However, whether or not the lack of efficacy of these experimental E. On the other hand, success for prevention of the common cold was shown over a four-month period in a large randomized, double-blind, placebo-controlled study published in A dose of 0. The extract was diluted in water and held in the mouth for 10 seconds before swallowing. There were no significant differences between adverse effects or tolerability between the two groups over the four-month period, indicating safe long-term use.
Contraindications and Potential for Drug Interactions. The German Commission E monographs 38 for the approved E. These contraindications remain controversial, as they are theoretical and not based on any actual clinical data.
Reactions may occur in allergic individuals, especially when aerial parts are used. Legitimate concerns about combining Echinacea species preparations with pharmaceutical drugs are also largely speculative and are based on in vitro research.
For example, as a precaution, patients undergoing organ transplantation who take immunosuppressive drugs, such as cyclosporine, should avoid the use of Echinacea preparations or should consider short-term use. When an E. After the 14 combination days, there was no change in lopinavir bioavailability. After the extract had been administered for 28 days, single doses of fexofenadine and midazolam were administered; the midazolam bioavailability was significantly reduced, but fexofenadine pharmacokinetics were not significantly altered.
This extract was shown to have a modest inducing effect on CYP3A as shown with midazolam, but not enough to counter the CYP3A inhibiting effect of ritonavir. It had no impact on P-glycoprotein efflux of fexofenadine. Most conventional pharmaceutical drugs, including the macrolide antibiotics clarithromycin and erythromycin, are metabolized by CYP3A4.
Endangerment and Cultivation. The issue of sustainable harvest of wild-crafted E. Echinacea angustifolia still grows over much of its historical range. Its global conservation status is ranked G4, i. Cultivation of Echinacea has increased rapidly because of the demand and its great value. Growth of the three major medicinal species, E. The traditional clinical applications of E. Simultaneous internal and local use was believed to increase efficacy.
The historical use of E. Clinical studies to investigate this possibility appear warranted, given the increasing incidence of antibiotic resistance. However, positive evidence from clinical research on E. Echinacea angustifolia also has been combined with E. Consequently, the recognition of E. Although sharing some similarities, selective use of Echinacea species, parts, and their preparations seems most appropriate for conditions established through empirical tradition e.
The safety of Echinacea products is a major advantage, with few theoretical contraindications or individual allergic sensitivities. Echinacea popularity has resulted in regional overharvesting of wild E. Nonetheless, commercial cultivation of E.
Maggie Heran and her staff at the Lloyd Library and Museum in Cincinnati, Ohio, provided copies of archival material published by the Lloyd brothers.
Brinker has written and edited numerous articles and monographs, and has authored six books on medicinal botanicals, including, most recently, Herbal Contraindications and Drug Interactions, 4 th ed. He also has served as a consultant for Eclectic Institute, Inc. Boulder, CO. There was no standardization claim.
On page , it specifies the E. Figure 1. I use Echinacea locally as a wet dressing, and internally in all infections. My medicine case is not complete without Echinacea. I use Echinacea more than any other drug. I have had uniformly good results from use of Echinacea in all cases indicated. The greatest remedy that we have for sepsis. Dependable and safe. Echinacea is my first choice of drugs. There is no medicine in the materia medica that can take its place.
Have used it successfully where all other remedies have failed. Echinacea is the best all-around medicine in use. This [Specific Medicine Echinacea] has never failed me and until it does I intend to keep on using that preparation. There is no substitute for Echinacea, nor have I found any product as useful.
Could hardly practice medicine successfully without Echinacea. I believe Echinacea is good in any trouble of the human. Could hardly get along without Echinacea in my practice.
The beneficial results I have obtained from Echinacea have not been equaled by other drugs in my practice. In spite of my endeavor to reduce the frequency of my use of Echinacea both internally and externally, I am still using more of it than any other remedy. I use large quantities of this drug, even give it in teaspoonful doses. Echinacea has never disappointed me in whatever case it was administered, either externally or internally.
Echinacea is the best drug yet. It would take a book to tell its virtues. This plant and its preparations are great gifts of God. As years go on my satisfaction in the use of Echinacea increases.
I use Echinacea in all septic cases, internally and externally. It has no equal. I always get favorable results when using Echinacea. I use Echinacea in so many different ways that I cannot well enumerate them. I simply must have Echinacea. Echinacea saved my own life. Echinacea is a remedy that grows upon any one who uses it, rather than diminishes.
Genuine Echinacea is good enough. None other is so good. Conditions calling for Echinacea cannot be met successfully by substitutes. I know of nothing better. Echinacea covers a broader and more important field than any other drug in the Materia Medica.
Experience and observation will prove this to any physician who uses it. Have defended the remedy many, many times. The greatest medicine. Would be lost without Echinacea.
Never lost a case of typhoid fever in which I used Echinacea. If I could but have one drug to use, Echinacea would be my choice. Here Echinacea is first, last and always with me. Echinacea or nothing with me. It is unique. I use Echinacea externally and internally. There is no better drug. I consider it invaluable. If you have but one medicine for the whole family, give Echinacea. Its uses are too many to enumerate.
I use Echinacea more than any other one remedy. Echinacea is one of the greatest medicines ever introduced. Echinacea is the best blood purifier in the world. I have great faith in the remedy. In these [septic conditions] I could not get along without Echinacea.
It is invaluable. The more I use of it the better I like it. It is always dependable. I consider Echinacea one of the most useful remedies ever given to the profession.
One of the great remedies in the Materia Medica. Echinacea is the best blood purifying agency in the Materia Medica. Every day calls for it. I consider Echinacea my best agent in snake and poisonous bites of all kinds. I consider Echinacea one of the best, if not the best, all-round remedy to be had, harmless but efficient. Large dose are best [for sepsis].
Echinacea, used locally and internally, is in my experience the best single remedy in the Materia Medica to combat any septic condition.
I find few conditions where Echinacea is not indicated. I could get along without any other one remedy better than without Echinacea. I use Echinacea daily, with full confidence. It is my sheet anchor. It is indispensable in all septic conditions. There is nothing better for cuts, stings, or bites of serpents. I use Echinacea in wounds to prevent or stop infection, and with absolute success.
Echinacea is not with me [as] an experiment but a matter of fact. It should be in the hands of every physician. I prescribe Echinacea as frequently as any other single remedy. My work is surgical. In blood poisoning Echinacea has won for me many patients. Where other remedies fail Echinacea is sure to bring good results. Echinacea is included in nearly all my prescriptions. It seems a wonderful assistant to the indicated remedies. I am never out of Echinacea.
I consider it one of the best remedies ever discovered. The good uses of Echinacea are too numerous to mention. Echinacea is one of the few remedies that always helps the patient.
Echinacea has come to stay. There is absolutely no doubt in my mind as to the clinical value of Echinacea. Echinacea is in a class of its own. If it had not been for Echinacea, I feel that I would have been in my grave long ago. It is not antiseptic in the usual meaning of the word but it corrects septic conditions. I think the dose usually recommended is much too small.
I give in urgent cases one-half teaspoonful Echinacea in water every one or two hours. People with tuberculosis, leukemia, diabetes, connective tissue disorders, multiple sclerosis, HIV or AIDS, any autoimmune diseases, or, possibly, liver disorders should not take echinacea.
There is some concern that echinacea may reduce the effectiveness of medications that suppress the immune system. For this reason, people receiving organ transplants who must take immunosuppressant medications should avoid this herb.
In rare cases, echinacea may cause allergic reactions, ranging from a mild rash to anaphylaxis a life-threatening reaction accompanied by throat tightening, shortness of breath, and, possibly fainting.
People with asthma and allergies may be at an increased risk for developing these adverse reactions. People with allergies to plants in the daisy family compositae should not take Echinacea without the supervision of a provider. There has been one report of an individual developing erythema nodosum a painful skin condition after taking echinacea to treat the flu.
Despite concerns that echinacea may be unsafe for pregnant or breastfeeding women, evidence suggests that the use of echinacea during pregnancy does not increase the risk of birth defects or other pregnancy related health problems. More research is needed. In the meantime, avoid using Echinacea during pregnancy or breastfeeding until more conclusive studies are conducted. If you are taking any prescription medications, including medications used during surgery, such as anesthesia medications, you should talk to your doctor before taking echinacea.
Some of the well-known interactions include the following:. Pharmaceutical and herbal products that may contribute to dry eyes. Plast Reconstr. Echinacea for treating the common cold: a randomized trial.
Ann Intern Med. Inflammation and Native American medicine: the role of botanicals. Am J Clin Nutr. Use of a standardized extract from Echinacea angustifolia Polinacea for the prevention of respiratory tract infections.
Altern Med Rev. Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. 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. Pregnancy outcome following gestational exposure to echinacea. Arch Intern Med. Echinacea purpurea polysaccharide reduces the latency rate in herpes simplex virus type-1 infections. 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. The effect of Echinacea preparations in three laboratory tests of anxiety: comparison with chlordiazepoxide. Phytother Res. Islam J, Carter R. Use of Echinacea in upper respiratory tract infection. South Med J. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 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. Mahady GB. Echinacea: recommendations for its use in prophylaxis and treatment of upper respiratory tract infections. Nutr Clin Care. Miller's Anesthesia. Mullins RJ, Heddle R. Adverse reactions associated with echinacea: the Australian experience. Ann Allergy Asthma Immunol. Nahas R, Balla A. Complementary and alternative medicine for prevention and treatment of the common cold. Can Fam Physician. 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.
Keep in Mind. Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions. For More Information. Toll-free in the U. Office of Dietary Supplements ODS , National Institutes of Health NIH ODS seeks to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, supporting research, sharing research results, and educating the public.
Key References. Echinacea for treating the common cold: a randomized trial. Annals of Internal Medicine. David S, Cunningham R. Echinacea for the prevention and treatment of upper respiratory tract infections: a systematic review and meta-analysis. Complementary Therapies in Medicine. Natural Medicines website. Accessed at naturalmedicines. Pharmacokinetic herb-drug interactions part 2 : drug interactions involving popular botanical dietary supplements and their clinical relevance.
Planta Medica. Plant microbiome-dependent immune enhancing action of Echinacea purpurea is enhanced by soil organic matter content.
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