Echinacea : Dosing and Safety

by MedlinePlus

(Page 2 of 2)

Dosing

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Some manufacturers standardize echinacea extracts to 4.0 to 5.0% echinacoside, while others standardize to cichoric acid. Because the active ingredient(s) has not been identified, standardization may not predict effectiveness.

Adults (18 years and older)

Capsules (of powdered herb): For treatment of upper respiratory tract infections, 500 to 1,000 milligrams by mouth three times daily for five to seven days has been used.

Expressed juice: Six to nine milliliters by mouth daily, divided into two or three doses, for five to seven days has been used.

Tincture (1:5): 0.75 to 1.5 milliliters, gargled then swallowed, 2 to 5 times daily for 5 to 7 days has been used (daily dose equivalent to 900 milligrams dried echinacea root). Some herbalists prefer tinctures due to theoretical immune stimulation in the tonsils when tinctures are gargled before swallowing.

Tea: Two teaspoons of coarsely powdered herb (four grams of echinacea) in one cup of boiling water for 10 minutes, drink daily for five to seven days, is a dose that has been used. There is early evidence that echinacea tea (equivalent of 1.275 milligrams of dried herb and root per tea bag) may reduce the symptoms of upper respiratory tract infection when 5 to 6 cups are taken on the first day and decreased by 1 cup each day for the next 5 days.

Applied to skin (semisolid preparation): 15% pressed herb (non-root) juice semisolid preparation has been applied daily for wounds and skin ulcers.

Injected/through the veins: Injected echinacea is not available commercially. Severe reactions to injected echinacea have been reported, and echinacea injections are not recommended.

Children (younger than 18 years)

The dosing and safety of echinacea have not been studied thoroughly in children. Reductions of recommended adult doses by 50-67% have been used in research without significant effects in the treatment of common cold symptoms, and an association with rash development. Parents considering echinacea for their children should discuss this decision with the child's health care provider before starting therapy. Some natural medicine practitioners recommend basing children's doses based on weight. To calculate the child's dose, they take the child's weight in pounds, divide by 150, and then multiply that number by the recommended adult dose.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

People with allergies to plants in the Asteraceae or Compositae family (ragweed, chrysanthemums, marigolds, daisies) are theoretically more likely to have allergic reactions to echinacea. Multiple cases of anaphylactic shock (severe allergic reactions) and allergic rash have been reported with echinacea taken by mouth. Allergic reactions including itching, rash, wheezing, facial swelling, and anaphylaxis may occur more commonly in people with asthma or other allergies. Echinacea injections have caused severe reactions and are not recommended.

Echinacea has been associated with an increased incidence of rash in children, and therefore the risks of use may outweigh potential benefits.

Side Effects and Warnings

Few side effects from echinacea are reported when it is used at the recommended doses. Reported complaints include stomach discomfort, nausea, sore throat, rash (allergic, hives, or painful lumps called "erythema nodosum"), drowsiness, headache, dizziness, and muscle aches. Rare cases of hepatitis (liver inflammation), kidney failure, or irregular heart rate (atrial fibrillation) have been reported in people taking echinacea, although it is not clear that these were due to echinacea itself. Injected echinacea may alter blood sugar levels and cause severe reactions, and should be avoided. Echinacea has been associated with an increased incidence of rash in children, and therefore the risks of use may outweigh potential benefits.

Some natural medicine experts discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus). However, there are no specific studies or reports in this area, and the risks of echinacea use with these conditions are not clear. Long term use of this herb may cause low white blood cell counts (leukopenia).

Pregnancy and Breastfeeding

At this time, echinacea cannot be recommended during pregnancy or breastfeeding. Although early studies show no effect of echinacea on pregnancy, there is not enough research in this area. Pregnant women should avoid tinctures because of the potentially high alcohol content.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

Natural medicine practitioners sometimes caution that echinacea may lead to liver inflammation. There is not clear information from laboratory or human studies in this area. Nonetheless, caution should be used when combining echinacea by mouth with other medications that can harm the liver. Examples of such agents include anabolic steroids, amiodarone, methotrexate, acetaminophen (Tylenol®), and antifungal medications taken by mouth (such as ketoconazole). Echinacea may affect the way certain drugs are broken down by the liver.

In theory, echinacea's ability to stimulate the immune system may interfere with drugs that are taken to suppress the immune system (including azathioprine, cyclosporine, and steroids such as prednisone). No clear human studies are available.

In one vague report, a person taking the antibiotic amoxicillin and an unclear echinacea preparation developed muscle damage, shock, and death.

Early information suggests that the use of echinacea with econazole nitrate cream (Spectazole®) on the skin may lower the frequency of vaginal yeast infections after treatment.

Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken with metronidazole (Flagyl) or disulfiram (Antabuse).

Interactions with Herbs and Dietary Supplements

Natural medicine practitioners sometimes caution that echinacea may lead to liver inflammation. Although there is no clear information from laboratory or human studies, in theory echinacea may add to liver toxicity caused by other agents. Herbs and supplements that have been proposed to cause possible liver damage include ackee, bee pollen, birch oil, blessed thistle,borage, bush tea, butterbur, chaparral, coltsfoot, comfrey, DHEA, Echium spp., germander, Heliotropium spp., horse chestnut (injections),Jin-bu-huan ( Lycopodium serratum ), kava, lobelia, L-tetrahydropalmatine (THP), mate, niacin (vitamin B-3), niacinamide, Paraguay tea, periwinkle, Plantago lanceolata , pride of Madeira,rue, sassafras, scullcap, Senecio spp./groundsel, tansyragwort,turmeric/curcumin,Tu-san-chi ( Gynura segetum ), uva ursi, and valerian. Echinacea may affect the way certain herbs and supplements are broken down by the liver.

Echinacea is sometimes used in combination products that are thought to stimulate the immune system. For example, Esberitox® (PhytoPharmica, Germany) contains Echinacea purpurea , Echinacea pallida , wild indigo root ( Baptisia tinctoria ), and thuja (white cedar). Echinacea may be combined with goldenseal or other herbs in some cold relief preparations. No high quality human studies have shown added benefits or interactions of these combinations.

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