Plant Part Used
E. angustifolia – root ; E. purpurea – root, aerial portion succus (fresh plant juice)
Introduction
Echinacea’s stimulatory effects on the immune system have made it one of the most popular herbs in the world. It’s ability to enhance the body’s natural defenses has applications in fighting common colds, influenza and other infections. Echinacea has also been used externally on wounds and is reported to have antibacterial and antifungal activity.
Should echinacea be used in a dosing cycle or is it safe to use echinacea continuously for long periods of time? The length of time to dose Echinacea has been a subject of debate for some time. The concern began following the publication of the work of Jurcic and his colleagues. (1) Their data seemed to indicate that with use of Echinacea greater than 5 days, the increase in immune system activity eventually returned to the levels measured before echinacea use, indicating that echinacea may lose its effectiveness. A recent review of the data suggests that the data was misinterpreted, noting that the levels of immune system activity only began declining after the echinacea was stopped. (2) Several human studies have been completed indicating the safety of echinacea with longer-term use. A study involving an 8-week treatment period demonstrated no significant difference in the occurrence of side effects between the echinacea group and the placebo group. (3) Another study concluded that “adverse events on oral administration [of echinacea] for up to 12 weeks are infrequent and consist mainly of unpleasant taste.” (4) The safety of echinacea when used for periods greater than 8 to 12 weeks has not been evaluated.
Interactions and Depletions
Interactions
Dosage Info
Dosage Range
250mg (standardized extract) up to 4 times a day during flu season. Some clinicians recommend a dosing cycle such as using it 3 weeks on and 1 week off or 8 weeks on and 1 week off. Please see the introduction for a discussion regarding cyclical dosing.
Angustifolia Root Tea: For colds, drink 1 cup freshly made tea several times daily. (5)
Most Common Dosage
Acute – 500mg (standardized extract), 3 times a day for day 1 then 250mg, 4 times a day. Prevention – 250mg (standardized extract), 2 times a day, a dosing cycle may be used as indicated above.
The recommended dose of Echinacea purpurea liquid (succus) is 60 drops, 3 times a day with food for 1 day, then 40 drops, 3 times a day with food for up to 10 days.
Angustifolia Root Tea: For colds, drink 1 cup freshly made tea several times daily.
Standardization
[span class=doc]Standardization represents the complete body of information and controls that serve to enhance the batch to batch consistency of a botanical product, including but not limited to the presence of a marker compound at a defined level or within a defined range.[/span]
The most current available medical and scientific literature indicates that this dietary supplement should be standardized to 4% echinacosides (angustifolia), 4% sesquiterpene esters (purpurea) per dose. Echinacea purpurea (succus) should be standardized to contain not less than 2.4% soluble beta-1,2 d-5 fructofuranosides per dose.
Reported Uses
Echinacea has positive activity on the immune system. A study in mice found that alcohol root extracts from Echinacea purpurea, Echinacea pallida and Echinacea angustifolia were found to enhance phagocytosis significantly. (6) Phagocytosis is the process in which a cell from the immune system response “eats” the foreign cell, such as a virus or bacteria. Echinacea is also claimed to activate and increase white blood cell activity and cell-mediated immunity. (7) , (8) , (9) Cell-mediated immunity provides resistance to a variety of pathogens and guards against the development of arthritis, allergies and other potential disorders. Echinacea contains arabinogalactan which is reported to increase the activity of other elements of the immune system including interferon, tumor necrosis factor and interleukin-1. (10)
One study evaluating the effectiveness of echinacea for the prevention of colds concluded that the preparation of echinacea used in the study had no effect on either the occurrence of infection or the severity of illness. Further investigation of the Echinacea product used questioned the presence of any active ingredients in the product. (11) Other studies have shown better results. (12)
Several reports have been conducted over the past few years regarding the effectiveness of echinacea preparations in the treatment and management of upper respiratory infections (URI’s). In the most recent report, sixteen trials with a total of 3396 participants were included. (13) Overall, the results suggested that certain echinacea preparations may be better than placebo in the management and treatment of URI’s. Another earlier analysis evaluated 13 trials where echinacea was used as a treatment or for the prevention of upper respiratory tract infections (URI’s). (14) The authors of this report concluded that echinacea may be beneficial for the early treatment of URI’s, yet there is very little evidence supporting the prolonged use of echinacea for the prevention of URI’s. A more recent trial confirmed these findings regarding the treatment of the common cold. Eighty adult patients who were experiencing the first signs of a cold participated in the study evaluating the effect of Echinacea on the number of days that common cold symptoms were experienced. The group using the Echinacea product experienced 6 days of cold symptoms versus 9 days for the placebo group. (15)
Other studies have demonstrated that echinacea is a reported antioxidant. (16) Animal studies have indicated anti-inflammatory properties in the roots of the Echinacea angustifolia plants. Echinacea is reported to have a wide level of antimicrobial activity on bacteria, fungi, and viruses. (17) , (18) Although in more of a traditional sense, echinacea has been used extensively.
Toxicities & Precautions
Introduction
[span class=alert]Be sure to tell your pharmacist, doctor, or other health care providers about any dietary supplements you are taking. There may be a potential for interactions or side effects.[/span]
General
This dietary supplement is considered safe when used in accordance with proper dosing guidelines. (19) , (20)
Allergy
Some individuals experience an allergic reaction when taking this dietary supplement. These reactions include skin rash, asthma attacks and anaphylaxis, a life threatening allergic reaction. (21) Call your doctor or seek medical attention if you have fast or irregular breathing, skin rash, hives or itching.
Health Conditions
If you have kidney disease or an active infection do not use this dietary supplement for more than 10 days. If you have a weakened immune system, talk to your doctor before taking this dietary supplement. (22)
Pregnancy/ Breast Feeding
To date, the medical literature has not reported any adverse effects related to fetal development during pregnancy or to infants who are breast-fed. (23) Yet limited information exists regarding the use of this dietary supplement while pregnant or breast-feeding. Therefore, it is recommended that you inform your healthcare practitioner of any dietary supplements you are using while pregnant or breast-feeding. (24)
Age Limitations
To date, the medical literature has not reported any adverse effects specifically related to the use of this dietary supplement in children. Since young children may have undiagnosed allergies or medical conditions, this dietary supplement should not be used in children under 10 years of age unless recommended by a physician.
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References
- Jurcic K, Melchart D, Holzmann M, Martin P, et al. Zwei Probandenstudien zur Stimulierung der Granulozyten-phagozytose durch Echinacea-Extrakt-haltige Präparate. Z Phytother. 1989;10(2):67-70.
- Bone K. Echinacea: When Should it be Used? Alt Med Rev. 1997;2(6):451-458.
- View Abstract: Grimm W, et al. A Randomized Controlled Trial of the Effect of Fluid Extract of Echinacea purpurea on the Incidence and Severity of Colds and Respiratory Infections. Am J Med. Feb1999;106(2):138-43.
- View Abstract: Parnham MJ. Benefit-Risk Assessment of the Squeezed Sap of the Purple Coneflower (Echinacea purpurea) for Long-Term Oral Immunostimulation. Phytomedicine. 1996;3(1):95-102.
- PDR for Herbal Medicines, 2nd edition. Montvale, NJ: Medical Economics Company; 2000:264.
- View Abstract: Bauer VR, Jurcic K, Puhlmann J, et al. Immunologic In Vivo and In Vitro Studies on Echinacea Extracts. Arzneimittelforschung. Feb1988;38(2):276-81.
- View Abstract: Wildfeuer A, et al. Unterschung des Einflusses von Phytopraparaten auf Zellulare Funktionen der Korpereigenen Abwehr. Arzneim-Forsch/Drug Res. 1994;44(1):361-66.
- View Abstract: Gaisbauer M, Schleich T, Stickl HA, et al. The Effect of Echinacea purpurea Moench on Phagocytosis in Granulocytes Measured by Chemiluminescence. Arzneimittelforschung. May1990;40(5):594-8.
- View Abstract: Roesler J, Emmendorffer A, Steinmuller C, et al. Application of Purified Polysaccharides from Cell Cultures of the Plant Echinacea purpurea to Test Subjects Mediates Activation of the Phagocyte System. Int J Immunopharmacol. 1991;13(7):931-41.
- View Abstract: Luettig B, et al. Macrophage Activation by the Polysaccharide Arabinogalactan Isolated from Plant Cell Cultures of Echinacea purpurea. J of the American Cancer Institute. 1989;81(9):669-75.
- View Abstract: Turner RB, Riker DK, Gangemi JD. Ineffectiveness of Echinacea for Prevention of Experimental Rhinovirus Colds. Antimicrob Agents Chemother. Jun2000;44(6):1708-9.
- View Abstract: Goel V, Lovlin R, Barton R, et al. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther. Feb2004;29(1):75-83.
- View Abstract: Melchart D, Linde K, Fischer P, et al. Echinacea for Preventing and Treating the Common Cold. Cochrane Database Syst Rev. 2000;(2):CD000530.
- View Abstract: Barrett B, Vohmann M, Calabrese C. Echinacea for Upper Respiratory Infection. J Fam Pract. Aug1999;48(8):628-35.
- View Abstract: Schulten B, Bulitta M, Ballering-Bruhl B, Koster U, Schafer M. Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Arzneimittelforschung. 2001;51(7):563-8.
- View Abstract: Hu C, Kitts DD. Studies on the Antioxidant Activity of Echinacea Root Extract. J Agric Food Chem. May2000;48(5):1466-72.
- View Abstract: Binns SE, Purgina B, Bergeron C, et al. Light-mediated Antifungal Activity of Echinacea Extracts. Planta Med. Apr2000;66(3):241-4.
- Wichtl M, In: Bisset NA, ed. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Scientific Press; 1994:182-84.
- Bradley PR, ed. British Herbal Compendium. Vol 1. Bournemouth: British Herbal Medicine Association; 1992:81-83.
- View Abstract: Mengs U, Clare CB, Poiley JA. Toxicity of Echinacea purpurea. Acute, Subacute and Genotoxicity Studies. Arzneimittelforschung. Oct1991;41(10):1076-81.
- View Abstract: Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Annals of Allergy, Asthma, & Immunology. 2002;88:42-51.
- Rakel: Conn’s Current Therapy 2001, 53rd ed. W B Saunders Company; 2001:1267.
- View Abstract: Gallo M, Sarkar M, Au W, et al. Pregnancy Outcome Following Gestational Exposure to Echinacea: A Prospective Controlled Study. Arch Intern Med. Nov2000;160(20):3141-3.
- View Abstract: Ondrizek RR, Chan PJ, Patton WC, King A. An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid. Fertil Steril. Mar1999;71(3):517-22.
