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Echinacea (E purpurea, E angustifolia, E pallida)

Echinacea is a native American wildflower referred to as the cone flower. It is a member of the daisy family. Echina means spiny (Greek). There are 9 species of the genus Echinacea, the most common E purpurae, E angustifolia & E pallida. Uses: Traditional use: It was used by North American Indians & introduced into western medicine in 1871 by Dr. Meyer of Nebraska. He used it to prepare a 'blood purifier' which he claimed to be useful in treating almost any condition. 1) rheumatism 2) migraine 3) pain 4) wounds 5) skin conditions 6) rattlesnake bites 7) infections a) malaria b) diptheria Commercial claims: - antiviral, antibiotic, antiseptic, analgesic, blood purifier, supportive therapy for upper respiratory tract infections* * No benefit for common cold [7,9,12,14] Current uses: 1) treatment & prevention of cold & flu (influenza)* 2) supportive treatment of recurrent infections: a) ears b) respiratory tract c) urinary tract d) vaginal yeast infections * may be of modest benefit for influenza [8]; may be of modest benefit in preventing symptoms of cold [10]; of no benefit in prevention or treatment of colds [13,14,16] Contraindications: 1) patients on immunosuppressive therapy 2) autoimmune disease 3) pregnancy (safety NOT demonstrated) Dose: 1) standardized preparation of fresh-pressed juice contains a minimum of 2.4% beta 1,2-fructo-furanosides in 22% ethanol 2-3 mL every 2-3 hours 2) dried root as tea: 1-2 g/day 3) freeze-dried plant: 325-650 mg TID 4) tincture (1:5): 3-4 mL TID 5) fluid extract (1:1): 1-3 mL TID 6) duration of therapy < 8 weeks; <= 10 days [15] 7) discontinue >= 2 weeks before surgery [15] 8) juice is prepared from the leaves & flowers 9) Herbal preparations from the roots of E purpurae & E angustifolia are also sold Pharmacokinetics: -> may induce cyt P450 Adverse effects: 1) no reported toxicity 2) hypersensitivity reactions -> persons allergic to the Asteraceae or Compositae plant family (ragweed, chrystantemums, marigolds, daisies) are at risk [5,15] 3) rash 4) pruritus 5) dizziness, vertigo [5] 6) dysgeusia (unpleasant taste) [16] 7) dyspepsia [16] 8) diarrhea [16] 9) no data of chronic effects 10) due to immunostimulatory properties, it is not recommended for patients with autoimmune disorders 11) no data on safety during pregnancy 12) tachyphylaxis make occur with administration for more than 8 weeks 13) hepatotoxicity may occur with administration for more than 8 weeks 13) long term use may suppress immunity; not recommended for patients with HIV infection Drug interactions: 1) none known 2) should not be taken in combination with hepatotoxic agents 3) immunosuppressive agents [5] Mechanism of action: 1) active ingredients: a) polysaccharides b) flavonoids c) caffeic acid derivatives d) echinacosides e) essential oils f) pyrrolizidine alkaloids 2) in vitro stimulating of phagocytic activity of human neutrophils by fat-soluble components 3) Echinacea polysaccharides bind to T-lymphocyte receptor - in vitro release of IL-1, TNF, interferon 4) Echinacea polysaccharides, fat soluble components & caffeic acid derivatives stimulate monocytes 5) caffeic acid derivative & echinacosides have antibacterial activity 6) in vitro inhibition of influenza, herpes virus & vesicular stomatitis virus

General

pharmaceutical herb; medicinal herb; herbal supplement; botanical

References

  1. Victoria Rand, UCSF Fresno Lecture, 10/7/98
  2. Melchart et al, Phytomedicine, 1994
  3. Kaiser Permanente, Northern California Regional Pharmacy & Therapeutics Committee
  4. Kaiser Permanente, Northern California, Drug Bulletin, Sept-Oct, 2000
  5. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  6. Prescriber's Letter 10(2):12 2003
  7. Journal Watch 23(4):35, 2003 Barrett BP et al, Ann Intern Med 137:939, 2002
  8. Prescriber's Letter 11(1):1 2004
  9. Journal Watch 24(2):19, 2004 Taylor JA et al, JAMA 290:2824, 2003 PMID: 14657066
  10. Journal Watch 24(13):104, 2004 Sperber SJ, Shah LP, Gilbert RD, Ritchey TW, Monto AS. Echinacea purpurea for prevention of experimental rhinovirus colds. Clin Infect Dis. 2004 May 15;38(10):1367-71. Epub 2004 Apr 26. PMID: 15156472
  11. Echinacea Not Effective in Treating Children's Colds http://nccam.nih.gov/health/alerts/echinacea/index.htm
  12. Prescriber's Letter 12(9): 2005 Echinacea for the Common Cold Detail-Document#: 210911 (subscription needed) http://www.prescribersletter.com
  13. Journal Watch 25(17):134, 2005 Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. N Engl J Med. 2005 Jul 28;353(4):341-8. PMID: 16049208 - Sampson W. Studying herbal remedies. N Engl J Med. 2005 Jul 28;353(4):337-9. No abstract available. PMID: 16049207
  14. Barrett B et al. Echinacea for treating the common cold: A randomized trial. Ann Intern Med 2010 Dec 21; 153:769. PMID: 21173411 http://www.annals.org/content/153/12/769.long
  15. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  16. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.

Component-of

ascorbate/echinacea ascorbate/echinacea/zinc sulfate Chizukit echinacea/hydrastis canadensis