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Echinacea (E. angustifolia, E. purpurea, E. pallida.) are plants related to sunflowers and ragweed. The leaf, flower, and root are used as medicine.

Echinacea species are native to areas east of the Rocky Mountains in the United States. Echinacea seems to activate chemicals in the body that decrease inflammation. It might also increase the body's immune system.

Echinacea is most commonly used for the common cold and other infections, but there is no good scientific evidence to support most of these uses. There is also no good evidence to support using echinacea for COVID-19.

Natural Medicines rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
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  • Common cold.  Taking echinacea orally while still healthy may help prevent the common cold, but the benefit is probably modest. Echinacea does not seem to have significant benefit for treating colds that have already developed.
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When taken by mouth: Echinacea is likely safe for most people in the short-term. Various echinacea products have been used safely for up to 10 days. Some products, such as Echinaforce (A. Vogel Bioforce AG), have been used safely for up to 6 months.

The most common side effects are stomach pain, constipation, diarrhea, heartburn, vomiting, and rash. Allergic reactions might occur in some people, especially in people who are allergic to ragweed, mums, marigolds, or daisies.

When applied to the skin: Echinacea is possibly safe when used short-term. A cream (Linola Plus Cream) containing echinacea has been used safely for up to 12 weeks. Applying echinacea to the skin might cause redness, itchiness, or a rash.

Special Precautions & Warnings:

Pregnancy: Echinacea is possibly safe when taken by mouth for up to 7 days when pregnant. There isn't enough reliable information to know if using echinacea for longer than 7 days is safe.

Breast-feeding: There isn't enough reliable information to know if echinacea is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: Echinacea is possibly safe when taken by mouth or applied to the skin for up to 10 days. Taking echinacea by mouth seems to be safe in most children ages 2-11 years, but rashes due to an allergic reaction can occur. There is some concern that allergic reactions to echinacea could be more severe in some children.

An inherited tendency toward allergies (atopy): People with this condition are more likely to develop an allergic reaction to echinacea. It's best to avoid exposure to echinacea if you have this condition.

"Auto-immune disorders" such as such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), a skin disorder called pemphigus vulgaris, or others: Echinacea might have an effect on the immune system that could make these conditions worse. Don't take echinacea if you have an auto-immune disorder.

Caffeine

Interaction Rating=Moderate Be cautious with this combination.

The body breaks down caffeine to get rid of it. Echinacea might decrease how quickly the body breaks down caffeine. Taking echinacea along with caffeine might cause too much caffeine in the bloodstream and increase the risk of side effects. Common side effects include jitteriness, headache, and fast heartbeat.

Medications changed by the body (Cytochrome P450 3A4 (CYP3A4) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the body.
Echinacea might change how the body breaks down some medications. Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the body.
Some medications changed by the body include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and many others.

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver.
Echinacea might decrease how quickly the liver breaks down some medications.
Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the liver.
Some of the medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.

Medications that decrease the immune system (Immunosuppressants)

Interaction Rating=Moderate Be cautious with this combination.

Echinacea can increase the immune system. Taking echinacea along with some medications that decrease the immune system might decrease the effectiveness of medications that decrease the immune system.
Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Midazolam (Versed)

Interaction Rating=Minor Be watchful with this combination.

Taking midazolam with echinacea increases how much midazolam the body absorbs. This might increase the effects and side effects of midazolam, but more information is needed.

There are no known interactions with herbs and supplements.

There are no known interactions with foods.

Echinacea is available in many different types of products, including supplements, liquids, creams, mouthwashes, and throat sprays. Doses vary widely depending on the type of product used. Speak with a healthcare provider to find out what type of product and dose might be best for a specific condition.

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