Categories & Effectiveness

Mood & Stress

Mood Elevation

4/10

Moderate evidence of effectiveness

Wellbeing Boost

4/10

Moderate evidence of effectiveness

Systemic Health

Immune System Boost

10/10

Strong evidence of effectiveness

Anti-Inflammatory (Systemic)

7/10

Strong evidence of effectiveness

Immune System Balance

4/10

Moderate evidence of effectiveness

Systemic Antioxidant

4/10

Moderate evidence of effectiveness

Dosage & Side Effects

Recommended Dosage

Common recommended dosages for adults vary widely depending on the specific Echinacea preparation, with studies utilizing daily amounts ranging from 40 mg of certain extracts to several grams of plant material or juice. While optimal doses are preparation-dependent, animal toxicity studies indicate high safety margins (e.g., oral LD50 for plant juice exceeding 15 g/kg in rats), and human studies lasting up to 6 months suggest good tolerability with long-term use. Evaluated Echinacea preparations are generally considered well-tolerated by both children and adults; a literature review indicated no increased risk for major or minor malformations during pregnancy, though it's crucial to consider product-specific safety data.

Potential Side Effects

Common mild side effects reported in clinical trials are generally infrequent and often not clearly linked to Echinacea itself. Although rare, more serious side effects such as abdominal pain or angioedema have been noted in some controversial clinical trial findings. It's advisable to exercise caution when combining Echinacea with certain pharmaceutical drugs, even though some studies on standardized Echinacea purpurea preparations have not found significant in vivo inhibition of key human drug-metabolizing enzymes like CYP2D6 and CYP3A4.

Bioavailability & Half-Life

The absorption and metabolic fate of Echinacea's components, such as alkamides, can differ based on the product. For example, following oral administration of lozenges containing Echinacea purpurea extract to healthy volunteers, alkamides were detectable in plasma, confirming their absorption. However, specific details like precise peak plasma times, comprehensive metabolic pathways for all active compounds (though interactions with CYP enzymes have been investigated, with some E. purpurea preparations not significantly inhibiting CYP2D6 and CYP3A4 in vivo), and exact elimination half-life ranges for all bioactive constituents are complex and vary depending on the specific compound and the formulation of the Echinacea product.

Interactions & Stacks

Echinacea is primarily utilized for its immune-supporting properties and is not commonly featured in synergistic nootropic stacks aimed at cognitive enhancement within the provided information. It is generally wise to be cautious when combining any herbs with pharmaceutical drugs due to the potential for interactions, such as altered drug bioavailability or effects, though specific problematic combinations with Echinacea are not extensively detailed beyond general considerations for CYP enzyme pathways. Meta-analyses confirm Echinacea's effectiveness in reducing respiratory tract infections and the associated need for antibiotics, reporting a similar incidence of adverse events compared to control treatments, which suggests a favorable safety profile for this application.

Benefits by Use Case

Respiratory Infection Prevention

Significantly reduces the monthly occurrence of respiratory tract infections (RTIs) and the number of patients experiencing at least one RTI. Efficacy can vary between different Echinacea preparations.

Reduced Antibiotic Need

Lowers the risk of RTI complications and the necessity for antibiotic therapy, with some extracts reducing total antibiotic therapy days by up to 70-80%. This effect is most pronounced with alcoholic extracts of freshly harvested Echinacea purpurea.

Immune System Support

Enhances immune cell activity, including macrophages and natural killer cells, and stimulates cytokine production and phagocytosis. The complexity of the immune system means nutrient interactions are multifaceted.

Skin Neuroprotection (Topical)

Topical application of Echinacea purpurea extract can protect skin nerve endings from UV radiation damage. This is based on ex vivo studies and may not translate directly to oral supplementation benefits.

Mood & Emotional Wellbeing

May improve positive and negative affect and emotional wellbeing, suggesting potential antidepressant effects, though it may not significantly reduce anxiety symptoms compared to placebo in mildly anxious individuals. These findings require further validation.

Mechanism of Action

Echinacea's therapeutic effects are derived from a complex synergy of its bioactive compounds, which include alkamides, caffeic acid derivatives (such as cichoric acid), polysaccharides, and flavonoids. These constituents modulate the immune system by boosting the activity of innate immune cells like macrophages (thereby increasing phagocytosis) and natural killer (NK) cells, and by promoting the production of various cytokines (e.g., TNF-alpha, interleukin-1, interleukin-6, interleukin-10). Alkamides are particularly recognized for their immunomodulatory capabilities and can interact with cannabinoid receptors (CB2), which are integral to immune regulation and inflammatory processes. Certain polysaccharides found in Echinacea also play a role in activating macrophages and other immune cells. Furthermore, Echinacea exhibits antiviral activity through direct actions on viruses such as influenza and herpes simplex, possibly by hindering viral entry or replication, while its antibacterial properties are effective against a range of respiratory and skin pathogens.

Frequently Asked Questions

Is Echinacea safe to take daily?

Can I take Echinacea if I'm pregnant?

Does Echinacea interact with medications?

What is Echinacea best for?

Are all Echinacea products the same?

Can Echinacea help with anxiety?

Does Echinacea have antioxidant properties?

Summary & Expert Opinion

Overall, Echinacea is a well-regarded herbal supplement, primarily recognized for its significant benefits in supporting the immune system and preventing respiratory tract infections. Its major strengths lie in its proven efficacy for reducing RTI occurrence and antibiotic use with a good safety profile; however, efficacy can vary between preparations, and its effects on mood or cognition are less established. Individuals looking to bolster their immune defenses, particularly to reduce the frequency or severity of common colds and other respiratory infections, may find Echinacea beneficial. While generally well-tolerated, individuals with known allergies to plants in the Asteraceae family (like ragweed or daisies) should exercise caution, and those on multiple medications should consult a healthcare provider due to potential, though generally low, risk of interactions.

Research Studies

Showing 5 of 11 studies

nutrition and immune function. (2004)

immune system nutrient modulation

Herb-drug interactions. (2000)

bleeding drug absorption drug bioavailability +2 more

Findings:

Concurrent use of herbs may mimic, magnify, or oppose the effect of drugs. Plausible herb-drug interactions include bleeding (e.g., warfarin with ginkgo), mild serotonin syndrome (St John's wort with SSRIs), decreased bioavailability of drugs like digoxin and cyclosporin with St John's wort, and decreased absorption of drugs by anthranoid-containing plants or soluble fibres. Health-care practitioners should caution patients against mixing herbs and pharmaceutical drugs.

Participants:

Patients (as subjects of reported herb-drug interactions, e.g., 'patients who mix St John's wort with serotonin-reuptake inhibitors', 'depressed patients who mix antidepressants and Panax ginseng')

Study Quality Assessment:

Many reports of herb-drug interactions are sketchy and lack laboratory analysis of suspect preparations.

All Effects:

bleeding drug absorption drug bioavailability herb-drug interactions serotonin syndrome

Adaptogenic and anxiolytic effects of ... associated disorders — a systematic review and meta-analysis...

anxiety reduction cortisol reduction safety profile +1 more

Findings:

Ashwagandha significantly reduced stress (Perceived Stress Scale MD = -4.72), anxiety (Hamilton Anxiety Scale MD = -2.19), and serum cortisol levels (MD = -2.58) compared to placebo in a meta-analysis of 9 studies involving 558 patients. Ashwagandha formulations are generally safe with some mild to moderate adverse events reported; however, further research on long-term safety is needed.

Participants:

558 patients involved in nine randomized controlled trials.

Dosage:

Doses ranged 125–600 mg daily for 30–90 days; both root alone and root-and-leaf combined formulations were used.

Study Quality Assessment:

Systematic review and meta-analysis of 9 randomized controlled trials (N=558 patients). Conducted according to PRISMA guidelines. Two authors independently extracted data. Four included studies reported mild to moderate adverse events. High heterogeneity (I² = 86 %, p < 0.001) noted for stress reduction effects across studies. Further information is required to determine long-term safety. Study limitations acknowledged but not detailed beyond heterogeneity and need for long-term safety data. Funding: Nil.

All Effects:

anxiety reduction cortisol reduction safety profile stress reduction

An investigation into the anxiety-relieving and mood-enhancing effects of Echinacea angustifolia (EP107™): A randomised, double-blind, placebo-controlled study

antidepressant effects anxiety emotional wellbeing +2 more

Findings:

Echinacea angustifolia extract (EP107TM) administered for 6 weeks at doses of 40mg and 80mg daily was not associated with greater improvements in anxiety in adults with mild-to-moderately severe anxiety compared to placebo. However, both doses of echinacea were associated with greater improvements in positive and negative affect (PANAS scores) and emotional wellbeing (SF-36 score) compared to placebo, suggesting antidepressant effects.

Participants:

108 adults with mild-to-moderately severe anxiety were recruited; data collected from 104 participants.

Dosage:

20 mg or 40 mg of echinacea angustifolia, twice daily (resulting in total daily doses of 40 mg and 80 mg) for 6 weeks.

Study Quality Assessment:

6-week, 3-arm, parallel-group, double-blind, randomised controlled trial; N=108 adults recruited (N=104 analyzed); Outcome measures: Clinically Useful Anxiety Outcome Scale (CUXOS), Positive and Negative Affect Scale (PANAS), Short Form-36 (SF-36), and Bergen Insomnia Scale (BIS); Limitations: The positive improvements associated with echinacea were only identified via the secondary outcome measures and, therefore, require validation in future trials. Further studies using clearly-defined populations and validated outcome measures will be useful in future trials.

All Effects:

antidepressant effects anxiety emotional wellbeing negative affect positive affect

Analysis of nerve damage induced by ultraviolet radiation and assessment of neuroprotection.

Echinacea purpurea UV damage reduction neuroprotection +2 more

Findings:

UVA and UVB irradiation significantly reduced (40–60%) densities of nerve endings in control skin samples treated with placebo. Skin samples treated with the test emulsion containing Echinacea purpurea extract completely blocked these UV-related damaging effects on skin nerve endings. These neuroprotective effects were observed regardless of patient age or the tissue source (breast versus abdomen). The new skincare formulation provides important neuroprotective effects against UV irradiation.

Participants:

Skin samples obtained from 20 healthy, female Caucasian patients (mean age 42 ± 20 years) enrolled for cosmetic plastic surgery (mammoplasty n=9, abdominoplasty n=11). Exclusion criteria included indoor tanning, diabetes, neoplasia, infectious or chronic inflammatory disease.

Dosage:

Test cream (+E. purpurea) and placebo (SPF 15) emulsions were manually applied to skin biopsies at a concentration of 2 mg/cm2 and allowed to remain for 30 minutes for penetration prior to UV exposure.

Study Quality Assessment:

Ex vivo study using skin biopsies. Comparison between a test skincare emulsion (from Echinacea purpurea extract, enriched with antioxidants) and a placebo emulsion (SPF 15). Skin samples exposed to UVA and UVB for 60 min. Nerve fibres identified by immunofluorescence (anti-human CD56). Cell damage quantified by image analysis. Evaluation of damage performed in a double-blind fashion. Statistical analysis included normality testing (Kolmogorov–Smirnov), factorial ANOVA, and post hoc analysis (Tukey). Sample size N=20 patients. Limitations acknowledged: need to identify exact plant bioactive products, demonstrate neuroprotection following chronic UV exposure, and correlate UV-related changes in cell density with absolute number of skin nerve fibres. Funding source: CNPq.

All Effects:

Echinacea purpurea UV damage reduction neuroprotection photo-ageing skin nerve endings

Echinacea Reduces Antibiotics by Preventing Respiratory Infections

RTI complication reduction RTI prevention antibiotic use reduction +2 more

Findings:

Echinacea significantly reduced monthly RTI occurrence (RR 0.68), the number of patients with ≥1 RTI (RR = 0.75), risk of recurrent infections (RR = 0.60), RTI complications (RR = 0.44), and the need for antibiotic therapy (RR = 0.60), with total antibiotic therapy days reduced by 70%. Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days (IRR 0.21). An equal number of adverse events occurred with Echinacea and control treatment, suggesting Echinacea can safely prevent RTIs and associated complications, thereby decreasing the demand for antibiotics.

Participants:

5652 subjects from 30 clinical trials (39 comparisons) studying Echinacea for the prevention or treatment of RTIs.

Dosage:

Alcoholic extracts from freshly harvested Echinacea purpurea were the strongest, with an 80% reduction of antibiotic treatment days (IRR 0.21 [95% CI 0.15-0.28]). Relevant differences exist between Echinacea preparations.

Study Quality Assessment:

Meta-analysis of 30 clinical trials (39 comparisons) involving 5652 subjects. Searched EMBASE, PubMed, Google Scholar, Cochrane DARE and clinicaltrials.gov. Conflict of interest statement provided: R.S., W.C.A. and S.L.J. received honoraria from A.Vogel AG Switzerland for consulting work; G.H. received honoraria for statistical evaluation. Figures mentioned include Funnel plots and Abbey plots (related to bias assessment in meta-analyses).

All Effects:

RTI complication reduction RTI prevention antibiotic use reduction recurrent RTI reduction safety profile

Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): A review of their chemistry, pharmacology and clinical properties

anti-inflammatory antioxidant antiviral +2 more

Findings:

This review details Echinacea purpurea's phytochemistry (notably alkamides, caffeic acid derivatives, polysaccharides), pharmacology, and analysis methods. It highlights its traditional and studied immunostimulatory and anti-inflammatory properties, along with other reported activities such as antianxiety, antidepressant, cytotoxic, antimutagenic, antioxidant, antibacterial, antiviral (including against influenza viruses), and larvicidal effects. The review emphasizes that clinical trial findings, particularly concerning efficacy for cold symptoms and the nature of side effects (which range from none to serious ones like abdominal pain or angioedema), are controversial, underscoring the need for further research to elucidate its mechanisms of action.

Participants:

The review paper discusses various studies involving human participants, such as 'patients' in clinical trials (e.g., '108 patients' in a trial for colds), 'healthy volunteers' (including 'six healthy volunteers' for lozenge pharmacokinetics and 'healthy nonsmoking volunteers' for CYP enzyme studies). Animal models mentioned include 'rats' (e.g., 'healthy rats', 'male rats' for prolactin secretion studies), 'mice' (e.g., 'Swiss mice', 'normal, leukemic, and aging mice', 'female mice' for toxicity studies), and 'rabbits'.

Dosage:

The review mentions various dosages from different studies: 'plant root powder was administered to the male rats (in two doses: 30 and 100 mg/kg)', 'Dried root powder of the plant, administered to the mice (30-100 mg/kg)', 'High concentrations of the plant (8 mg/ml) reduced sperm motility'. Toxicity studies reported 'LD50 value was calculated as 2500 mg/kg in an intraperitoneal injection of the polysaccharide fraction of the plant in female mice', and for plant juice, 'LD50 values of oral... more than 30 g/kg... in mice, and 15 g/kg... in rats', and intravenous administration 'more than... 10 g/kg in mice, and 5 g/kg in rats'. Lozenges with E. purpurea extract showed effects where 'All the doses significantly decreased proinflammatory cytokines'.

Study Quality Assessment:

This text is a review article. It references various study types including 'clinical trials' (some described as 'randomized blinded trial', 'double-blind, placebo-controlled cross-over study'), 'in vivo studies', and 'in vitro studies'. Analytical methods like 'high-performance liquid chromatography (HPLC)', 'LC-MS/MS', 'capillary electrophoresis (CE)', and 'micellar electrokinetic chromatography (MEKC)' are mentioned for phytochemical analysis. The review notes that findings of clinical trials are 'controversial', 'many questions remain unanswered', and cites another review indicating that some studies on common cold treatment 'failed to meet the criteria of experimental design'.

All Effects:

anti-inflammatory antioxidant antiviral cold symptoms immunostimulatory

Molecular Defensive Mechanism of Echinacea purpurea (L.) Moench against PAH Contaminations

Passiflora incarnata in neuropsychiatric disorders — a systematic review

anxiety reduction insomnia relief neuropsychiatric symptoms +2 more

Findings:

This systematic review of nine clinical trials concluded that Passiflora incarnata preparations generally reduced anxiety levels, with the effect being less evident in people with mild anxiety symptoms. No adverse effects, including memory loss or collapse of psychometric functions, were observed in the reviewed studies. The review suggests Passiflora incarnata may be helpful in treating some symptoms in neuropsychiatric patients, potentially alleviating stress reactivity, insomnia, and depression-like behaviors, with an anti-anxiety effect comparable to drugs like oxazepam or midazolam in some contexts.

Participants:

Systematic review of 9 clinical trials. Participants in the included studies were adults (no less than 18 years old). The vast majority of participants in these trials were healthy; one study included participants with a diagnosis of Generalized Anxiety Disorder (GAD). Sample sizes in the individual reviewed studies ranged from N=16 to N=128.

Dosage:

Dosages in the 9 reviewed clinical trials varied widely and included: 45 drops/day of extract; 700 mg/5 mL of syrup; 500 mg tablets; 260 mg pill; 192 mg of P. incarnata extract; 40 drops/day of extract; an infusion (2 g in 250 mL water); 1000 mg. Administration was typically oral. The duration of the studies included in the analysis varied from a single day up to 30 days.

Study Quality Assessment:

Systematic review of 9 randomized clinical trials (RCTs). Scientific databases (PubMed, ClinTrials.gov, Embase) were searched up to October 22, 2019. Data extraction followed PRISMA guidelines (no study protocol registration). The Cochrane Collaboration’s tool was used for assessing risk of bias (ROB) of the included studies; three studies were assessed as low quality (<5 points ROB), while six had higher scores (≥5 points ROB). The majority of the analyzed studies (7/9) were double-blind (DB), with some being single-blind (SB) or cross-over. Acknowledged limitations of the review include the small number of studies (9), small sample sizes in the primary studies (ranging from 16 to 128 persons), high heterogeneity precluding meta-analysis, and sometimes a lack of information on which part of the plant was used. Funding source for the review project was mentioned.

All Effects:

anxiety reduction insomnia relief neuropsychiatric symptoms no adverse effects stress reduction

Phytochemistry, Mechanisms, and Preclinical Studies of Echinacea Extracts in Modulating Immune Responses to Bacterial and Viral Infections: A Comprehensive Review

Review and Assessment of Medicinal Safety Data of Orally Used Echinacea Preparations

CYP inhibition adverse events drug interactions +3 more

Findings:

This systematic review assesses safety data for orally used Echinacea preparations (Echinacea purpurea, Echinacea angustifolia, Echinacea pallida), emphasizing that safety data are product-specific. Key findings include: standardized E. purpurea preparations showed no significant in vivo inhibition of human CYP2D6 and CYP3A4 (though in vitro results using liver microsomes are contradictory); adverse events reported during clinical trials were generally mild and mostly without causality; long-term use (up to 6 months) is considered safe. Contraindications for autoimmune diseases, immune-suppression, and use during pregnancy are questioned, with a literature review finding no association with an increased risk for major or minor malformations during organogenesis; overall, evaluated Echinacea preparations are considered well-tolerated in children and adults.

Participants:

The review covers studies involving humans (including pregnant and nursing women, children, and adults) and mice (for embryonic angiogenesis studies).

Dosage:

Long term studies with continuous ingestion of different Echinacea preparations up to 6 months.

Study Quality Assessment:

Systematic review of available literature. Assesses data from pharmacokinetic herb-drug interaction studies (in vivo and in vitro using liver microsomes, noting contradictory results for the latter), clinical trials, and long-term studies (continuous ingestion up to 6 months). The document type is 'Review'.

All Effects:

CYP inhibition adverse events drug interactions long-term use pregnancy safety safety assessment

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Categories & Effectiveness

Mood & Stress

Mood Elevation

Wellbeing Boost

Systemic Health

Immune System Boost

Anti-Inflammatory (Systemic)

Immune System Balance

Systemic Antioxidant

Dosage & Side Effects

Recommended Dosage

Potential Side Effects

Bioavailability & Half-Life

Interactions & Stacks

Benefits by Use Case

Respiratory Infection Prevention

Reduced Antibiotic Need

Immune System Support

Skin Neuroprotection (Topical)

Mood & Emotional Wellbeing

Mechanism of Action

Frequently Asked Questions

Summary & Expert Opinion

Research Studies

nutrition and immune function. (2004)

Findings:

Herb-drug interactions. (2000)

Findings:

Participants:

Study Quality Assessment:

All Effects:

Adaptogenic and anxiolytic effects of ... associated disorders — a systematic review and meta-analysis...

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

An investigation into the anxiety-relieving and mood-enhancing effects of Echinacea angustifolia (EP107™): A randomised, double-blind, placebo-controlled study

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Analysis of nerve damage induced by ultraviolet radiation and assessment of neuroprotection.

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Echinacea Reduces Antibiotics by Preventing Respiratory Infections

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench): A review of their chemistry, pharmacology and clinical properties

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Molecular Defensive Mechanism of Echinacea purpurea (L.) Moench against PAH Contaminations

Passiflora incarnata in neuropsychiatric disorders — a systematic review

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Phytochemistry, Mechanisms, and Preclinical Studies of Echinacea Extracts in Modulating Immune Responses to Bacterial and Viral Infections: A Comprehensive Review

Review and Assessment of Medicinal Safety Data of Orally Used Echinacea Preparations

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

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