Encyclopedia/Botanical/Folk medicine · TEM/encyclopedia-echinacea

Echinacea

Echinacea spp. (E. purpurea, E. angustifolia, E. pallida)

Sources

9 listed

Best forNorth American medicinal plant genus with traditional use and mixed clinical findings for the common cold.

Clinical evidence

Emerging

SafetyUse with cautionThe caution rating reflects possible severe allergies and restrictions in autoimmune disease or immunosuppression. Many healthy adults tolerate studied preparations well in short-term use. This does not exclude individual risks or automatically apply to other products or longer use.

Tradition

Folk medicineTEM

In short

Summary of findings for quick reference

The main medicinal echinacea species are E. purpurea, E. angustifolia and E. pallida. Their use originates in Indigenous North American communities. An 1804 journal entry by William Clark mentions a root described through Hugh Heney, identified by later editors as E. angustifolia. That written record does not date the beginning of Indigenous practice. The plant spread in Eclectic medicine in the late nineteenth century and later in European phytotherapy.

Clinical findings for the common cold are mixed. The 2014 Cochrane review included 24 trials with 4631 participants and emphasized differences between preparations. The EMA recognizes short-term cold use for specified expressed-juice preparations from fresh E. purpurea herb. This does not establish efficacy for echinacea in general. Laboratory findings on alkylamides and immune cells suggest possible mechanisms but do not demonstrate symptom relief in people.

Do not use these medicines if you have a known allergy to echinacea or other Asteraceae plants. Oral use is not recommended in autoimmune disease or during immunosuppression. Data are also insufficient for children under twelve and for pregnancy or breastfeeding. Check the species, plant part, preparation and leaflet: doses and treatment durations cannot be transferred between expressed juice, tincture and extract capsules.

Clinical evidence ↔ Historical significance

We display two separate evidence categories: clinical evidence from modern trials and historical significance from documented healing tradition. Both are valuable, but they answer different questions.

In every encyclopedia entry we evaluate two distinct categories of evidence. Clinical evidence as used in trials meets a narrower but scientifically essential bar. At the same time, the hundreds of thousands of plant species worldwide have only partially been captured and tested in modern studies.

Alongside the trial picture our researchers compile a comprehensive overview of where and since when a plant has been used across different traditions of natural medicine. When a plant has been used as a medicinal plant in many cultures across many generations, that historical significance deserves to be visible too.

Our position: a truly informative overview emerges only when both categories sit side by side. We communicate transparently what counts as what.

Overview

Echinacea is a genus of North American plants in the daisy family (Asteraceae). The main medicinal species are Echinacea purpurea, E. angustifolia and E. pallida. Depending on the species, preparations use the herb (aerial parts) or roots. Clinical trials test different preparations that cannot simply be treated as equivalent.

The European Medicines Agency’s herbal medicines committee (EMA/HMPC) recognizes short-term prevention and treatment of common colds as well-established use for specified expressed-juice preparations from fresh E. purpurea herb. Traditional use in the same monograph concerns small superficial wounds. The 2014 Cochrane review found mixed cold-trial results overall. Findings for one tested preparation therefore do not apply to every echinacea product.

History

Various Indigenous communities of the Great Plains used echinacea, particularly E. angustifolia root. Recorded uses include toothache, sore throat and injuries, but accounts differ by community, species and plant part. Use after snakebite is also documented; this is historical evidence of practice, not proof of efficacy for that medical emergency.

In the late nineteenth century, North American Eclectic medicine popularized E. angustifolia preparations. King’s American Dispensatory of 1898 describes the plant in detail. E. purpurea gained importance in European phytotherapy in the twentieth century. Herb preparations and extracts developed there differ from earlier root preparations, so historical uses and modern trials must each be linked to the appropriate species and preparation.

Mechanism

Echinacea species contain alkylamides, caffeic-acid derivatives and polysaccharides, among other constituents. Composition depends on species, plant part and processing. Cichoric acid is characteristic of E. purpurea, whereas echinacoside is particularly associated with E. angustifolia and E. pallida. In cell experiments, alkylamides affect immune-cell signalling, including pathways involving cannabinoid CB2 receptors.

Cell and animal experiments show various effects on inflammatory signalling and immune-cell activity. They do not establish general immune “strengthening” from oral echinacea. Whether and how these effects contribute to clinical benefit remains unclear. The EMA monograph likewise does not specify an established mechanism of action for the expressed-juice preparations it covers.

Karsch-Völk and colleagues reviewed 24 randomized trials involving 4631 participants for Cochrane in 2014. Because species, plant parts and extracts differed, they did not combine all preparations in a single primary analysis. Treatment results were mixed. Only individual trials found a statistically significant reduction in cold duration. The review therefore did not establish a reliable general treatment effect, although a weak benefit from individual products remained possible.

Goel and colleagues recruited 282 adults in 2004; 128 developed a cold during the trial. Among participants adhering to the protocol, the standardized E. purpurea extract Echinilin reduced the daily symptom score by 23.1% compared with placebo. In 2012, Jawad and colleagues studied an alcoholic extract of 95% fresh E. purpurea herb and 5% root for four months. Of 755 randomized adults, 717 had follow-up data. Cumulative cold days and episodes treated with painkillers were lower, but the total episode count was not significantly different.

The EMA monograph and Cochrane review address different questions: the monograph evaluates defined medicinal preparations, while the review compares trials of quite different products. For specified oral expressed juices from fresh E. purpurea herb, the EMA recognizes well-established use for short-term prevention and treatment of common colds. This classification does not establish efficacy for arbitrary supplements, other species or other extracts.

Evidence

3 Outcomes evaluated. Sorted by grade.

Outcome	Class	Grade	Effect	Refs
Short-term cold use: specified E. purpurea expressed juices	Emerging	I	The EMA recognizes well-established use of specified expressed-juice preparations from fresh E. purpurea herb for short-term prevention and treatment of common colds. Traditional use in the same monograph concerns small superficial wounds. The classification does not apply to all extracts.	[9]
Prevention and treatment of the common cold	Emerging	I	The 2014 Cochrane review of 24 trials and 4631 participants found mixed results. Preparations differed in species, plant part and processing. A general treatment effect was not established; weak benefits from individual products or a small preventive effect remained possible.	[5][6][2][1]
In vitro immune cell modulation	Traditional	I	Cell and animal studies show effects on inflammatory signalling and immune cells. They do not establish general immune strengthening or reliable symptom relief from taking an echinacea product.	[8][3][4]

Usage

Forms and preparation

Depending on the product, echinacea medicines contain expressed juice, tinctures or dry extracts. The species, plant part and manufacturing method matter. The EMA monograph on fresh E. purpurea herb covers expressed juice with a drug-extract ratio of 1.5 to 2.5:1 and corresponding dried juice. An alcoholic extract is not automatically equivalent. Follow the leaflet for the specific medicine.

Dosage by outcome

Outcome	Dose	Form	Duration	Population
Acute common cold, starting at first symptoms	6 to 9 mL/d, Divided into single doses of 1.5–4.5 mL; total 6–9 mL daily	Fresh E. purpurea herb expressed juice (DER 1.5–2.5:1) or equivalent dried juice
Prevention of common colds in the trial protocol	2.7 mL/d, 0.9 mL three times daily	Echinaforce: alcoholic extract of fresh E. purpurea herb (95%) and root (5%)

For adults and adolescents aged twelve and over, the EMA gives an oral total of 6 to 9 mL daily for the E. purpurea expressed-juice preparations covered, with single doses of 1.5 to 4.5 mL. Treatment starts at the first signs of a cold and lasts no more than ten days; the same limit applies to short-term prevention. This is not a general tincture dose. Seek medical advice for high fever, worsening symptoms or symptoms persisting beyond ten days. Other extracts require their own product-specific instructions.

Safety

Safety profile

The EMA does not recommend oral use of the covered E. purpurea preparations in autoimmune disease, progressive systemic disorders, immunodeficiency, immunosuppression or disorders of the white blood cells. Discuss use with your treating team in these situations. Trials do not establish general immune strengthening. Use is contraindicated in known allergy to echinacea or other Asteraceae plants. Allergic reactions can include anaphylaxis, and their frequency is unknown. If you are prone to allergies, including atopic conditions, consult a clinician before use.

Interactions

Substance	Severity	Mechanism	Recommendation
Immunosuppressants (tacrolimus, ciclosporin, methotrexate)	High	Opposition to immunosuppression is theoretically possible but not clinically established. The combination is not recommended because of possible immune effects.	Avoid the combination and discuss planned use with your treating team.
Caffeine	Low	An E. purpurea root preparation reduced caffeine clearance in a small study. Relevance to other preparations or noticeable symptoms is uncertain.	Caffeine-sensitive users may want to reduce intake during echinacea courses.
Midazolam	Medium	In a study of E. purpurea root, intravenous midazolam clearance increased while no statistically significant change in oral clearance was detected. Clinical significance is uncertain.	Inform anaesthetist before procedures requiring sedation.

Drug interactions

In a study of twelve healthy adults, an E. purpurea root preparation altered the clearance of caffeine and intravenous midazolam. No statistically significant change in oral midazolam clearance was detected. These findings do not apply automatically to all echinacea products or all CYP3A4 substrates, and their clinical significance is uncertain. Antagonism of immunosuppressants is a theoretical concern, not an established clinical interaction. Echinacea is not recommended during immunosuppression.

Contraindications

Do not use in hypersensitivity to echinacea or other Asteraceae plants. The EMA does not recommend the covered expressed-juice preparations for children under twelve because data are insufficient. Oral use during pregnancy or breastfeeding is likewise not recommended unless advised by a clinician. The restrictions above also apply to autoimmune disease, immunodeficiency and immunosuppression.

Side effects

Effect	Frequency	Severity	Notes
Unpleasant taste / tingling tongue (tincture)	Unknown	Mild	Alkylamides can cause tingling. This proves neither product quality nor efficacy. Do not dismiss swelling, rash or breathing problems as a harmless taste effect.
Mild GI upset	Unknown	Mild	Stop use and seek medical or pharmaceutical advice if symptoms persist.
Allergic skin reactions (rash, itching)	Unknown	Moderate	Stop and seek medical advice. Do not use with known echinacea or Asteraceae allergy.
Anaphylaxis	Unknown	Severe	Seek immediate medical help for breathing difficulty, circulatory symptoms or swelling of the tongue or throat. Risk is not confined to people with known Asteraceae allergy.

Reported effects include gastrointestinal symptoms and unpleasant sensations in the mouth. Allergic reactions can involve rash, itching and swelling, and severe reactions are known. Reliable frequencies for individual reactions are not established. Stop the product if you suspect an allergy. Breathing difficulty or swelling of the tongue or throat requires immediate medical help.

Look-alikes

Botany

Family

Asteraceae

Native regions

Eastern North America, Central North America (Great Plains)

FAQs

Does echinacea actually work for colds?

A reliable benefit across all echinacea products has not been established. The 2014 Cochrane review found mixed results and considered weak benefits from individual preparations possible. The EMA recognizes short-term cold use for specified expressed-juice preparations from fresh E. purpurea herb. It therefore matters which species, plant part and extract were actually studied.

Who should NOT take echinacea?

Do not use these medicines with known allergy to echinacea or other Asteraceae plants. Oral use is not recommended in autoimmune disease, immunodeficiency or immunosuppression. Data are insufficient for children under twelve and during pregnancy or breastfeeding. Discuss planned use with your treating team in these situations.

How long can I take echinacea?

The EMA monograph limits oral use of its covered E. purpurea expressed-juice preparations to ten days. Jawad’s trial studied a particular herb-root extract for four months. That cannot be transferred to other preparations and is not a general recommendation for continuous use. These sources also establish no general rule for fixed on/off cycles. Follow the product leaflet.

Echinacea purpurea, angustifolia, or pallida, which species is best?

Trials do not identify a universally best species. E. purpurea, E. angustifolia and E. pallida differ chemically, and plant part and processing also matter. A whole-plant extract is not automatically better than a herb or root preparation. Check precise labelling and whether the evidence actually concerns that preparation.

References

9 sources.

Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. 2007. doi:10.1016/S1473-3099(07)70160-3
Jawad M, Schoop R, Suter A, Klein P, Eccles R. Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial. 2012. doi:10.1155/2012/841315
Mattace Raso G, Pacilio M, Di Carlo G, Esposito E, Pinto L, Meli R. In-vivo and in-vitro anti-inflammatory effect of Echinacea purpurea and Hypericum perforatum. 2002. doi:10.1211/002235702760345464
Zhai Z, Solco A, Wu L, Wurtele ES, Kohut ML, Murphy PA, Cunnick JE. Echinacea increases arginase activity and has anti-inflammatory properties in RAW 264.7 macrophage cells, indicative of alternative macrophage activation. 2009. doi:10.1016/j.jep.2008.11.028
Karsch-Völk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. 2014. doi:10.1002/14651858.CD000530.pub3
Goel V, Lovlin R, Barton R, Lyon MR, Bauer R, Lee TDG, Basu TK. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. 2004. doi:10.1111/j.1365-2710.2003.00542.x
Gorski JC, Huang SM, Pinto A, Hamman MA, Hilligoss JK, Zaheer NA, Desai M, Miller M, Hall SD. The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. 2004. doi:10.1016/j.clpt.2003.09.013
Gertsch J, Schoop R, Kuenzle U, Suter A. Echinacea alkylamides modulate TNF-alpha gene expression via cannabinoid receptor CB2 and multiple signal transduction pathways. 2004. doi:10.1016/j.febslet.2004.10.064
European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Echinacea purpurea (L.) Moench, herba recens. 2015. Source

Legal notice: The depiction of historical significance and traditional use is context within our encyclopedia and not a health claim for any product, not a treatment promise, and not a substitute for medical advice. What may be stated on product labels, product pages, or in advertising is governed by the applicable legal requirements.