiihonen 1995, Van Strater 2012)

Etoposide: Echinacea may increase the serum concentration of etoposide. Monitor therapy.(Bossaer 2012, Gorski 2004, Gurley 2004, Hansen 2008, Penzak 2010, Yale 2005)

Etoposide phosphate: Echinacea may increase the serum concentration of etoposide phosphate. Monitor therapy.(Bossaer 2012, Gorski 2004, Gurley 2004, Hansen 2008, Penzak 2010, Yale 2005)

Nimodipine: CYP3A4 inducers (weak) may decrease the serum concentration of nimodipine. Monitor therapy.(Nimodipine April 2015, Tartara 1991)

Selpercatinib: CYP3A4 inducers (weak) may decrease the serum concentration of selpercatinib. Monitor therapy.(Retevmo May 2020)

Ubrogepant: CYP3A4 inducers (weak) may decrease the serum concentration of ubrogepant. Consider therapy modification.(Ubrelvy December 2019)

Adverse Reactions

In reviews and meta-analyses of clinical trials of echinacea in the treatment and prevention of the common cold, the most relevant adverse effects were allergic reactions, facial edema, and mild transient GI complaints.Engebretsen 2015, Karsch-Volk 2014, Schapowal 2015 In trials evaluating echinacea for the treatment of the common cold, equal dropout rates due to adverse events were reported for the control and treatment arms. In prevention studies, there was a trend toward higher dropout rates due to adverse effects in the treatment arm.Karsch-Volk 2014

Echinacea should be used with caution in individuals with hypersensitivity to ragweed, chrysanthemum, marigold, daisies, or related allergens.Barnes 2005, Blumenthal 1998, Maskatia 2010

A case report of leukopenia, possibly caused by long-term use of echinacea, has been published.Kemp 2002

There is debate regarding echinacea use in patients with autoimmune disorders. Until this issue is clarified, echinacea should not be used in any condition potentially affected by immune stimulation or suppression, such as HIV, tuberculosis, multiple sclerosis, rheumatoid arthritis, psoriasis, inflammatory bowel disease, and use of immunosuppressive agents.Barnes 2005, Tsai 2012 One case report describes potential activation of autoimmune disease (Sjogren syndrome) with echinacea use.Logan 2003

Individuals with hepatic impairment should use echinacea with caution.Tsai 2012 Acute cholestatic hepatitis likely associated with echinacea root tablets (600 mg/day for 5 days) was reported in a 44-year-old healthy Greek male. Possible product adulteration was not evaluated.Gabranis 2015 In a study of patients with advanced gastric cancer, an association between use of IV E. purpurea extract and the deaths of 2 patients could not be eliminated.Melchart 2002


There is little evidence regarding toxicity with echinacea, despite its widespread use. In general, animal studies evaluating different preparations and fractions of Echinacea species have indicated low toxicity.Barnes 2005, Barrett 2003 Echinacea has not been associated with acute or chronic toxic effects.Barnes 2005

Despite low levels of pyrrolizidine alkaloids in echinacea,Duke 2002, WHO 1999 limited case reports describe acute cholestatic hepatitis related to supplementation with echinacea in adults,Gabranis 2015, Kocaman 2008 and acute liver failure was reported in a child after 2 weeks of supplementation (total daily echinacea dose of 100.7 mg).Lawrenson 2014 Patients with hepatic impairment should use echinacea with caution.

High-dose oral and IV administration (ie, several times the standard human therapeutic dose) of the expressed juice of E. purpurea to rodents for 4 weeks produced no short-term, genotoxic, carcinogenic, mutagenic, or other toxic reactions.Mengs 1991 However, an association between the use of IV E. purpurea extract and the deaths of 2 patients with advanced gastric cancer could not be eliminated.Melchart 2002



This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

Frequently asked questions

Albassam AA, Mohamed ME, Frye RF. Inhibitory effect of six herbal extracts on CYP2C8 enzyme activity in human liver microsomes. Xenobiotica. 2015;45(5):406-412.25430798
Amer MR, Cipriano GC, Venci JV, Gandhi MA. Safety of popular herbal supplements in lactating women. J Hum Lact. 2015;31(3):348-353.25881578
Awortwe C, Manda VK, Avonto C, et al. Echinacea purpurea up-regulates CYP1A2, CYP3A4 and MDR1 gene expression by activation of pregnane X receptor pathway. Xenobiotica. 2015;45(3):218-229.25377539
Baatsch B, Zimmer S, Rodrigues Recchia D, Büssing A. Complementary and alternative therapies in dentistry and characteristics of dentists who recommend them. Complement Ther Med. 2017;35:64-69. doi:10.1016/j.ctim.2017.08.00829154070
Barnes J, Anderson LA, Gibbons S, Phillipson JD. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties. J Pharm Pharmacol. 2005;57(8):929-954.16102249
Barrett B. Medicinal properties of Echinacea: a critical review. Phytomedicine. 2003;10(1):66-86.12622467
Barrett B, Brown R, Rakel D, et al. Placebo effects and the common cold: a randomized controlled trial. Ann Fam Med. 2011;9(4):312-322.21747102
Baumann CW, Bond KL, Rupp JC, Ingalls CP, Doyle JA. Echinacea purpurea supplementation does not enhance VO2max in distance runners. J Strength Cond Res. 2014;28(5):1367-1372.24045635
Bellar D, Moody KM, Richard NS, Judge LW. Efficacy of a botanical supplement with concentrated Echinacea purpurea for increasing aerobic capacity. ISRN Nutr. 2014;2014:149549.24967264
Birt DF, Widrlechner MP, Lalone CA, et al. Echinacea in infection. Am J Clin Nutr. 2008;87(2):488S-492S.18258644
Blumenthal M, Busse WR, eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council; 1998.
Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Integrative Medicine Communications; 2000.
Bossaer JB, Odle BL. Probable etoposide interaction with Echinacea. J Diet Suppl. 2012;9(2):90-95.22607644
Bradley PR, ed. British Herbal Compendium. Vol 1. British Herbal Medicine Association; 1992:81-83.
Brush J, Mendenhall E, Guggenheim A, et al. The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD69 expression and immune cell activation in humans. Phytother Res. 2006;20(8):687-695.16807880
Capek P, Šutovská M, Kocmálová M, Fraňová S, Pawlaczyk I, Gancarz R. Chemical and pharmacological profiles of Echinacea complex. Int J Biol Macromol. 2015;79:388-391.25999016
Carbatrol (carbamazepine) extended-release capsules [prescribing information]. Lexington, MA: Shire US Inc.; August 2018.
Chicca A, Adinolfi B, Martinotti E, et al. Cytotoxic effects of Echinacea root hexanic extracts on human cancer cell lines. J Ethnopharmacol. 2007;110(1):148-153.17052874
Clozaril (clozapine) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; September 2015.
Coeugniet EG, Elek E. Immunomodulation with Viscum album and Echinacea purpurea extracts. Onkologie. 1987;10(3)(suppl):27-33.3309759
Colombo D, Lunardon L, Bellia G. Cyclosporine and herbal supplement interactions. J Toxicol. 2014;2014:145325.24527031
Cruz I, Cheetham JJ, Arnason JT, Yack JE, Smith ML. Alkamides from Echinacea disrupt the fungal cell wall-membrane complex. Phytomedicine. 2014;21(4):435-442.24252333
Currier NL, Miller SC. Echinacea purpurea and melatonin augment natural-killer cells in leukemic mice and prolong life span. J Altern Complement Med. 2001;7(3):241-251.11439845
Dapas B, Dall'Acqua S, Bulla R, et al. Immunomodulation mediated by a herbal syrup containing a standardized Echinacea root extract: a pilot study in healthy human subjects on cytokine gene expression. Phytomedicine. 2014;21(11):1406-1410.24877712
Darwish M, Bond M, Yang R, Hellriegel ET, Robertson Jr P. Evaluation of the potential for pharmacokinetic drug-drug interaction between armodafinil and carbamazepine in healthy adults. Clin Ther. 2015;37(2):325-327.25438721
Dogan Z, Ergul B, Sarikaya M, et al. The protective effect of Echinacea spp. (Echinacea angustifolia and Echinacea purpurea) in a rat colitis model induced by acetic acid. Pak J Pharm Sci. 2014;27(6):1827-1835.25362606
Duke J. Handbook of Biologically Active Phytochemicals and Their Activities. CRC Press Inc; 1992.
Duke J, Bogenschutz-Godwin M, duCellier J, Duke P. Handbook of Medicinal Herbs. 2nd ed. CRC Press; 2002.
Echinacea angustifolia DC. USDA, NRCS. 2020. The PLANTS Database (, 15 September 2020). National Plant Data Team, Greensboro, NC 27401-4901 USA.
Elsässer-Beile U, Willenbacher W, Bartsch HH, Gallati H, Schulte Mönting J, von Kleist S. Cytokine production in leukocyte cultures during therapy with echinacea extract. J Clin Lab Anal. 1996;10(6):441-445.8951617
Engebretsen KA, Johansen JD, Thyssen JP. Herbal medicine as a cause of recurrent facial oedema. Contact Dermatitis. 2015;72(5):342-344.25711432
Equetro (carbamazepine) extended-release capsules [prescribing information]. Parsippany, NJ: Validus Pharmaceuticals LLC; September 2016.
Facino RM, Carini M, Aldini G, et al. Direct characterization of caffeoyl esters with antihyaluronidase activity in crude extracts from Echinacea angustifolia roots by fast atom bombardment tandem mass spectrometry. Farmaco. 1993;48(10):1447-1461.8117383
Fonseca FN, Papanicolaou G, Lin H, et al. Echinacea purpurea (L.) Moench modulates human T-cell cytokine response. Int Immunopharmacol. 2014;19(1):94-102.24434371
Genton P, Nguyen VH, Mesdjian E. Carbamazepine intoxication with negative myoclonus after the addition of clobazam. Epilepsia. 1998;39(10):1115-1118.9776334
Gabranis I, Koufakis T, Papakrivos I, Batala S. Echinacea-associated acute cholestatic hepatitis. J Postgrad Med. 2015;61(3):211-212.26119446
Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Arch Intern Med. 2000;160(20):3141-3143.11074744
Goey AK, Meijerman I, Rosing H, et al. The effect of Echinacea purpurea on the pharmacokinetics of docetaxel. Br J Clin Pharmacol. 2013;76(3):467-474.23701184
Gorski JC, Huang SM, Pinto A, et al. The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. Clin Pharmacol Ther. 2004;75(1):89-100.14749695
Grappe F, Nance G, Coward L, Gorman G. In vitro inhibitory effects of herbal supplements on tamoxifen and irinotecan metabolism. Drug Metabol Drug Interact. 2014;29(4):269-279.25153228
Guiotto P, Woelkart K, Grabnar I, et al. Pharmacokinetics and immunomodulatory effects of phytotherapeutic lozenges (bonbons) with Echinacea purpurea extract. Phytomedicine. 2008;15(8):547-554.18583121
Gurley BJ, Gardner SF, Hubbard MA, et al. In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Clin Pharmacol Ther. 2004;76(5):428-440.15536458
Haefeli WE, Carls A. Drug interactions with phytotherapeutics in oncology. Expert Opin Drug Metab Toxicol. 2014;10(3):359-377.24387348
Hájos N, Holderith N, Németh B, et al. The effects of an Echinacea preparation on synaptic transmission and the firing properties of CA1 pyramidal cells in the hippocampus. Phytother Res. 2012;26(3):354-362.21717515
Hall H, Fahlman MM, Engels HJ. Echinacea purpurea and mucosal immunity. Int J Sports Med. 2007;28(9):792-797.17436202
Haller J, Freund TF, Pelczer KG, Füredi J, Krecsak L, Zámbori J. The anxiolytic potential and psychotropic side effects of an Echinacea preparation in laboratory animals and healthy volunteers. Phytother Res. 2013;27(1):54-61.22451347
Haller J, Hohmann J, Freund TF. The effect of Echinacea preparations in three laboratory tests of anxiety: comparison with chlordiazepoxide. Phytother Res. 2010;24(11):1605-1613.21031616
Hansen TS, Nilsen OG. In vitro CYP3A4 metabolism: inhibition by Echinacea purpurea and choice of substrate for the evaluation of herbal inhibition. Basic Clin Pharmacol Toxicol. 2008;103(5):445-449.18947363
Hinz B, Woelkart K, Bauer R. Alkamides from Echinacea inhibit cyclooxygenase-2 activity in human neuroglioma cells. Biochem Biophys Res Commun. 2007;360(2):441-446.17599805
Holst L, Wright D, Haavik S, Nordeng H. Safety and efficacy of herbal remedies in obstetrics-review and clinical implications. Midwifery. 2011;27(1):80-86.19782445
Jerling M, Lindström L, Bondesson U, Bertilsson L. Fluvoxamine inhibition and carbamazepine induction of the metabolism of clozapine: evidence from a therapeutic drug monitoring service. Ther Drug Monit. 1994;16(4):368-374.7974626
Joksić G, Petrović S, Joksić I, Leskovac A. Biological effects of Echinacea purpurea on human blood cells. Arh Hig Rada Toksikol. 2009;60(2):165-172.19581209
Joos AA, Frank UG, Kaschka WP. Pharmacokinetic interaction of clozapine and rifampicin in a forensic patient with an atypical mycobacterial infection. J Clin Psychopharmacol. 1998;18(1):83-85.9472849
Junghan U, Albers M, Woggon B. Increased risk of hematological side-effects in psychiatric patients treated with clozapine and carbamazepine? Pharmacopsychiatry. 1993;26(6):262.8127933
Karsch-Völk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014;2(2):CD000530.24554461
Kemp DE, Franco KN. Possible leukopenia associated with long-term use of echinacea. J Am Board Fam Pract. 2002;15(5):417-419.12350064
Kocaman O, Hulagu S, Senturk O. Echinacea-induced severe acute hepatitis with features of cholestatic autoimmune hepatitis. Eur J Intern Med. 2008;19(2):148.18249315
Landmann M, Kanuri G, Spruss A, Stahl C, Bergheim I. Oral intake of chicoric acid reduces acute alcohol-induced hepatic steatosis in mice. Nutrition. 2014;30(7-8):882-889.24985007
Langbehn DR, Alexander B. Increased risk of side-effects in psychiatric patients treated with clozapine and carbamazepine: a reanalysis. Pharmacopsychiatry. 2000;33(5):196.11071023
Lawrenson JA, Walls T, Day AS. Echinacea-induced acute liver failure in a child. J Paediatr Child Health. 2014;50(10):841.25288248
Logan JL, Ahmed J. Critical hypokalemic renal tubular acidosis due to Sjögren's syndrome: association with the purported immune stimulant echinacea. Clin Rheumatol. 2003;22(2):158-159.12740687
Lopresti AL, Smith SJ. An investigation into the anxiety-relieving and mood-enhancing effects of Echinacea angustifolia (EP107™): A randomised, double-blind, placebo-controlled study. J Affect Disord. 2021;293:229-237. doi:10.1016/j.jad.2021.06.05434217960
Maskatia ZK, Baker K. Hypereosinophilia associated with echinacea use. South Med J. 2010;103(11):1173-1174.20890257
Melchart D, Clemm C, Weber B, et al. Polysaccharides isolated from Echinacea purpurea herba cell cultures to counteract undesired effects of chemotherapy—a pilot study. Phytother Res. 2002;16(2):138-142.11933115
Mengs U, Clare CB, Poiley JA. Toxicity of Echinacea purpurea. Acute, subacute and genotoxicity studies. Arzneimittelforschung. 1991;41(10):1076-1081.1799389
Miller DD. Effect of phenytoin on plasma clozapine concentrations in two patients. J Clin Psychiatry. 1991;52(1):23-25.1988414
Miller SC. Echinacea: a miracle herb against aging and cancer? Evidence in vivo in mice. Evid Based Complement Alternat Med. 2005;2(3):309-314.16136209
Moazami Y, Gulledge TV, Laster SM, Pierce JG. Synthesis and biological evaluation of a series of fatty acid amides from Echinacea. Bioorg Med Chem Lett. 2015;25(16):3091-3094.26105195
Moltó J, Valle M, Miranda C, Cedeño S, Negredo E, Clotet B. Herb-drug interaction between Echinacea purpurea and etravirine in HIV-infected patients. Antimicrob Agents Chemother. 2012;56(10):5328-5331.22869560
Muller T, Becker T, Fritze J. Neuroleptic malignant syndrome after clozapine plus carbamazepine. Lancet. 1988;2(8626-8627):1500.2904624
Munoz JJ, De Salamanca RE, Diaz-Obregon C, Timoneda FL. The effect of clobazam on steady state plasma concentrations of carbamazepine and its metabolites. Br J Clin Pharmacol. 1990;29(6):763-765.2378792
Nimodipine [prescribing information]. Montvale, NJ: Ascend Laboratories LLC; April 2015.
Penzak SR, Robertson SM, Hunt JD, et al. Echinacea purpurea significantly induces cytochrome P450 3A activity but does not alter lopinavir-ritonavir exposure in healthy subjects. Pharmacotherapy. 2010;30(8):797-805.20653355
Peritogiannis V, Pappas D, Antoniou K, Hyphantis T, Mavreas V. Clozapine-rifampicin interaction in a patient with pulmonary tuberculosis. Gen Hosp Psychiatry. 2007;29(3):281-282.17484952
Perri D, Dugoua JJ, Mills E, Koren G. Safety and efficacy of echinacea (Echinacea angustafolia, E. purpurea and E. pallida) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13(3):e262-e267.17085774
Radix Echinaceae. In: WHO Monographs on Selected Medicinal Plants. Vol. 1. World Health Organization; 1999. Accessed September 21, 2020.
Raitasuo V, Lehtovaara R, Huttunen MO. Effect of switching carbamazepine to oxcarbazepine on the plasma levels of neuroleptics. A case report. Psychopharmacology (Berl). 1994;116(1):115-116.7862923
Retevmo (selpercatinib) [prescribing information]. Indianapolis, IN: Lilly USA, LLC; May 2020.
Ritchie MR, Gertsch J, Klein P, Schoop R. Effects of Echinaforce treatment on ex vivo-stimulated blood cells. Phytomedicine. 2011;18(10):826-831.21726792
Ross IA. Echinacea angustifolia. In: Ross IA, ed. Medicinal Plants of the World. Humana Press; 2001:119-130.
Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132(3):e796-e809.23979084
Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.23653088
Saunders PR, Smith F, Schusky RW. Echinacea purpurea L. in children: safety, tolerability, compliance, and clinical effectiveness in upper respiratory tract infections. Can J Physiol Pharmacol. 2007;85(11):1195-1199.18066121
Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015;32(3):187-200.25784510
Schwarz E, Parlesak A, Henneicke-von Zepelin HH, Bode JC, Bode C. Effect of oral administration of freshly pressed juice of Echinacea purpurea on the number of various subpopulations of B- and T-lymphocytes in healthy volunteers: results of a double-blind, placebo-controlled cross-over study. Phytomedicine. 2005;12(9):625-631.16194048
Sennoune S, Mesdjian E, Bonneton J, Genton P, Dravet C, Roger J. Interactions between clobazam and standard antiepileptic drugs in patients with epilepsy. Ther Drug Monit. 1992;14(4):269-274.1519299
Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007;7(7):473-480.17597571
Sharma M, Anderson SA, Schoop R, Hudson JB. Induction of multiple pro-inflammatory cytokines by respiratory viruses and reversal by standardized Echinacea, a potent antiviral herbal extract. Antiviral Res. 2009;83(2):165-170.19409931
Sharma M, Schoop R, Suter A, Hudson JB. The potential use of Echinacea in acne: control of Propionibacterium acnes growth and inflammation. Phytother Res. 2011;25(4):517-521.20830697
Shin DM, Choi KM, Lee YS, et al. Echinacea purpurea root extract enhances the adipocyte differentiation of 3T3-L1 cells. Arch Pharm Res. 2014;37(6):803-812.24085629
Stevenson JL, Krishnan S, Inigo MM, Stamatikos AD, Gonzales JU, Cooper JA. Echinacea-based dietary supplement does not increase maximal aerobic capacity in endurance-trained men and women. J Diet Suppl. 2016;13(3):324-338.26317662
Tartara A, Galimberti CA, Manni R, et al. Differential effects of valproic acid and enzyme-inducing anticonvulsants on nimodipine pharmacokinetics in epileptic patients. Br J Clin Pharmacol. 1991;32(3):335-340.1777370
Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. JAMA. 2003;290(21):2824-2830.14657066
Tegretol (carbamazepine) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; March 2018.
Tiihonen J, Vartiainen H, Hakola P. Carbamazepine-induced changes in plasma levels of neuroleptics. Pharmacopsychiatry. 1995;28(1):26-28.7746842
Torkan S, Khamesipour F, Katsande S. Evaluating the effect of oral administration of Echinacea hydroethanolic extract on the immune system in dog. Auton Autacoid Pharmacol. 2015;35(1-2):9-13.25832590
Tsai HH, Lin HW, Simon Pickard A, Tsai HY, Mahady GB. Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review. Int J Clin Pract. 2012;66(11):1056-1078.23067030
Tubaro A, Tragni E, Del Negro P, Galli CL, Della Loggia R. Anti-inflammatory activity of a polysaccharidic fraction of Echinacea angustifolia. J Pharm Pharmacol. 1987;39(7):567-569.2886631
Ubrelvy (ubrogepant) [prescribing information]. Madison, NJ: Allergan USA Inc; December 2019.
Van Strater AC, Bogers JP. Interaction of St John's wort (Hypericum perforatum) with clozapine. Int Clin Psychopharmacol. 2012;27(2):121-124.22113252
Vonau B, Chard S, Mandalia S, Wilkinson D, Barton SE. Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes? Int J STD AIDS. 2001;12(3):154-158.11231867
Wahl RA, Aldous MB, Worden KA, Grant KL. Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial. BMC Complement Altern Med. 2008;8:56.18831749
Walsh NP, Gleeson M, Pyne DB, et al. Position statement. Part two: maintaining immune health. Exerc Immunol Rev. 2011;17:64-103.21446353
Williams CA, Lamprecht ED. Some commonly fed herbs and other functional foods in equine nutrition: a review. Vet J. 2008;178(1):21-31.17689992
Wolsko PM, Solondz DK, Phillips RS, Schachter SC, Eisenberg DM. Lack of herbal supplement characterization in published randomized controlled trials. Am J Med. 2005;118(10):1087-1093.16194636
Yale SH, Glurich I. Analysis of the inhibitory potential of Ginkgo biloba, Echinacea purpurea, and Serenoa repens on the metabolic activity of cytochrome P450 3A4, 2D6, and 2C9. J Altern Complement Med. 2005;11(3):433-439.15992226
Zitkevicius V, Smalinskiene A, Lesauskaite V, et al. Influence of Echinacea purpurea (L.) Moench extract on the toxicity of cadmium. Ann N Y Acad Sci. 2007;1095:585-592.17404072

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.