echinacea

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

REMS

Bacterial and viral infections
Prevention and treatment of colds, coughs, flu, and bronchitis
Fevers
Wounds and burns
Inflammation of the mouth and pharynx
Urinary tract infections
Vaginal candidiasis

Action ⬆ ⬇

Medicinal parts derived from the roots, leaves, or whole plant of perennial herb (Echinacea).
Echinacea purpurea herba has been reported to promote wound healing, which may be due to an increase in white blood cells, spleen cells, and increased activity of granulocytes, as well as an increase in helper T cells and cytokines.
E. purpurea radix has been shown to have antibacterial, antiviral, anti-inflammatory, and immune-modulating effects.

Therapeutic effects:

Resolution of respiratory and urinary tract infections.
Decreased duration and intensity of common cold.
Improved wound healing.
Stimulates phagocytosis; inhibits action of hyaluronidase (secreted by bacteria), which helps bacteria gain access to healthy cells.
Externally, has antifungal and bacteriostatic properties.

Pharmacokinetics ⬆ ⬇

Absorption: Unknown.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Multiple sclerosis, leukosis, collagenoses, AIDS, tuberculosis, autoimmune diseases;
Hypersensitivity and cross-sensitivity in patients allergic to plants in Asteraceae/Compositae plant family (daisies, chrysanthemums, marigolds, etc.);
OB: Pregnancy and lactation.

Use Cautiously in:

Diabetes;
Pedi: May increase risk of rash in children;
Tinctures should be used cautiously in alcoholics or patients with liver disease;
Do not take longer than 8 wk: may suppress immune function.

Adv. Reactions/Side Effects ⬆ ⬇

CNS: dizziness, fatigue, headache, somnolence

EENT: sore throat, tingling sensation on tongue

GI: abdominal pain, constipation, diarrhea, heartburn, nausea, vomiting

Derm: allergic reaction, rash (more common in children)

Misc: fever

Interactions ⬆ ⬇

Natural-Drug Products:

May possibly interfere with immunosuppressants because of its immunostimulant activity.
May ↑ risk for hepaotoxicity from anabolic steroids, methotrexate, or ketoconazole when taken with echinacea.
May ↑ midazolam availability.

Natural-Natural Products:

May ↑ risk for hepatotoxicity when taken with kava.

Route/Dosage ⬆ ⬇

PO (Adults ): Tablets: 6.78 mg tablets, take 2 tabs 3 times daily. Capsules: 500–1000 mg 3 times a day for 5–7 days. Fluid extract: 1–2 mL tid; solid form (6.5:1): 150–300 mg tid. Should not be used for more than 8 wk at a time. Tea: ½tsp comminuted drug, steeped and strained after 10 min, 1 cup 5–6 times daily on the first day, titrating down to 1 cup daily over the next 5 days. Echinacea purpuren herb juice: 6–9 mL/day. Liquid: 20 drops every 2 hr for the first day of symptoms, then 3 times daily for up to 10 days.
(Adults ): Ointment, lotion, tincture used externally: 1.5–7.5 mL tincture, 2–5 g dried root.

Availability ⬆ ⬇

Capsules: ^OTC
Tablets : ^OTC
Dried Root: ^OTC
The dried root can be steeped and strained in boiling water and taken as a tea: ^OTC
Liquid extract: ^OTC
1:1 in 45% alcohol: ^OTC
Tincture: ^OTC
1:5 in 45% alcohol: ^OTC
Blended teas: ^OTC
Echinacea purpuren herb juice: ^OTC

Assessment ⬆ ⬇

Assess wound for size, appearance, and drainage prior to the start of and periodically during therapy.
Assess frequency of common mild illnesses (such as a cold) in response to use.

Implementation ⬆ ⬇

Tinctures may contain significant concentrations of alcohol and may not be suitable for children, alcoholics, patients with liver disease, or those taking disulfiram, metronidazole, some cephalosporins, or sulfonylurea oral antidiabetic agents.
Prolonged use of this agent may cause overstimulation of the immune system, and use beyond 8 wk is not recommended. Therapy of 10–14 days is usually considered sufficient.
May be taken without regard to food.

Patient/Family Teaching ⬆ ⬇

Herb is more effective for treatment than prevention of colds. Take at first sign of symptoms.
Advise patient to seek immediate treatment for an illness that does not improve after taking this herb.
Instruct patient that the usual course of therapy is 10–14 days and 8 wk is the maximum.
Inform patient that use of this herb is not recommended in severe illnesses (e.g., AIDS, tuberculosis) or autoimmune diseases (e.g., multiple sclerosis, collagen diseases, etc.).
Caution patient that prolonged use of this herb may result in overstimulation of the immune system, possibly with subsequent immunosuppression.
Instruct patient to consult health care professional before taking any prescription or OTC medications concurrently with echinacea.
Keep tincture in a dark bottle away from sunlight. Should be taken several times a day.
Store herb in airtight container away from sunlight.
Rep: Advise females of reproductive potential to avoid pregnancy or breast feeding during use.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇