How to take echinacea?

Can Echinacea Fend Off the Common Cold?

If you’re one of the 38 percent of American adults who have tried alternative medicine, you may have taken echinacea for cold prevention or to help ease cold symptoms. However, the jury is still out as to whether or not echinacea actually prevents colds.

“If taken early in the course of an illness, there is some indication that echinacea can shorten the duration of a cold by as much as one day,” says Steven R. Brown, MD, a family physician with Banner Good Samaritan Medical Center, in Phoenix, Ariz., “although not all research confirms this finding.”

Echinacea: What Is It and Why Use It?

Used many years ago as a North American medicinal herb, echinacea derives its name from the Greek word “echinos,” or hedgehog, for its prickly scales and cone-shaped seed head. The roots of echinacea, as well as the part of the plant above the ground, contain polysaccharides, glycoproteins, alkamides, volatile oils, and flavonoids — substances known to boost the activity of the immune system.

Today, echinacea remains popular since it is believed to prevent colds by strengthening the immune system. And, studies aside, some doctors adamantly believe in echinacea’s ability to reduce cold symptoms.

“It works as an immune system stimulant,” says Jacob Teitelbaum, MD, medical director of the National Fibromyalgia and Fatigue Centers, located throughout the country. “I recommend taking it at the first sign of a cold, but not for prevention.”

The Possible Downside of Echinacea

While the effectiveness of echinacea remains under debate, it is considered safe for most adults, says Dr. Brown. Yet, “pregnant women or breast-feeding women should not take echinacea and caution should be used in giving it to children.”

Also, be careful if you have allergies. Individuals allergic to ragweed or other flowers may experience severe allergic reactions to echinacea. People with other types of allergies may be at increased risk for an allergic reaction as well.

In addition, do not take echinacea if you:

  • Have a history of asthma, rheumatoid arthritis, lupus, HIV, cancer, collagen disease, tuberculosis, diabetes, leukemia, organ transplant, pneumonia, stomach problems, or multiple sclerosis
  • Are taking antibiotics, corticosteroids, or chemotherapy
  • Have a fever or an infection

Concentrations of echinacea vary among manufacturers, as does the mixture of plant species and the various parts of the echinacea plant. “As with all herbal remedies, there is no oversight from the Food and Drug Administration, so preparations of echinacea may be inconsistent,” says Brown. “In fact, one study showed that 10 percent of preparations purchased in retail stores contained no echinacea and only 43 percent of standardized preparations met the quality standard described on the label.”

Before purchasing echinacea, ask your doctor to make a recommendation of a credible brand. You can also talk to an herbal supplement professional at a credible health food or vitamin store for suggestions.

Echinacea Dosage Recommendations

Echinacea supplement manufacturers recommend various dosages, so check the label or ask your doctor to recommend how much echinacea you should take. Most dosages suggest one or two capsules between two and four times per day for up to 10 days. Other forms of echinacea require different dosage recommendations. Below are some general recommendations for taking echinacea to boost your immune system.

Depending on the form of echinacea, take three times a day:

  • Tea made from dried echinacea root: 1 to 2 grams
  • Standardized tincture extract: 2 to 3 milliliters (ml)
  • Powered echinacea extract (with 4 percent phenolics): 300 milligrams
  • Tincture (concentrated form — use a 1:5 dilution): 1 to 3 ml (20 to 90 drops)
  • Stabilized fresh echinacea extract: 0.75 ml (15 to 23 drops)

Experts recommend checking with your doctor before taking echinacea to be sure it doesn’t interfere with any medications you currently take.

Complementary and Alternative Medicine

Supporting Research

Auerbach: Auerbach Wilderness Medicine . 5th ed. Philadelphia, PA: Elsevier Mosby; 2007.

ConsumerLab.com. Product review: echinacea. Accessed on April 1, 2002.

Di Pierro F, Rapacioli G, Ferrara T, Togni S. Use of a standardized extract from Echinacea angustifolia (Polinacea) for the prevention of respiratory tract infections. Altern Med Rev . 2012;17(1):36-41.

Frank LG. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double blind, placebo-controlled study. J Comp Alt Med . 2000;6(4):327-34.

Gallo M, Sarkar M, Au W, et al. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med . 2000;160:3141-3.

Ghemi A, Soleimanjahi H, Gill P, Arefian E, Soudi S, Hassan Z. Echinacea purpurea polysaccharide reduces the latency rate in herpes simplex virus type-1 infections. Intervirology . 2009;52(1):29-34.

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):1605-1.

Islam J, Carter R. Use of Echinacea in upper respiratory tract infection. South Med J . 2005;98(3):311-8.

Karsch-Volk 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:CD000530.

Linde K, Barrett B, Wolkart K, Bauer R, Melchart D. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev . 2006;1:CD000530.

Lindenmuth GF, Lindenmuth EB. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. J Altern Complement Med . 2000;6(4):327-34.

Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care . 2001;4(4):199-208.

Melchart D, Linde K, Fischer P, Kaesmayr J. Echinacea for preventing and treating the common cold. . Cochrane Database Syst Rev . 2000;2:CD000530.

Miller. Miller’s Anesthesia . 7th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2009.

Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol . 2002;88(1):42-51.

Nahas R, Balla A. Complementary and alternative medicine for prevention and treatment of the common cold. Can Fam Physician . 2011;57(1):31-6.

Naser B, Lund B, Henneicke-von Zepelin HH, Kohler G, Lehmacher W, Scaglione F. A randomized, double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold. Phytomedicine . 2005;12(10):715-22.

Percival SS. Use of echinacea in medicine. . Biochem Pharmacol . 2000;60(2):155-8.

Rakel. Rakel: Integrative Medicine . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Schapowal A. Efficacy and safety of Echinaforce in respiratory tract infections. Wien Med Wochenschr . 2013;163(3-4):102-5.

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):625-31.

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):517-21.

Soon SL, Crawford RI. Recurrent erythema nodosum associated with Echinacea herbal therapy. J Am Acad Dermatol . 2001;44(2):298-9.

Summaries for patients. Echinacea for the common cold. Ann Intern Med . 2010 Dec;153(12):1-43.

Taheri JB, Azimi S, Rafieian N, Akhaven Zanjani H. Herbs in dentistry. Int Dent J . 2011;61(6):287-96.

Tsai YL, Chiu CC, Yi-Fu Chen J, Chan KC, Lin SD. Cytotoxic effects of Echinacea purpurea flower extracts and cichoric acid on human colon cancer cells through induction of apoptosis. J Ethnopharmacol . 2012;143(3):914-9.

Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother . 2000;44:1708-9.

Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med . 2005;353(4):341-8.

von Maxen A, Schoenhoefer P. Benefit of echinacea in the prevention and treatment of the common cold? The Lancet Infectious Disease . 2008;8(6).

Weber W, Taylor JA, Stoep AV, Weiss NS, Standish LJ, Calabrese C. Echinacea purpurea for prevention of upper respiratory tract infections in children. J Altern Complement Med . 2005;11(6):1021-6.

Woelkart K, Marth E, Suter A, et al. Bioavailability and pharmacokinetics of Echinacea purpurea preparations and their interaction with the immune system. Int J Clin Pharmacol Ther . 2006;44(9):401-8.

Yamada K, Hung P, Park TK, Park PJ, Lim BO. A comparison of the immunostimulatory effects of the medicinal herbs Echinacea, Ashwagandha and Brahmi. J Ethnopharmacol . 2011;137(1):231-5.

Echinacea

What Is It?
One of the most popular herbal remedies in the world, echinacea contains active ingredients thought to fight colds, flu, and other infections. There are nine species of this herb, commonly called the purple coneflower, but just three (Echinacea angustifolia, E. pallida, and E. purpurea) are used medicinally. Various parts of the plant (flowers, leaves, stems, or roots) from a variety of species appear in literally hundreds of commercial preparations. Depending on the species and plant part used, the herb will stimulate the immune system and combat bacteria, viruses, and other disease-causing microbes.

Health Benefits

Both safe and powerful, echinacea stimulates various immune system cells that are key weapons against infection. The herb also helps boost the cells’ production of a virus-fighting substance called interferon.

Specifically, echinacea may help to:

Reduce susceptibility to and duration of colds, flu, and sore throat. Echinacea is most effective if taken at the first sign of a cold, the flu, or a sore throat. Though findings vary, in one study, those using the herb for eight weeks were 35% less likely to catch a cold than those on a placebo. If you’ve already got the aches, congestion, or fever common to colds or flu, echinacea can cause these symptoms to be less severe and to subside sooner.

Fight recurrent respiratory infections, such as bronchitis, sinusitis, strep throat, and earache. The herb’s immune-boosting properties make it particularly helpful for fighting chronic upper respiratory infections. For best results, take echinacea at the first sign of illness.

Combat vaginal yeast and urinary tract infections. As an immune-booster, echinacea can be particularly helpful for fighting these recurrent infections. For yeast infections, the herb seems to stimulate white blood cells to destroy the yeast. Urinary tract infections can be helped by consuming extra fluids, including immune-boosting echinacea tea, which helps wash away the bacteria.

Promote healing of skin wounds and inflammations, including canker sores, burns, and cuts and scrapes. As a natural antibiotic and infection fighter, echinacea promotes the healing of all kinds of skin irritations, including burns, cuts and scrapes, boils, abscesses, canker sores, and eczema, as well as herpes infections (including genital herpes, cold sores, and shingles). It can be applied topically to a wound or be taken internally to strengthen the immune system.

Treat chronic fatigue syndrome. Echinacea is currently being studied as a possible treatment for chronic fatigue syndrome, a condition marked by profound and persistent exhaustion. One theory holds that this mysterious disorder represents the body’s response to a past viral infection that managed to permanently weaken the immune system. By bolstering the immune system and fighting any further viral (or bacterial) presence, echinacea may help those who suffer from this disorder.

Build immunity during cancer treatments and possibly protect against certain forms of cancer. Rotating echinacea with extracts of medicinal mushrooms may help to strengthen overall immunity during cancer treatments. While additional research is needed to define the potential role of echinacea in fighting cancer, a small German study showed that in patients with advanced colon cancer the herb appeared to prolong survival in those who took it in conjunction with standard chemotherapy. The herb presumably boosted the immune system’s ability to fight invading cancer cells.
Note: Echinacea has also been found to be useful for a number of other disorders. For information on these additional ailments, see our Dosage Recommendations Chart for Echinacea.

Forms

tincture
tablet
softgel
lozenge
liquid
dried herb/tea
capsule

Dosage Information

Special tips:

For maximum effect, take echinacea in liquid form–either as a fresh-pressed juice (standardized to contain 2.4% beta-1, 2-fructofuranosides) or as an alcohol-based tincture (containing a 5:1 concentration of the herb).

If you don’t like the bitter taste of the liquid, try standardized extracts in pill form. Look for pills containing at least 3.5% echinacosides, the active ingredient.

The various echinacea products available–capsules, tablets, juice, fluid extract–commonly contain echinacea made from either a single or mixed species. Check the label carefully to ensure that the species–and the plant part–you need is present in the product you select. Use the following as a guide:

For long-term use as a general immune-booster: Take supplements made from the whole plant (the roots and leaves) of E. angustifolia. To get the maximum benefit, alternate echinacea (200 mg twice a day) with other immune-enhancing herbs such as goldenseal, astragalus, pau d’arco, or maitake, reishi, and/or shiitake mushrooms. Pick two of these other herbs, use each one for a week, and then return to echinacea every third week. This practice is good for chronic fatigue sufferers and for those who want to boost immunity during cancer treatments.

For cold and flu prevention: Take 200 mg a day, preferably from supplements made from the above-ground plant of E. purpurea and the root of E. pallida. Or try rotating echinacea in three-week cycles with astragalus (500 mg a day), a Chinese herb that acts on the immune system in a way similar to echinacea.

For sore throat: To lessen the symptoms, a high dose is necessary: Take 200 mg four or five times a day. For immediate sore throat relief, add 1 teaspoon echinacea tincture to 1/2 cup warm water, gargle, and swallow four or five time a day until the pain subsides. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida.

For chronic bronchitis: Take 200 mg twice a day. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida.

For earache: Take 200 mg three times a day. Use in a cycle of three weeks on, one week off for recurrent infections. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida.

For vaginal yeast infections: Take 200 mg three times a day. Use in a cycle of three weeks on, one week off for recurrent infections. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida.

For urinary tract infections: Drink 1 cup of echinacea tea several times a day. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida. To make the tea, use 2 teaspoons echinacea for each 8-ounce cup of very hot (not boiling) water. Steep for 15 minutes and strain. Sweeten to taste with honey, if desired.

For skin wounds and inflammation: Add 3 drops of liquid extract to 1 teaspoon of water and apply to the wound. Or take 200 mg three times a day to prevent infection. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida.

For canker sores: Take 200 mg three times a day at the first sign of a sore. Begin taking echinacea at the higher dose and reduce the dosage as the sore heals. For prevention, take 200 mg each morning for three weeks of each month. Select supplements made from the above-ground plant of E. purpurea and the root of E. pallida.

Be sure to check out our Dosage Recommendations Chart for Echinacea, which lists therapeutic dosages for specific ailments at a glance.

Guidelines for Use

Use echinacea alone for no longer than eight weeks, followed by a one-week rest period before you start taking it again. With continuous use, the herb’s immunity-enhancing effects begin to decrease. Starting and stopping echinacea, or rotating it with goldenseal and the other herbs mentioned above, may maximize its effectiveness.

You can take echinacea with or without food.

General Interaction

There are no known drug or nutrient interactions associated with echinacea.

Possible Side Effects

At recommended doses, echinacea has no known side effects. However, people who are allergic to flowers in the daisy family may be allergic to echinacea as well.

Cautions

Echinacea is not a replacement for antibiotics or other infection-fighting drugs, but it can be used to complement them.

Because echinacea could, in theory at least, overstimulate the immune system, it could worsen the condition of lupus, multiple sclerosis, rheumatoid arthritis, and other autoimmune disorders. Consult your doctor before taking the herb if you suffer from any of these disorders.

Don’t take echinacea for progressive infections such as tuberculosis.

Ailments-Dosage

Bronchitis Acute: 300-500 mg standardized extract or freeze-dried whole herb or 1-2 tsp. liquid extract 4 or 5 times a day. Chronic: 300-500 mg once a day, for 1-2 weeks; use in rotation with astragalus, pau d’arco, and medicinal mushrooms.
Burns 1-2 tsp. liquid extract (dilute in 1/2 cup of water) or 325-650 mg dried herb or 90 mg liquid caps 3 times a day
Cancer 1-2 tsp. liquid extract 3 times a day or 325-650 mg freeze-dried herb capsules 3 times a day or 90 mg liquid caps 3 times a day
Canker Sores 325-650 mg of the dried root and herb as a standardized extract or the freeze-dried form 4 or 5 times a day at the first sign of sore. With a liquid extract, mix 1 tsp. in 1/2 cup water 4 times a day. For prevention, take 325 mg a day for 3 weeks each month.
Chronic Fatigue Syndrome 400-600 mg a day
Cold Sores For acute flare-up: 1-2 tsp. fluid extract 3 times a day; or 325-650 mg freeze-dried whole herb 3 times a day; or 90 mg liquid caps 3 times a day.
For maintenance: In rotation with astragalus and mushroom combination, 1 tsp. fluid extract daily; or 325-650 mg freeze-dried whole herb daily or 90 mg liquid caps daily.
Colds To lessen cold symptoms, 300-500 mg standardized extract or freeze-dried whole herb or 1-2 tsp. liquid extract 4 or 5 times a day.
For prevention, 300-500 mg a day in 1- or 2-week rotations with astragalus and medicinal mushrooms.
Cuts and Scrapes 350-650 mg freeze-dried root OR 2 tsp. liquid extract 3 times a day. Apply 1 tsp. liquid extract (diluted with 1 tbsp. water) to wound 2 or 3 times a day as alternative to aloe vera or lavender oil.
Earache 300-500 mg standardized extract or freeze-dried whole herb or 1-2 tsp. liquid extract diluted in water 3 times a day. For recurrent infections, reduce to one dose a day and use in a cycle of 3 weeks on, 1 week off.
Flu To lessen flu symptoms, 300-500 mg standardized extract or freeze-dried whole herb or 1-2 tsp. liquid extract 4 or 5 times a day.
For prevention, 300-500 mg a day in 1- or 2-week rotations with astragalus and medicinal mushrooms.
Shingles 200 mg echinacea 4 times a day during the acute phase only. To help prevent recurrences, reduce to 200 mg a day 3 weeks of each month.
Sinusitis 1-2 tsp. liquid extract or 50-90 mg liquid capsules or 325-650 mg freeze-dried herb 3 times a day
Sore Throat For an acute infection: 200 mg 4 or 5 times a day. Alternatively, as a gargle, add 1 tbsp. liquid extract to 1/2 cup warm water, gargle, and swallow. Repeat 4 or 5 times a day until pain subsides.
For prevention: 200 mg each morning in 3-week cycles, alternating with another immune-stimulating herb such as astragalus (400 mg a day).
Urinary Tract Infections 1 cup echinacea tea several times a day
Yeast Infection (Vaginal) For acute infection: 250-400 mg standardized extract 3 times a day; 350 mg freeze-dried herb 3 times a day; 1 tsp. liquid extract 3 times a day; 90 mg liquid capsules 3 times a day.
For maintenance: Same dose but once a day, in a cycle of 3 weeks on, 1 week off.

Doctor Recommendations
David Edelberg, M.D.

Echinacea is one of the best-known medicinal herbs and enjoys a worldwide reputation for its immune-enhancing properties. You’re actually best off with a combination of at least two of the echinacea species, E. purpurea and E. angustifolia. If your preparation contains some Echinacea pallida, that’s fine, too.

HOW IT HELPS COLDS

Remember, when you have a cold, you’re using echinacea for two purposes: first, to jump-start your own immune system to get rid of the infection, and second, to directly challenge the cold virus. This actually makes echinacea a more sensible choice than antibiotics, which don’t boost your own immune system and are utterly powerless against cold viruses. Start taking echinacea early, especially if everybody is sniffling and sneezing around you. At the first telltale signs of a cold–scratchy throat, runny nose, and so forth–be generous. If you have 100 mg capsules, take two every four hours. If you have the liquid extract, take a teaspoonful every two to three hours. Maintain these substantial doses during the first couple of days; then you can reduce your dose by about half.

WHAT TO LOOK FOR

Echinacea comes in a wide variety of forms–ranging from capsules and lozenges to liquids and dried herbs for teas. This makes choosing and buying echinacea potentially confusing.

Forms

Liquids are preferred by most herbalists. Your choices are: Fresh-pressed juice (standardized to contain 2.4% beta-1, 2-fructofuranosides) Liquid extract (5:1 concentration of echinacea) needs to be diluted in water. Pills. Pills are another fine option and are particularly useful if the somewhat bitter taste of the liquid bothers you. Your choices are: Tablets, softgels, or capsules, which also come in standardized extracts.

Standardization

Look for a brand containing at least 3.5% echinacosides, the herb’s active ingredient.

OTHER SUGGESTIONS

If you do decide to try echinacea, here are a couple of useful pointers: About the liquids: If the product has lost its ability to make your tongue tingle, the echinacea is probably no longer effective. On a personal note: I’ve always found it a lot more convenient to stash a day’s supply of echinacea capsules–rather than a liquid-filled bottle–in my back pocket. All you need is for the bottle of liquid extract to leak just once and you’ll understand my preference for capsules. Medicinally, however, both forms work well.

Echinacea oral dosage forms

What is this medicine?

ECHINACEA (EK e nay sha) is an herbal product or dietary supplement. It is promoted to help support the body’s natural defense systems. It is commonly used for colds or sore throats caused by cold viruses. However, there is limited evidence that echinacea helps colds or similar illnesses. The FDA has not approved this herb for any medical use.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Junior Strength Immune Support With Echinacea

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • cancer

  • diabetes

  • immune system problems

  • HIV or AIDS

  • kidney disease

  • liver disease

  • lung or breathing disease, like asthma

  • organ transplant

  • other chronic illness

  • tuberculosis

  • an unusual or allergic reaction to echinacea, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

Take by mouth with a glass of water. Follow the directions on the package labeling or ask your health care professional. If this supplement upsets your stomach, take it with food. Do not take this supplement more often than directed.

Talk to your pediatrician regarding the use of this supplement in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

  • antiviral medicines for HIV or AIDS

  • medicines for cancer

  • medicines that lower your chance of fighting infection

  • medicines to prevent organ transplant rejection like cyclosporine

  • nimodipine

  • steroid medicines like prednisone or cortisone

  • warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

See your doctor if your symptoms do not get better or if they get worse. Do not take this supplement for more than 2 weeks unless your doctor tells you to. Long term use of this supplement has not been proven to be helpful and may be harmful.

If you are scheduled for any medical or dental procedure, tell your healthcare provider that you are taking this supplement. You may need to stop taking this supplement before the procedure.

Herbal or dietary supplements are not regulated like medicines. Rigid quality control standards are not required for dietary supplements. The purity and strength of these products can vary. The safety and effect of this dietary supplement for a certain disease or illness is not well known. This product is not intended to diagnose, treat, cure or prevent any disease.

The Food and Drug Administration suggests the following to help consumers protect themselves:

  • Always read product labels and follow directions.

  • Natural does not mean a product is safe for humans to take.

  • Look for products that include USP after the ingredient name. This means that the manufacturer followed the standards of the US Pharmacopoeia.

  • Supplements made or sold by a nationally known food or drug company are more likely to be made under tight controls. You can write to the company for more information about how the product was made.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

  • breathing problems

  • bloody or watery diarrhea

  • fever, chills

  • signs and symptoms of liver injury like dark yellow or brown urine; general ill feeling or flu-like symptoms; light-colored stools; loss of appetite; nausea; right upper belly pain; unusually weak or tired; yellowing of the eyes or skin

  • sores in the eyes, mouth, nose

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • changes in taste

  • headache

  • nausea

  • stomach upset

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature or as directed on the package label. Protect from moisture. Throw away any unused supplement after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

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Echinacea

Background

  • There are nine known species of echinacea, all of which are native to North America. They were used by Native Americans of the Great Plains region as traditional medicines.
  • Echinacea is used as a dietary supplement for the common cold and other infections, based on the idea that it might stimulate the immune system to more effectively fight infection. Echinacea preparations have been used topically (applied to the skin) for wounds and skin problems.
  • The roots and above-ground parts of the echinacea plant are used fresh or dried to make teas, squeezed (expressed) juice, extracts, capsules and tablets, and preparations for external use. Several species of echinacea, most commonly Echinacea purpurea or Echinacea angustifolia, may be included in dietary supplements.

How Much Do We Know?

  • Many studies have been done on echinacea and the common cold. Much less research has been done on the use of echinacea for other health purposes.

What Have We Learned?

  • Taking echinacea after you catch a cold has not been shown to shorten the time that you’ll be sick.
  • Taking echinacea while you’re well may slightly reduce your chances of catching a cold. However, the evidence on this point isn’t completely certain. Currently, the National Center for Complementary and Integrative Health (NCCIH) is funding research to identify the active constituents in echinacea and to study the effects on the human immune system of substances in bacteria that live within echinacea plants.

What Do We Know About Safety?

  • There are many different echinacea products. They may contain different species of plants or different parts of the plant, be manufactured in different ways, and have other ingredients in addition to echinacea. Most of these products have not been tested in people.
  • For most people, short-term oral (by mouth) use of echinacea is probably safe; the safety of long-term use is uncertain.
  • The most common side effects of echinacea are digestive tract symptoms, such as nausea or stomach pain.
  • Some people have allergic reactions to echinacea, which may be severe. Some children participating in a clinical trial of echinacea developed rashes, which may have been caused by an allergic reaction. People with atopy (a genetic tendency toward allergic reactions) may be more likely to have an allergic reaction when taking echinacea.
  • Current evidence indicates that the risk of interactions between echinacea supplements and most medications is low.

Keep in Mind

  • Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Echinacea cold study claims analysed

Echinacea “can prevent colds”, reports The Daily Telegraph, while the Daily Mail reports that the “largest ever clinical study into Echinacea finds herbal remedy can protect against colds”.

These headlines were based on a study which found that giving healthy adults three doses of the herbal remedy Echinacea daily for four months reduced the combined number and duration of cold episodes by an average of 26% compared to placebo.

What was not widely reported in the news was that the study also reported finding no significant difference between the groups when they looked at the number of colds each group caught. So, the difference seems to have been related to how long a cold lasted, rather than the frequency of cold.

This randomised control trial was well designed and had a good sample size (755 participants), however, there are a number of oddities in the reporting of the study findings that cast a shadow of doubt over the results, such as:

  • no declaration of funding and only partial disclosure of conflict of interests
  • no results table
  • limited reporting of unpleasant side effects
  • no estimates of error around the results reported
  • selective reporting of results
  • the applicability of the results to the general population

Many of these basic problems would usually be picked up by the peer review process or journal editors. The lack of such quality standards may leave the reporters and editors a little red-faced. This news story should stand as a warning to journalists of the dangers of taking research at face value without bringing any critical faculties to bear.

In conclusion, based on this study alone, it is not clear whether taking Echinacea prevents cold episodes, though it does suggest it may reduce their duration. Further research is needed to confirm or refute these findings and also to see if they also apply to people with long-term health conditions such as asthma.

Where did the story come from?

The study was carried out by researchers from the Common Cold Centre in Cardiff University. The study was published in the open access, peer-reviewed medical journal Evidence-Based Complementary and Alternative Medicine.

No funding source was reported in the published research article, but three of the five authors declared no conflict of interest. Information on the other two authors’ potential conflicts of interest was absent.

The lack of funding information and incomplete declaration of conflicts of interest by all the study authors is unusual. The standard practice in all good science or medical journals is to clearly state all funding sources and conflicts of interest, or how the funder was involved in the research design or write-up. This article falls short of this standard, and this should arouse a healthy scepticism in readers.

Interestingly, both the Mail and the Telegraph reported that the study was part funded by A. Vogel, a Swiss manufacturer of herbal remedies, including Echinacea products (such as Echinacea toothpaste). This could not be confirmed from the research article alone, although the Echinacea used in the research was provided by this company, and the study is highlighted on the A. Vogel website’s blog.

The media reporting was generally focused on the finding that “taking three daily doses of the common remedy for four months reduced the number of colds and duration of the illness by an average of 26%”. This finding is the result of combining the number of colds and their duration into one variable.

The media chose not to report the finding that the number of colds alone was not significantly different between the two groups, which is also informative.

Finally, the media did not highlight the numerous and significant limitations of the study discussed below.

What kind of research was this?

This was a was a randomised, double blind, placebo-controlled clinical trial designed to assess the safety and benefit of Echinacea purpurea (Echinacea) extract in the prevention of common colds.

Common colds are caused by a range of viruses that result in the familiar symptoms of a runny nose, cough, and sore throat and sometimes complaints of headache and fever. The authors report that the common cold is the most prevalent disease in Western civilisation, with substantial related healthcare costs, so a medication to reduce this disease burden would be welcomed.

What did the research involve?

A total of 755 healthy subjects were randomly assigned to receive an extract of Echinacea purpurea (a flowering plant found in North America, supposed to have immune-boosting properties), or a placebo for a period of four months.

The Echinacea administered was a commercially available product called “Echinaforce drops”, supplied by A. Vogel Bioforce. The placebo drops were similar in shape, colour, consistency, odour and flavour. Participants and study investigators were ‘blinded’ to which treatment was given to which participant.

Participants took three doses of 0.9ml of the drops each day for four months in an attempt to prevent colds. This corresponded to 2,400mg of Echinacea extract per day. During a cold (cold episode), participants were instructed to increase the dose to five doses of 0.9ml per day (4,000mg per day). Each dose was diluted in water and held in the mouth for 10 seconds, a method described by researchers as having “maximum local anti-viral effects”, although why this would be the case is unclear.

Throughout the investigation period participants were required to keep a diary to record adverse events by answering questions, such as “did you have any unusual or unexpected symptoms today?”.
Researchers considered whether any reported adverse effects could be related to the study medication, documenting this as “unlikely”, “possible”, “probable/likely”. Participants were also asked to record and rate cold-related issues and the use of any medications in a diary.

When participants got a cold they were asked to collect nasal secretions using home kits which were then screened for viruses.

The statistical analysis employed by the researchers was basic and potentially incomplete.

No summary table of the comparisons that the researchers tested was provided in the write-up.

This lack of clarity in reporting makes it harder for the reader to see exactly what statistical comparisons have been tested, and which were significant.

The researchers combined individual measures of the number of colds caught (cold episodes) with cold duration (episode days) to create a single variable of “cumulative events” (cold episodes and episode days combined).

Combining the results in this manner falls far from the standards of transparency you would expect to see from a well-conducted randomised controlled trial.

What were the basic results?

Of the 755 participants randomised, 673 (89%) completed the study. The researchers aimed to examine two main topics, safety and effectiveness. Unfortunately, due to the way the findings were reported (and the lack of a clear results table) the exact comparison and findings of this study were difficult to pin down.

Safety

There were no significant differences in the number of adverse events reported in the Echinacea group compared to the placebo group. As mentioned, very little information was given on adverse events, in both the Echinacea and placebo group.

This is somewhat surprising as the researchers write that one of the main reasons they are conducting the study is to establish whether Echinacea has ‘a good safety profile’.

There were also no significant differences between the two groups on key blood and biochemical measures.

Effectiveness

The authors report that the placebo group had 188 cold episodes, lasting 850 episode days, compared to the Echinacea group which had a total of 149 episodes, lasting 672 episode days. They report that the combined “cumulative events” variable (number of episodes and their duration) was 26% lower in participants given Echinacea, compared to placebo, and that this was statistically significant, but without giving a 95% confidence interval level – the usual measure of statistical validity. The researchers also found that there was a 59% reduction in recurring cold infections in the Echinacea group compared with placebo (again, no 95% confidence interval level was reported). Not reporting confidence intervals for results is unusual for a randomised controlled trial.

The authors found that significantly more people (52% more, without 95% confidence interval) in the placebo group used aspirin, paracetamol, or ibuprofen to treat their cold while in the study, than in the Echinacea group. There were 58 cold episodes treated with pain medication in the Echinacea group compared to 88 in the placebo group.

The authors then did a subgroup analysis on those that had followed the study medication protocol for the entire four months of the treatment (84 people who took all doses in the Echinacea group; the number in the placebo group not reported). Those who had deviated in any way from the medication, or who had dropped out, were excluded. This sub-analysis showed that the Echinacea group had 53% fewer cold episode days, which was statistically significant (no 95% confidence level reported). The results of a comparison of cold episodes, the other key variable, were not reported.

How did the researchers interpret the results?

The authors concluded that “prophylactic intake of E. purpurea over a four-month period appeared to provide a positive risk to benefit ratio”.

Conclusion

This study appears to show that giving healthy adults Echinacea every day for four months may result in an average 26% reduction in the combined number and duration of cold episodes compared to placebo over the same period. Combining outcomes in this way is a potentially useful way of reporting outcomes. However, in some cases it is used to “fish” for statistically significant findings when the individual outcomes fail to reach significance on their own. Indeed, when this combined variable was ‘disaggregated’ the researchers found no significant difference between the numbers of colds that occurred in the two groups.

This study appeared to be well designed, and may have collected important results. However, the way in which it was written up meant that it was difficult to assess the findings. These basic problems should really be picked up by the peer review process or journal editors.

The following issues with the study’s reporting muddied the water of interpreting these findings fully and clearly:

No declaration of funding and only partial disclosure of conflict of interest

The lack of funding information and incomplete declaration of conflicts of interest by all the study authors is highly unusual. The standard practice in all good science or medical journals is to clearly state all funding sources and conflicts of interest. This article falls short of this standard. While it is not unusual for commercial companies to fund, or provide drugs, for research purposes (which is not in itself a bad thing), it is unusual when this is not declared in the publication.

No results table

Unconventionally, this study did not contain a results table showing which statistical comparisons were made, for example, the number of colds in the placebo group versus the control group (and whether this was statistically significant). Describing only a few significant results in the results section makes it unclear whether other comparisons were performed and whether they were left out because they turned out to be non-significant. The discussion section of the article makes suggestions of non-significant findings that were not mentioned in the results section. The study also failed to list any adverse effects or side effects in a meaningful way.

No estimates of error around measures of effect reported

For the results that were reported, there were no 95% confidence intervals. The research does include the probability (p values), which confirms the significance of these calculations, but the 95% confidence intervals would be valuable. These can demonstrate, for example, if risk reductions only just reached significance, or, if the confidence intervals were wide, it would mean we could have less confidence in the accuracy of the estimated effect of Echinacea.

Selective reporting of results

In their discussion section, the authors state that statistically significant findings between the Echinacea group and placebo group were only found for “cumulative cold episode days” and on the use of pain medications to treat cold episodes. They also mention (in the discussion only) that the number of cold episodes alone was not statistically significant between the Echinacea and placebo group. Only raising important non-significant findings in the discussion without first mentioning them in the results section is a further unconventional practice. It also raises questions over whether the authors have reported only significant findings in the results section, which would give a biased view of their findings.

Statistical analysis

The authors highlight that the Echinacea group had a higher susceptibility to colds than those in the placebo group at the start of the study (measured by assessing the number of colds in the past). They also report that participants in the Echinacea group reported less frequent use of common pain medications. They point out that adjusting for these covariates would most likely have resulted in an even higher beneficial effect of Echinacea.

The researchers employed the double-blind randomised control trial method as this is rightly seen as the gold standard in judging whether a treatment is both effective and safe. However, they left out many of details you would expect to see in the reporting of a well-conducted randomised control trial – details that would ultimately add credibility to the results.

It could well be the case that Echinacea may have a role in the prevention or treatment of colds. But, based on the results of this study, it is very hard to state that with any certainty*.
*

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Largest ever clinical study into echinacea finds herbal remedy can protect against colds

Daily Mail, 10 October 2012

Echinacea ‘can prevent colds’

The Daily Telegraph, 10 October 2012

Links to the science

Jawad M, Schoop R, Suter A, Klein P, Eccles R.

Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial

Evidence-Based Complementary and Alternative Medicine. Published online September 16 2012

What Is Echinacea—and Can It Really Help a Cold?

RELATED: 20 Over-the-Counter Cold Remedies: What Works, What Doesn’t

Will echinacea really help your cold?

The few studies that have been done on echinacea suggest that the plant may shorten a common cold at least a little bit. “The best scientific evidence involves the plant’s ability to reduce the length of a cold when started at the onset of symptoms,” says Kristen Kajewski, DO, a family medicine provider at Mayo Clinic Health System in Minnesota. “There have been quite a few studies with positive outcomes in this regard.” The key is “started at the onset of symptoms,” which means you’ll need to start taking echinacea at the first sign of sniffles if you want to see any benefit.

Even still, there’s a miniscule chance that taking this supplement is going to get you better in time for that important meeting that’s only a day or two away. Echinacea may shorten the lifespan of your cold, but it’s not a miracle cure—it won’t take you from feeling lousy to feeling great overnight. “Usually, someone would need to take echinacea three to four times a day for seven to 14 days, and this could shorten the course of the illness by one to two days and decrease the severity of symptoms,” Dr. Kajewski says.

Shortening a cold by a day or two sounds pretty good, so you may be ready to run to the drugstore and buy some echinacea. But those results haven’t been consistent across studies, so there’s no guarantee that taking echinacea will affect you that way. Some studies have shown only a half-day reduction in cold duration and a small, basically insignificant reduction in symptom severity, according to the Mayo Clinic. Overall, there isn’t a big enough body of research on echinacea to prove that it does or does not help fight colds.

RELATED: 4 Things You Should Know About Zinc and the Common Cold

Is echinacea safe?

The supplement industry is not well regulated, so you can’t be 100% sure that any echinacea pill, oil, or tea you’re picking up is the pure, unadulterated plant. “As with many supplements, ensuring a quality product is difficult,” Dr. Kajewski says. “Adulteration, substitution, and products of poor quality have been a long-standing problem with echinacea.”

Then there’s the trouble that no two echinacea supplements are created equal. Echinacea pills, oils, teas, and syrups may all contain different species of the plant, different parts (the petals, the stems, the leaves, etc.), be manufactured in different ways, or have other ingredients added, according to the National Institutes of Health. And all of this may affect both how effective the supplement you choose is, as well as how much scientists really know about echinacea supplements in general (since every study may be testing a different form).

Still, if you want to give it a try, most of the supplements seem to be pretty safe. Some people report nausea or stomach pain with echinacea, and in one clinical trial some children who took echinacea syrup developed a rash. But most people have no side effects with these supplements, Dr. Kajewski says, and taking echinacea is generally considered safe even when combined with other supplements or medications meant to treat your cold.

RELATED: 11 Signs It’s More Serious Than the Common Cold

So should you take echinacea?

Bottom line: Go ahead and take echinacea if you want to. There are very few risks involved, and it might even have a slight benefit. It’s unlikely that taking an echinacea supplement or drinking some echinacea tea (we like Traditional Medicinals’s Lemon Echinacea Throat Coat) will make you feel 100% before that important date you have coming up in your calendar, but it just might help get you over your cold faster. As always, though, it’s a good idea to chat with your doctor about any supplements you want to try.

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Echinacea. Photo: James And James/Getty Images

It never fails: Mention you’re coming down with a cold, and people will start pushing echinacea on you. But aside from a vague sense that it’s something like non-branded Airborne, how much do you actually know about echinacea? For our own sanity (and yours), the Cut talked with some experts to figure out the actual benefits of the herb, how it works, and why you should take it. Next time you get repeatedly sneezed on in the subway or receive a hug from an especially snot-nosed toddler, you’ll know where to turn.

What even is echinacea? Nearly impossible to spell and only slightly easier to pronounce (it’s eck-en-ay-sha, basically), echinacea is an herb that contains therapeutic chemicals and has been used as a health remedy for over 400 years. Registered dietitian and nutritionist Amy Shapiro told the Cut that the entire plant is actually beneficial — from its roots to its leaves.

But what does it do? Echinacea is believed to boost the immune system — so in other words, if you take it when you’re coming down with a cold or flu, it’s supposed to help you fight off the illness and get better faster. But Dr. Chris D’Adamo, an assistant professor at the University of Maryland School of Medicine, told the Cut that studies go back and forth on whether it actually helps prevent the common cold. For instance, one study found that people with a cold who drink tea with echinacea in it every day for five days felt better faster than those who just drank normal tea. But at the same time, another study found echinacea doesn’t really “significantly” change the severity and length of a cold. The science is enough to convince Dr. D’Adamo, though — he says he takes it, personally.

When should I take it? Even though the science is out on echinacea’s effect on colds, both Dr. D’Adamo and Shapiro agree that, by and large, the herbal remedy is at least somewhat beneficial. However, the positive benefits of echinacea are only seen if you take them at the first sign of a cold and flu, or if you’ve been exposed to someone who may be sick (in which case you can take it preventatively). “It may help treat a cold but you have to get it at the very first sign,” D’Adamo stressed. “Once you’re full on in it with congestion and feeling terrible, it’s unlikely to do anything.”

Does it do anything else I should know about? On top of probably helping stave off cold and flu, echinacea is also a great anti-inflammatory remedy, Shapiro said. If you find yourself coming down with some general form of pain — from a headache to a sore throat — you can take the herb to help reduce whatever inflammation is afflicting you. On top of that, because echinacea can help relax your gastrointestinal tract, you could also take it as a mild laxative to get things moving.

Additionally, given its anti-inflammatory powers, echinacea can also help reduce skin inflammation. So if you feel an eczema flare-up coming on, or if you’re suffering from a bug bite or psoriasis, you can take it to ease your skin’s irritation. “All of these things go back to immunity and anti-inflammatory,” the nutrition expert noted.

How do I take it? You can take echinacea as a tablet or capsule, or you can also take it in tea form if you prefer your supplements to be as cozy as possible.

And how can I get some? You can basically find echinacea at any drugstore or natural market. Shapiro warns, however, that when it comes to buying echinacea capsules, you should make sure you’re buying from a well-known brand. Health and wellness are hot topics at the moment — and supplements aren’t regulated. So a ton of new companies are popping up all over the place trying to profit off of your quest for wellness, and their supplements might not be as good as a well-known brand, like Twin Labs or Nature’s Way. “ more likely to want to protect their name as opposed to just being like, ‘Oh, let me try these and then do something else if they don’t work,’” she said.

On the other hand, Dr. D’Adamo added that it’s also a good idea to try to buy echinacea supplements that are actually organic.

Who shouldn’t take it, though? Dr. D’Adamo recommends that women who are breastfeeding or pregnant should stay away from echinacea as a precaution, since there isn’t much information out there as to what effect it could have on a baby.

Additionally, people taking immunosuppressant drugs as treatment for cancer or autoimmune diseases shouldn’t take it either, because it may interfere with those medications.

Should I take it all year long so that I’m healthy 24/7? Since echinacea can (probably) boost your immune system, it might seem logical to just take it all the time and live your healthiest possible life. But Dr. D’Adamo said that constantly taking echinacea is “unnecessary.” He recommends only taking it when you feel a cold coming on or you’ve been hanging around sick people. “I wouldn’t take it every day,” he said.

Echinacea for preventing and treating the common cold

Preparations of the plant Echinacea are widely used in some European countries and in North America for common colds. Echinacea preparations available on the market differ greatly as different types (species) and parts (herb, root or both) of the plant are used, different manufacturing methods (drying, alcoholic extraction or pressing out the juice from fresh plants) are used and sometimes also other herbs are added.

We reviewed 24 controlled clinical trials with 4631 participants investigating the effectiveness of several different Echinacea preparations for preventing and treating common colds or induced rhinovirus infections. Our review shows that a variety of products prepared from different Echinacea species, different plant parts and in a different form have been compared to placebo in randomized trials. Due to the significant differences in the preparations tested, it was difficult to draw strong conclusions. Five trials were rated as having a low risk of bias in all five categories of the Cochrane ‘Risk of bias’ tool. Five more trials were rated as low risk of bias, having an unclear risk of bias in only one category. Eight trials were rated as having a high risk of bias in at least one category and the remaining six as having an unclear risk of bias.

The majority of trials investigated whether taking Echinacea preparations after the onset of cold symptoms shortens the duration, compared with placebo. Although it seems possible that some Echinacea products are more effective than a placebo for treating colds, the overall evidence for clinically relevant treatment effects is weak. In general, trials investigating Echinacea for preventing colds did not show statistically significant reductions in illness occurrence. However, nearly all prevention trials pointed in the direction of small preventive effects. The number of patients dropping out or reporting adverse effects did not differ significantly between treatment and control groups in prevention and treatment trials. However, in prevention trials there was a trend towards a larger number of patients dropping out due to adverse events in the treatment groups.

The evidence is current to July 2013.

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