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

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 ⬆ ⬇

Echinacea purpurea herba has been reported to promote wound healing, which may be due to an ↑ in WBCs and spleen cells and ↑ activity of granulocytes, helper T cells, and cytokines.
E. purpurea radix has been shown to have antibacterial, antiviral, anti-inflammatory, and immune-modulating effects.
Stimulates phagocytosis; inhibits action of hyaluronidase (secreted by bacteria), which helps bacteria gain access to healthy cells.
Externally, has antifungal and bacteriostatic properties.

Therapeutic effects:

Resolution of respiratory and urinary tract infections.
Decreased duration and intensity of common cold.
Improved wound healing.

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:

Autoimmune disorders;
HIV;
Hypersensitivity and cross-sensitivity to plants in the Asteraceae/Compositae family (daisies, chrysanthemums, marigolds, etc.);
Multiple sclerosis;
Tuberculosis.

Use Cautiously in:

Diabetes;
Tinctures should be used cautiously in patients who consume alcohol or have liver disease;
Do not take >8 wk: may suppress immune function;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety not established in children <12 yr. May ↑ risk of rash.

Adv. Reactions/Side Effects ⬆ ⬇

Neuro: 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 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 daily for 5–7 days. Fluid extract: 1–2 mL 3 times daily; solid form (6.5:1): 150–300 mg 3 times daily. Should not be used for >8 wk at a time. Tea: ½teaspoon comminuted drug, steeped and strained after 10 min; 1 cup 5–6 times daily on the 1st 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 1st 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 before and periodically during therapy.
Assess frequency of common mild illnesses (cold) in response to use.

Lab Test Considerations:

Monitor liver function tests periodically during therapy.

Implementation ⬆ ⬇

Tinctures may contain significant concentrations of alcohol and may not be suitable for children; patients who consume alcohol or have liver disease; or those taking disulfiram, metronidazole, some cephalosporins, or sulfonylureas.
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.
PO: Administer with or without food.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of herb to patient.
Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
Advise patient the herb is more effective for treatment than prevention of colds. Take at 1st sign of symptoms.
Advise patient to seek immediate treatment for an illness that does not improve after taking this herb.
Advise patient the usual course of therapy is 10–14 days and 8 wk is the maximum.
Advise patient use of this herb is not recommended in severe illnesses (HIV, tuberculosis) or autoimmune diseases (multiple sclerosis, collagen diseases, etc.).
Advise patient prolonged use of this herb may result in overstimulation of the immune system, possibly with subsequent immunosuppression.
Advise patient to keep tincture in a dark bottle away from sunlight. Should be taken several times a day.
Advise patient to store herb in airtight container away from sunlight.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding before using this herb.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇