C l i n i c a l O v e r v i e w

Echinacea
Echinacea purpurea (L.) Moench, E. pallida (Nutt.) Nutt.,
E. angustifolia DC.
[Fam. Asteraceae]

OVERVIEW DOSAGE AND ADMINISTRATION

The native American medicinal plant, The German Commission E recommends
echinacea, is one of the most popular herbs limiting the use of internal and external
in the U.S. marketplace. Preparations echinacea preparations to 8 weeks because
made from several plant species and plant the conditions for which echinacea prepara-
parts of the genus Echinacea constituted tions are used are usually relatively minor
the top-selling herbal medicine in all chan- and transient. If symptoms still persist after
nels of sales (mass market, multilevel, and 8 weeks of echinacea therapy, more aggres-
natural food stores) in 1997, capturing 9% sive treatment is presumably needed.
of the total market based on $3.6 billion of Internal
total sales. Echinacea preparations ranked E. purpurea herb
fourth with retail sales of over $58 million EXPRESSED JUICE FROM FRESH AERIAL PARTS:
in the mainstream market in 2000. While (2.5:1), stabilized in 22% alcohol: 6–9 ml
the main constituents in the different daily.
species and plant parts have pharmacologi-
cal activity, the exact compounds responsi- INFUSION: For upper respiratory and flu
ble for the therapeutic value are unclear. symptoms, 150–240 ml boiling water
For this reason it is important to note the poured over about 1 g dried herb and
taxonomic source and type of preparation steeped, covered, for 10–15 minutes,
for each clinical study. 5–6 times daily.
TINCTURE: 1:10 (w/v), in 65% (v/v) alco-
PRIMARY USES hol: 5 drops, 1–3 times daily. For acute

Echinacea
Photo © 2003 stevenfoster.com
• Upper respiratory tract infections conditions, 5 drops every 1/2–1 hr.
(URTIs) — Treatment E. purpurea, E. pallida, E. angustifolia root
DRIED ROOT: 0.9–1 g, approximately 900 mg cut root 3 times
OTHER POTENTIAL USES daily.
Internal I NFUSION : 0.9 g root in 150 ml boiled water steeped for
• Immune system stimulant 10 min., several times daily between meals.
• Adjunct therapy in chronic candidiasis in women DECOCTION: 1 g in 150 ml water boiled for 10 min., 3 times
• URTIs — Prevention daily.
External FLUID EXTRACT: 1:1 in 45% alcohol: 0.5–1.0 ml 3 times daily.
• Wound healing
Clinical Overview
TINCTURE: 1:5 (g/ml), ethanol 55% (v/v): 30–60 drops, approx-
imately 1.5–5 ml, 3 times daily.
PHARMACOLOGICAL ACTIONS
Internal External
Promotes immunomodulatory activity. In animal studies: OINTMENT: Semisolid preparation containing at least
demonstrates antitumor activity in combination with Thuja occi- 15% pressed juice in a base of petroleum jelly, or anhydrous
dentalis tips and Baptisia tinctoria rhizome; increases phagocyto- lanolin, and vegetable oil applied locally.
sis; increases serum leukocytes; stimulates granulocyte migration; POULTICE: Semisolid paste or plaster containing at least
stimulates cytokine production; protective effects on influenza A- 15% pressed juice applied locally.
virus infection in mice.
External
Protects against photodamage; promotes wound healing; increas-
es total lymphocyte count with a decreased percentage of T-helper
cells.

The ABC Clinical Guide to Herbs 85

 C l i n i c a l O v e r v i e w

CONTRAINDICATIONS The prevention of URTIs was studied in five R, PC studies with

Caution may be advised with internal echinacea preparations in a total of 1,209 subjects focused on the use of distinct mono-
cases of increased tendency for allergies, especially to members of preparations and unique combination products. Two of these
the family Asteraceae, including arnica (Arnica spp.), chamomile studies did not find a significant effect. Non-continuous admin-
(Matricaria spp.), marigold (Calendula officinalis), yarrow istration of the treatment in one study may have been a factor,
(Achillea spp.), ragweed (Ambrosia spp.), asters (Aster tataricus), though the authors attributed the results to a sample size smaller
and chrysanthemums (Chrysanthemum spp.). Based on theoreti- than desired. In another study, the authors reported that the
cal considerations, the Commission E also advises using “treatment with fluid extract of Echinacea purpurea did not sig-
echinacea with caution in progressive systemic diseases such as nificantly decrease the incidence, duration or severity of colds and
tuberculosis, leukosis, collagenosis, multiple sclerosis, AIDS, respiratory infections compared to placebo.”
HIV infection, and other autoimmune diseases. No contraindi- Other trials included a study on genital herpes that found no
cations are known for external echinacea preparations. demonstrated effect. One R, PC study on immunology in ath-
PREGNANCY AND LACTATION: No known restrictions. In a recent letes concluded that the echinacea group had no URTIs com-
controlled trial, echinacea consumption by pregnant women pared to placebo. Women using echinacea drops as an adjunct
showed no evidence of risk. therapy in the treatment of chronic candidiasis showed a reduced
recurrence rate. A study on the safety of echinacea during preg-
ADVERSE EFFECTS nancy found no statistical difference between echinacea and con-
Few adverse effects have been reported for internal and external trol groups.
echinacea preparations. Ingestion of an echinacea preparation A review of 13 R, DB, PC trials studying the treatment and pre-
made of E. angustifolia (whole plant) and E. purpurea root has vention of URTIs evaluated the effectiveness of orally ingested
been associated with anaphylaxis. It is possible that pollens might echinacea preparations. The authors concluded that the pub-
be present in echinacea preparations made with aerial parts and lished trials suggest echinacea may be beneficial for treatment, but
not in those preparations containing root material only. the variation of preparations and compositions (including com-
bination products containing other botanicals) makes recom-
DRUG INTERACTIONS mending specific doses problematic. They claimed that there was
None known. very little evidence supporting the prolonged use of echinacea for
prevention of URTIs. An assessment of the methodology of 26
CLINICAL REVIEW controlled clinical trials concluded that the published clinical
Of 21 studies on echinacea that included a total of 3,508 partic- studies suggest that some preparations containing echinacea can
ipants, all but three demonstrated positive effects for indications be efficacious as immunomodulators. However, the evidence is
including cold, flu, upper respiratory tract infections (URTIs), insufficient to recommend an exact dosage or specific preparation
candidiasis, and gestational safety. Five positive randomized, dou- for use. A review observed that despite contraindications in auto-
ble-blind, placebo-controlled (R, DB, PC) studies, involving a immune diseases based on theoretical considerations (e.g., those
total of 825 subjects, supported the use of specific and unique suggested by Commission E), current clinical use and scientific
echinacea monopreparations for the treatment (incidence, severi- evidence do not support limitations on long-term use of echi-
ty, and/or duration) of acute upper respiratory or flu-like nacea with particular auto-immune diseases. The author suggest-
infections. The acute treatment was further supported by six ed echinacea should be considered an immunomodulator rather
additional R, DB, PC studies using combination preparations than an immunostimulant.
containing echinacea and other herbs. One R, DB, PC study on
an echinacea monopreparation did not find measurable benefit
for treatment of URTI symptoms, though this may be due to the
low dose and lack of severity of the symptoms.

86 The ABC Clinical Guide to Herbs

 Echinacea
Echinacea purpurea (L.) Moench, E. pallida (Nutt.) Nutt., E. angustifolia DC.

[Fam. Asteraceae]

OVERVIEW
The native American medicinal plant echinacea is one of
the most popular herbs in the U.S. marketplace.
Preparations made from several plant species and parts of
echinacea are used, including the above-ground parts, or
the roots, stems or leaves from Echinacea purpurea, E. pal-
lida, and/or E. angustifolia. While all of these species vari-
ations can be effective for treating different ailments, the
exact chemical compounds responsible for the therapeutic
effects are not yet known.
S h e e t

USES
Supportive care to treat colds and chronic infections of
the upper respiratory tract.
DOSAGE
Consult your healthcare practitioner if symptoms have
not improved within eight weeks.
E. purpurea herb
TINCTURE: 5 ml, 3 times daily.
E. purpurea, E. pallida, E. angustifolia root
I n f o r m a t i o n

DRIED ROOT: 900 mg, 3 times daily.

FLUID EXTRACT: 0.5–1.0 ml, 3 times daily.
TINCTURE: 30–60 drops, 3 times daily.
Echinacea preparations are also available as teas,
capsules, and tablets.
CONTRAINDICATIONS ADVERSE EFFECTS

Echinacea
Consult your healthcare provider before ingesting echi- Rare cases of allergic reactions to plants in the family
nacea preparations in cases of an increased tendency Asteraceae are the only known adverse effects of
toward allergies to plants in the daisy family (Asteraceae), echinacea.
including arnica, chamomile, chrysanthemum, marigold,
ragweed, and yarrow. DRUG INTERACTIONS
PREGNANCY AND LACTATION: There are no known restric- There are no known drug interactions.
tions for use during pregnancy or while breast-feeding.

Patient Information Sheet

P a t i e n t

Comments
When using a dietary supplement, purchase it from a reliable source. The information contained on this sheet has been
For best results, use the same brand of product throughout the period excerpted from The ABC Clinical Guide to Herbs
of use. As with all medications and dietary supplements, please inform © 2003 by the American Botanical Council (ABC).
your healthcare provider of all herbs and medications you are taking. ABC is an independent member-based educational
Interactions may occur between medications and herbs or even among organization focusing on the medicinal use of herbs.
different herbs when taken at the same time. Treat your herbal supple- For more detailed information about this herb please
ment with care by taking it as directed, storing it as advised on the consult the healthcare provider who gave you this sheet.
label, and keeping it out of the reach of children and pets. Consult your To order The ABC Clinical Guide to Herbs or become a
healthcare provider with any questions. member of ABC, visit their website at
www.herbalgram.org.

The ABC Clinical Guide to Herbs 87

 Echinacea
Echinacea spp.
Echinacea purpurea (L.) Moench, E. pallida (Nutt.) Nutt., E. angustifolia DC.
[Fam. Asteraceae]

OVERVIEW DESCRIPTION

T
he medicinal plant echinacea, indigenous to the U.S., is Nine species of the genus Echinacea have been classified taxo-
one of the most popular herbs in the U.S. marketplace. nomically (Hobbs, 1994) although recent chemical and genetic
The roots of several species were the most widely used research suggests possible reclassification of the genus to four
medicines of Native Americans of the Great Plains. species (Binns et al., 2002). Echinacea preparations consist of
Ethnobotanist M.R. Gilmore noted, “Echinacea seems to have any one or more of the plant parts from three Echinacea species
been used as a remedy for more ailments than any other plant” [Fam. Asteraceae], including the fresh, above-ground parts
(Gilmore, 1911). Foster (1991) and Moerman (1998) have (harvested at the time of flowering), the fresh or dried root of
reviewed the ethnobotany of both the roots and leaves of various E. purpurea (L.) Moench, and the fresh or dried root of E. pall-
species of Echinacea. They were used by Native Americans for ida (Nutt.) Nutt., and/or E. angustifolia D.C., and their prepa-
toothache, enlarged glands (mumps), sore throat, snakebite, rations in effective dosage. Occasionally, the fresh or dried
coughs, burns, and as an analgesic. Eclectic medical physicians of above-ground parts of E. pallida, collected at the time of flower-
the late 19th century employed E. angustifolia root for a variety ing, are used but are often labeled incorrectly as “E. angustifolia”
of indications, both internally and externally, including sepsis in the marketplace (Blumenthal et al., 2000).
(e.g., gangrene, boils, septicemia), foul mucous discharges, can-
cerous growths, typhoid, various types of fevers, and locally PRIMARY USES
applied for chronic skin sores (Felter and Lloyd, 1898). They Respiratory
also used it for mitigation of the pain of gonorrhea and syphilis, • Treatment of symptoms and duration in upper respiratory
as a local anesthetic, for snakebite and other venomous stings tract infections (URTIs)
(Foster, 1991). E. purpurea herb and root (Brinkeborn, 1998; Hoheisel et
al., 1997; Bräunig et al, 1992)
E. pallida root (Dorn et al., 1997)
E. angustifolia root (Galea et al., 1996)
E. purpurea and E. angustifolia stems and E. purpurea root
(Lindenmuth and Lindenmuth, 2000)
E. purpurea and E. pallida roots (Henneicke-von Zepelin et
al., 1999; Reitz et al., 1990; Vorberg, 1984)
OTHER POTENTIAL USES
Internal
• Immune system stimulant
E. purpurea (Berg et al., 1998; Brinkeborn, 1999; Hoheisel
et al., 1997; Braunig et al., 1992)
E pallida (Dorn et al., 1997)
• Adjunct therapy in chronic candidiasis in women
Photo © 2003 stevenfoster.com
E. pupurea (Coeugniet and Kuhnast et al., 1986)
• Prevention of URTIs:
Preparations made from several plant species and plant parts of
E. purpurea (Grimm and Müller, 1999; Schöneberger et al.,
the genus Echinacea constituted the top-selling herbal supple-
1992)
ment sold in all U.S. channels of sales (mass market, multilevel,
and natural food stores) in 1997, consisting of 9% of the total E. angustifolia (Melchart et al, 1998)
market based on $3.6 billion in total sales (Brevoort, 1998). In E. purpurea and E. pallida (Forth et al., 1981)
2000, echinacea preparations ranked fourth in the mainstream E. angustifolia herb and root combination (Schmidt et al.,
market with retail sales of $58,422,932 (Blumenthal, 2001). 1990)
While the main constituents of the different species and plant
parts have pharmacological activity, the exact compounds External
responsible for echinacea’s therapeutic value are unclear. For this • Wound healing
reason, it is important to note the taxonomic source, plant part, E. purpurea (Blumenthal et al., 1998; WHO, 1999)
and type of preparation for each clinical study (Parnham, 1999; E. pallida root (Speroni et al., 1998)
Bauer 1999; Melchart and Linde, 1999). E. angustifolia root (Bradley, 1992)
88 The ABC Clinical Guide to Herbs
DOSAGE Bauer and Liersch, 1993). E. purpurea root differs in containing
Internal polyacetylene derivatives; polysaccharides (fructosans, arabino-
Crude Preparations galactans); glycoproteins comprised of approximately 3% pro-
E. purpurea herb tein, of which the dominant sugars are 64–84% arabinose,
1.9–5.3% galactose, and 6% glucosamine, and up to 0.2% essen-
JUICE: 6–9 ml daily expressed juice from fresh E. purpurea aerial tial oil (Bauer 1999; Bauer and Liersch, 1993; ESCOP, 1999;
parts 2.5:1, stabilized in 22% alcohol, (Bauer and Liersch, 1993; Pietta et al., 1998).
Blumenthal et al., 1998).
E. pallida herb contains caffeic acid derivatives including cichor-
INFUSION: For upper respiratory and flu symptoms, 150–240 ml ic acid, caftaric acid, echinacoside, verbascoside, chlorogenic acid,
boiling water poured over about 1 g dried herb and steeped cov- and isochlorogenic acid; flavonoids (mainly rutoside); alkamides;
ered, for 10–15 minutes, 5–6 times daily (Lindenmuth and and <0.1% essential oil (Bauer, 1998; Bauer and Liersch, 1993;
Lindenmuth, 2000). Leung and Foster, 1996; Pietta et al., 1998).
TINCTURE: 5 drops, 1–3 times daily 1:10 (w/v), in 65% (v/v) E. pallida root contains caffeic acid derivatives, mainly 0.7–1.0%
alcohol. For acute conditions, 5 drops every 1/2–1 hour (Bauer echinacoside, followed by isochlorogenic acid, 6–O-caffeoylechi-
and Liersch, 1993). nacoside, and chlorogenic acid; 0.2–2.0% essential oil comprised
E. purpurea, E. pallida, E. angustifolia root mainly of ketoalkynes and ketoalkenes, polyacetylenes, polysac-
DRIED ROOT: 0.9–1 g (approximately 900 mg) cut root, 3 times charides, and glycoproteins (Bauer, 1999; Bauer and Liersch,
daily. 1993; ESCOP, 1999; Pietta et al., 1998). Methyl jasmonate, a
INFUSION: 0.9 g root in 150 ml boiled water steeped for 10 min- naturally-occurring cellular signal molecule, increased content of
utes, several times daily between meals (Bauer and Liersch, 1993; alkamides and ketoalene/ynes (Binns, 2001).
Wichtl and Bisset, 1994). E. angustifolia herb contains caffeic acid derivatives such as
DECOCTION: 1 g in 150 ml water boiled for 10 minutes, 3 times cichoric acid, echinacoside, verbascoside, chlorogenic acid, and
daily (Bradley, 1992). isochlorogenic acid; flavonoids (mostly quercetin); alkamides;
polysaccharides; and less than 0.1% essential oil (Bauer, 1998;
FLUID EXTRACT: 1:1 in 45% alcohol, 0.5–1.0 ml 3 times daily Bauer and Liersch, 1993; Leung and Foster, 1996; Pietta et al.,
(Newall et al., 1996; Bradley, 1992). 1998).
TINCTURE: 1:5 (g/ml), ethanol 55% (v/v) 30–60 drops, approxi- E. angustifolia root contains caffeic acid derivatives, mainly
mately 1.5–5 ml (Bradley, 1992), three times daily (Bauer and 0.3–1.7% echinacoside, followed by chlorogenic acid; an
Liersch, 1993; ESCOP, 1999). isochlorogenic acid and its characteristic constituent, cynarin;
External polysaccharides, including 5.9% inulin; glycoproteins comprised
Crude Preparations of approximately 3% protein, of which the dominant sugars are
OINTMENT: Semisolid preparation containing at least 64–84% arabinose, 1.9–5.3% galactose, and 6% glucosamines;
15% pressed juice in a base of petroleum jelly or anhydrous 0.01–0.15% alkamides; and less than 0.1% essential oil (Bauer,
lanolin, and vegetable oil applied locally (Blumenthal et al., 1998; 1998; Bauer, 1999; Bauer and Liersch, 1993; Pietta et al., 1998).

Echinacea
Blumenthal et al., 2000).
POULTICE: Semisolid paste or plaster containing at least PHARMACOLOGICAL ACTIONS
15% pressed juice, applied locally (Blumenthal et al., 2000). Echinacea’s pharmacological activity is believed to result from the
combined effect of several of its chemical constituents, found
DURATION OF ADMINISTRATION within the different species and parts of echinacea.
Internal and External Internal
The German Commission E recommended use for no longer Human
than eight weeks (Blumenthal et al., 1998). NOTE: This duration E. angustifolia
limit has been misinterpreted as meaning that echinacea prepara- Promotes immunomodulatory activity (Melchart et al., 1994).
tions may not be safe for use for longer than eight weeks, but this
E. pallida
is not the case. This restriction was adopted by the Commission
Exhibits immunomodulatory (Melchart et al., 1994) and
Monograph
E due to its opinion that most conditions for which echinacea
preparations are to be used are usually relatively minor and tran- immunostimulant activity (Dorn et al., 1997).
sient. Therefore, if therapy with echinacea has not succeeded E. purpurea
within eight weeks, and symptoms still persist, more aggressive Demonstrates immunomodulatory (Melchart et al., 1994);
treatment is presumably needed. immunostimulant (Berg et al., 1998; Braunig et al., 1992;
Brinkeborn, 1999; Hoheisel et al., 1997; Parnham, 1996); and
CHEMISTRY antimycotic activity (Coeugniet and Kuhnast, 1986).
The constituents of echinacea preparations vary depending on
the particular species and plant part used. Animal
E. angustifolia and E. pallida
E. purpurea herb (i.e., aerial parts) and root both contain caffeic Demonstrate antitumor activity (Voaden et al., 1972) in combi-
acid derivatives (0.6–2.1% in roots), including mainly cichoric nation with Thuja occidentalis tips and Baptisia tinctoria rhizome
acid (1.2–3.1% in the flowers), caffeic acid, caftaric acid, chloro- (per oral application).
genic acid and 0.001–0.04% alkamides. E. purpurea herb also
contains water-soluble polysaccharides (arabinoxylan and ara- E. purpurea
binogalactan types); fructans; 0.48% flavonoids of quercetin and Increases phagocytosis (Bauer, 1999; Roesler et al., 1991; Wagner
kaempferol type; and 0.08–0.32% essential oil (Bauer, 1999; et al., 1988; Mose, 1983); increases serum leukocytes (Bauer,
The ABC Clinical Guide to Herbs 89
1999); stimulates granulocyte migration (Roesler et al., 1991; flower (Braun et al., 1996); ragweed (Ambrosia spp.); asters (Aster
Wildfeuer and Mayerhofer, 1994); stimulates cytokine production tataricus); and chrysanthemum (Chrysanthemum spp.)
(Bauer, 1999; Burger et al., 1997; Wagner et al., 1985); protective (Blumenthal et al., 2000). The Commission E noted that pro-
effects on influenza A-virus infection in mice (Bodinet, 1999). gressive systemic diseases such as tuberculosis, leukosis, col-
In vitro lagenosis, multiple sclerosis, Acquired Immune Deficiency
E. purpurea Syndrome (AIDS), Human Immunodeficiency Virus (HIV)
infection, and other autoimmune diseases are contraindicated
Enhances phagocytosis (Bauer, 1999); increases NO-production
(Blumenthal et al., 1998), though these cautions were made
of macrophages (Bodinet, 1999); demonstrates natural killer cell
based on theoretical considerations and not on reports of adverse
action (See et al., 1997); and enhances the cytotoxicity of
findings (Bone, 1997–98).
macrophages against tumor cells (Stimpel et al., 1984).
External
E. purpurea, E. angustifolia, E. pallida
None known (Blumenthal et al. 1998).
Enhances antibody production (IgM, number of antibody-produc-
ing cells) (Beuscher et al., 1995; Bodinet, 1999); induces cytokine PREGNANCY AND LACTATION: The Commission E found no
production (IL-1, IL-6, TNFa, IFNab) (Beuscher et al., 1995). known restrictions (Blumenthal et al., 1998). Although
consumption of most medications and herbs is contraindicated
External during the first trimester, one recent controlled trial showed no
Human evidence of increased risk for pregnant women who consumed
E. angustifolia echinacea (E. angustifolia and E. purpurea) (Gallo et al., 2000).
Promotes wound-healing for skin inflammation and abrasions
(Boon and Smith, 1999). ADVERSE EFFECTS
E. purpurea There are few reported adverse effects for internal and external
Increases total lymphocyte count with a decreased percentage of applications. Aanaphylaxis has been reported with ingestion of an
T-helper cells in patients with eczema, neurodermatitis, candida, echinacea preparation made of E. angustifolia (whole plant) and
and herpes simplex (Boon and Smith, 1999). E. purpurea root (Mullins, 1998; Mullins and Heddle, 2002). It
is possible that pollens might be present in echinacea preparations
E. purpurea, E. angustifolia, E. pallida made with aerial parts and not in those preparations containing
Protect against photodamage (Facino et al., 1995). root material only. NOTE: One source suggests that hepatotoxic
Animal effects have been reported with the persistent use of echinacea,
E. pallida and E. angustifolia causing one source to caution against the simultaneous use of
Inhibit inflammation (Speroni et al., 1998; Tubaro et al., 1987; echinacea with known hepatotoxic agents (e.g., anabolic steroids,
Tragni et al., 1985). amiodarone, methotrexate, or ketoconazole) (Miller, 1998).
However, the significance of this purported hepatotoxicity is
E. pallida questionable, since echinacea lacks the 1, 2 unsaturated necine
Demonstrates cicatrizing and vulnerary activity (Speroni et al., ring system associated with hepatotoxic pyrrolizidine alkaloids
1998). (PAs) (Roeder et al., 1984). PAs do not constitute a significant
part of echinacea chemistry, and those PAs found in echinacea
MECHANISM OF ACTION species are not of the saturated type. No known documentation
Although the mechanism of action for Echinacea spp. is not fully of hepatotoxicity is associated with ingestion of echinacea.
understood, the following are proposed:
• Binds polysaccharides to carbohydrate receptors on the cell DRUG INTERACTIONS
surface of T-cell lymphocytes and macrophages (Wagner et The Commission E stated that there are no known interactions
al., 1984; Mose et al., 1983). (Blumenthal et al., 1998). Several sources raise the issue of poten-
• Promotes tissue regeneration and reduces inflammation by tial interactions with immunosuppressive drugs (e.g.,
inhibiting hyaluronidase production (Tragni et al., 1985). cyclosporine and corticosteroids), but to date these concerns are
speculative and lack clinical documentation (Brinker, 2001).
• Generates oxidative burst and selective cytokine production
in macrophages, leading to specific toxicity to tumor cell AMERICAN HERBAL PRODUCTS ASSOCIATION
lines (Luettig et al., 1989; Stimpel et al., 1984). (AHPA) SAFETY RATING
• A combination of three polysaccharides from E. purpurea CLASS 1: Herbs that can be consumed safely when used appro-
cell cultures produced a substantial increase in the number priately (McGuffin et al., 1997).
of peripheral blood leukocytes, due to an increase in poly-
morphanuclear cells (PMNs) in mice (Roesler, 1991). REGULATORY STATUS
• Enhances phagocytosis by human neutrophils in vitro and AUSTRIA: The combination E. purpurea and E. pallida root,
in human studies (Mose, 1983; Parnham, 1996). Thuja occidentalis herb, and Baptisia tinctoria root is approved as
a nonprescription drug.
CONTRAINDICATIONS CANADA: When labeled as a Traditional Herbal Medicine (THM)
Internal or as a homeopathic drug, echinacea root (E. angustifolia, E. palli-
Individuals with an increased tendency to have allergies, especial- da, E. purpurea) is regulated as a nonprescription drug, requiring
ly allergies to members of the family Asteraceae including arnica premarket registration and assignment of a Drug Identification
(Arnica spp.) flower, chamomile (Matricaria spp.) flower, Number (DIN) (Health Canada, 1990, 1997, 2000; WHO, 1998).
marigold (Calendula officinalis L.) flower, yarrow (Achillea spp.)

90 The ABC Clinical Guide to Herbs

FRANCE: The homeopathic mother tincture of the whole fresh vent URTIs. In the Melchart (1998) study, the treatment was
plant, 1:10 (w/v) in 55% alcohol, is official in the French administered noncontinuously, which may have been a factor in
Pharmacopoeia (Ph.Fr.X) (Bauer and Liersch, 1993). the lack of positive results, although the authors attributed the
GERMANY: Approved by Commission E as a nonprescription drug results to a subject group that was smaller than desired. Grimm
(E. purpurea herb and E. pallida root) (Blumenthal et al., 1998). and Muller (1999) reported that the “treatment with fluid extract
The combination of E. purpurea and E. pallida root, Thuja occi- of Echinacea purpurea did not significantly decrease the inci-
dentalis herb, and Baptisia tinctoria root has not yet been dence, duration or severity of colds and respiratory infections
approved as a nonprescription drug. The homeopathic mother compared to placebo.”
tincture of the whole fresh plant (E. angustifolia or E. pallida) or Other trials included a study on genital herpes that found no
aerial parts (E. purpurea) and dilutions are official in the German demonstrated effect (Vonau et al., 2001). One R, PC study on
Homeopathic Pharmacopoeia (HAB, 2000). immunology in athletes, concluded that the echinacea group had
SWEDEN: Classified as a natural remedy, intended for self-medica- no URTIs compared to placebo (Berg et al., 1998). Women using
tion, requiring advance application for marketing authorization echinacea drops as an adjunct therapy in the treatment of chron-
(MPA, 2001; Tunón, 1999; WHO, 1998). A monograph for ic candidiasis showed a reduced recurrence rate (Coeugniet and
Echinagard® (Echinacin®), is published in the Medical Products Kuhnast et al., 1986). A prospective, controlled study on the safe-
Agency (MPA) “Authorised Natural Remedies” (MPA, 1997). ty of echinacea during pregnancy found no statistical difference
between the groups (Gallo et al., 2000).
SWITZERLAND: Echinacea anthroposophical, homeopathic, and
phytomedicines have positive classification (List D) by the A review of 13 R, DB, PC trials studying the treatment and pre-
Interkantonale Konstrollstelle für Heilmittel (IKS) and correspon- vention of URTIs, evaluated the effectiveness of orally ingested
ding sales category D, with sale limited to pharmacies and drug- echinacea preparations (Barrett et al., 1999). The authors con-
stores, without prescription (Morant and Ruppanner, 2001; cluded that the published trials suggest echinacea may be benefi-
Codex, 2000/01; WHO, 1998). cial for treatment, but the variation of preparations and composi-
tions (including combination products containing other botani-
U.K.: Herbal medicine in General Sale List, Schedule 1 (medici-
cals) makes recommending specific doses problematic. They
nal products requiring a full Product License), Table A (for inter-
claimed that there was little evidence supporting the prolonged
nal or external use) (Bradley, 1992).
use of echinacea for prevention of URTIs (Barrett et al., 1999). An
U.S.: Dietary supplement (USC, 1994). Homeopathic mother assessment of the methodology of 26 controlled clinical trials
tincture, 1:10 (w/v) in 55% alcohol (v/v), is a Class C over-the- concluded that the published clinical studies suggest that some
counter (OTC) drug official in the Homeopathic Pharmacopoeia preparations containing echinacea can be efficacious as
of the United States (1991), Official Compendium (1992). immunomodulators. However, the evidence is insufficient to rec-
Rhizome with roots, powdered root and powdered extract are ommend an exact dosage or specific preparation for use
subjects of botanical monographs in development for the USP- (Melchart et al., 1994). A review by Bone (1997-1998) observed
NF. Previews of the standards development were published in that despite contraindications in auto-immune diseases based on
Pharmacopeial Forum (USP, 2002). theoretical considerations (e.g., those suggested by Commission
E), current clinical use and scientific evidence do not support
CLINICAL REVIEW

Echinacea
limitations on long-term use of echinacea with particular auto-
Twenty-one studies are outlined in the following table “Clinical immune diseases. Bone suggested echinacea should be considered
Studies on Echinacea,” including a total of 3,508 participants. All an immunomodulator rather than an immunostimulant.
but three of these studies (Galea and Thacker, 1996; Melchart et
al., 1998; Vonau et al., 2001), demonstrated positive effects for BRANDED PRODUCTS*
indications including cold, flu, upper respiratory tract infections Echinacea Plus®: Traditional Medicinals®, Inc. / 4515 Ross Road
(URTIs), candidiasis, and gestational safety. Five positive ran- / Sebastopol, CA 95472 U.S.A. / Tel: (707) 823-8911 / Fax:
domized, double-blind, placebo-controlled (R, DB, PC) studies, (800) 886-4349 / www.traditionalmedicinals.com. Each tea bag
involving a total of 825 subjects, supported the use of echinacea 1,095 mg of the flowering aerial parts of E. purpurea and E.
monopreparations for the treatment (incidence, severity, and/or angustifolia, 30 mg of Echinacea purpurea extract (6:1) and flavor
duration) of acute upper respiratory or flu-like infections components lemongrass leaf and spearmint leaf.

Monograph
(Brinkeborn et al., 1998, 1999; Dorn et al., 1997; Hoheisel et al.,
Echinacin®: Madaus AG / Ostermerheimer Strausse 198 / Köln,
1997; Bräunig et al., 1992). The acute treatment was further sup-
Germany / Tel: +49-22-18-9984-76 / Fax: +49-22-18-9987-21 /
ported by six additional R, DB, PC studies using combination
Email: [email protected]. Expressed juice of the aerial parts
preparations of echinacea and other herbs (Lindenmuth and
of Echinacea purpurea, stabilized with 22% ethanol, by volume.
Lindenmuth, 2000; Henneicke-von Zepelin et al., 1999; Reitz et
al., 1990; Dorn 1989; Vorberg and Schneider, 1989; Vorberg, Echinaforce®: Bioforce AG / CH-9325 Roggwil TG/ Switzerland
1984). One R, DB, PC study on an echinacea monopreparation / Tel: +41 71 454 61 61 / Fax: +41 71 454 61 62 / E-mail:
did not find measurable benefit for treatment of URTI symp- [email protected] / www.bioforce.com. Each tablet contains 400
toms, though this may be due to the low dose and lack of severi- mg dried extract, concentrated from a hydroalcoholic mother
ty of the symptoms (Galea and Thacker, 1996). tincture (1:10) of E. purpurea herb fresh-flowering tops (380 mg)
and E. purpurea root (20 mg), plus inert excipients materials.
The prevention of URTIs was studied in a total of five R, PC
studies with a total of 1,209 subjects, focused on the use of dis- EchinaGuard®: Nature’s Way Products, Inc. / 10 Mountain Spring
tinct monopreparations (Grimm and Müller, 1999; Melchart et Parkway / Springville, Utah 84663 / U.S.A. / Tel: (801) 489-1500
al., 1998; Schöneberger, 1992) and unique combination prod- / www.naturesway.com. Expressed juice of the aerial parts of
ucts (Schmidt et al., 1990; Forth and Beuscher, 1981). Two of Echinacea purpurea, stabilized with 22% ethanol, by volume.
these studies concluded that echinacea did not significantly pre-
The ABC Clinical Guide to Herbs 91
Esberitox® (prior to 1985): Schaper and Brümmer GmbH & Co. Bräunig B, Knick E. Therapeutical experiences with Echinacea pallida for influenza-
KG / Bahnhofstrasse 35 / 38259 Salzgitter / like infections. [in German]. Naturheilpraxis 1993;1:72–5.
Bräunig B, Dorn M, Limburg E, et al. Echinacea purpurea radix for strengthening the
Ringelheim / Germany / Tel: +49-5341-30-70 / Fax: +49-5341- immune response in flu-like infections. [in German]. Z Phytother 1992;13:7–13.
30-71-24 / Email: [email protected] / Brevoort P. The booming US botanical market. HerbalGram 1998;44:33–40.
www.schaper-bruemmer.com. Ethanolic extract of 7.5 mg of Brinkeborn R, Shah D, Degenring F. Echinaforce® and other Echinacea fresh plant
extracts of E. purpurea and E. pallida root (1:1), 2 mg of Thuja preparations in the treatment of the common cold. A randomized, placebo con-
trolled, double-blind clinical trial. Phytomedicine 1999;6(1):1–6.
occidentalis herb, and 10 mg Baptisia tinctoria root and homeo- Brinkeborn R, Shah D, Geissbuhler S, Degenring F. Echinaforce® in the treatment
pathic dilutions of Apis mell. (D4), Crotalus (D6), Lachesis of acute colds: Results of a placebo-controlled, double-blind study carried out in
(D4), and Silicea (D4). Sweden. [in German] Schweizensche Z Ganz Med 1998;10(1):16-9.
Esberitox® N1 Tablets (1985 formulation based on Esberitox®): Brinker F. Herb Contraindications and Drug Interactions, 3rd ed. Sandy, OR: Eclectic
Medical Publications; 2001:84–5.
Schaper and Brümmer GmbH & Co. KG. 7.5 mg of extracts of Bruneton J. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier
E. purpurea and E. pallida root (1:1), 2 mg of Thuja occidentalis Publishing; 1995:151.
herb, and 10 mg Baptisia tinctoria. Burger R, Torres A, Warren R, et al. Echinacea-induced cytokine production by
human macrophages. Int J Immunopharmacol 1997;19(7):371–9.
Esberitox® N2 Tablets (1990 formulation based on Esberitox® Codex 2000/01. (Monographs): Floraceae Echinacea Kautabletten und Saft; Echinacin
N1): Schaper and Brümmer GmbH & Co. KG. 7.5 mg of E. Salbe; Echinaforce Tabletten und Tropfen; Echinamed Tabletten; Similasan
purpurea and E. pallida root (1:1), 2 mg of Thuja occidentalis Echinacea Homöopathische Globuli; Wala Echinacea Anthroposophisches
herb, and 10 mg Baptisia tinctoria root. Subsequently changed Mundspray; Esberitox N Tabletten. Schönbühl, Switzerland: Galenical
sources of echinacea. Informations Systems; 2000.
Coeugniet E. Kühnast R. Recurrent candidiasis: adjutant immunotherapy with dif-
Resistan®: TRUW Arzneimittel Vertriebs GmbH / Ziethenstrasse ferent formulations of Echinacin®. Therapiewoche 1986;36:3352–8.
8 / 33330 Gutersloh / Germany / Tel: +49-52-41-3007-40 / Dorn M, Knick E, Lewith G. Placebo-controlled, double-blind study of Echinacea
www.truw.de. Each 100 mg of Resistan® contains: 12 g Echinacea pallida radix in upper respiratory tract infections. Complement Ther Med
1997;5:40–2.
angustifolia; 2.9 g Eupatorium perfoliatum; 2 g Baptista tinctoria; Dorn, M. Mitigation of flu-like effects by means of a plant immunostimulant. Natur
2 g Arnica montana D2. Contains 13 vol. percent. (NOTE: this und Ganzheitsmedizin 1989;2:314–9.
product is being reformulated and may change names.) ESCOP. Echinacea—Proposal for the Summary of Product Characteristics.
Monographs on the Medicinal Uses of Plant Drugs. Exeter, U.K.: European Scientific
* American equivalents, if any, are found in the Product Table Cooperative on Phytotherapy; 1999.
beginning on page 398. Facino R, Carini M, Aldini G, et al. Echinacoside and caffeoyl conjugates protect col-
lagen from free radical-induced degradation: a potential use of Echinacea extracts
in the prevention of skin photo damage. Planta Med 1995;61(6):510–4.
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Beuscher N, Bodinet C, Willigmann I, Egert D. Immune-stimulating effect of sever-
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Binns SE, Livesey JF, Arnason JT, Baum BR. Phytochemical variation in echinacea
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Wustenberg P. Efficacy and safety of a fixed combination phytomedicine in the
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randomized, double blind, placebo controlled, multicenter study. Curr Med Res
Bodinet K. Immune-pharmacological assessment of a plant derived immune-stimula-
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Hobbs C. Echinacea: A Literature Review. HerbalGram 1994;30:33–48.
Bone K. Echinacea: When should it be used? Eur J Herb Med 1997–1998;3(3):13–7.
Hoheisel O, Sandberg M, Bertram S, et al. Echinagard® treatment shortens the
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Homopathisches Arzneibuch. Echinacea. In: HAB 2000. Stuttgart, Germany: Medicine. New York: Springer-Verlag; 1997:259–60, 273–8.
Deutscher Apotheker Verlag; 2000. See D, Berman S, Justis J, et al. A Phase I study on the safety of Echinacea angustifo-
HPUS. See: Homeopathic Pharmacopoeia of the United States. lia and its effect on viral load in HIV infected individuals. JAMA 1998;1(1):14–7.
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Association Botanical Safety Handbook. Boca Raton, FL: CRC Press; 1997. Stoll A, Renz J, Brack A. Antibacterial substances II. Isolation and constitution of
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Sweden: Medical Products Agency; 1997. anti–inflammatory action of a natural extract, Echinacea B. Food Chem Toxicol
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(ed.). Immunomodulatory agents from plants. Basel; Boston; Berlin: Birkhäuser Wagner H, Proksch A, Riess-Maurer I, et al. Immunostimulant action of polysaccha-
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The ABC Clinical Guide to Herbs 93

Clinical Studies on Echinacea (Echinacea spp.)
Cold/Flu/Upper Respiratory Tract Infection (URTI) Treatment
Author/Year Subject Design Duration Dosage Preparation Results/Conclusion
Brinkeborn et URTI R, DB, PC 7 days 2 tablets, Echinaforce® Relative reduction in complaint index for 12 symptoms
al., 1999 symptoms (4 arm) from the start 3x/day concentrate, in the 4 groups differed significantly (p=0.015).
n=246 of acute URTI special E. pur- Echinacea patients reductions in complaint index were
subjects with (1–2 days of purea root significantly higher than in the placebo group (p=0.003
colds symptoms) preparation and p=0.020). Echinacea was concluded to be a low-
risk, effective alternative for symptomatic acute treat-
ment of the common cold.

Brinkeborn et URTI R, DB, PC 8 days Two, 400 mg Echinaforce® Based on 12 symptoms, the "overall clinical picture" for
al., 1998 symptoms n=119 from the start tablets 3x/day tablet the intention-to-treat was reduced in the treatment
of acute URTI group from 9.0 to 4.1 (p=0.045), while the placebo
(1–2 days of group decreased from 8.8 to 5.3. Echinacea was con-
symptoms) cluded to be a low-risk, effective alternative for sympto-
matic acute treatment of the common cold.

Dorn et al., URTI R, DB, PC 8–10 days 45 drops Brand not The length of the illness decreased from 13 to 9.8 days
1997 symptoms n=160 from onset of extract 2x/day stated (bacterial infections) and to 9.1 days (viral infections)
(ages >18 flu-like (equivalent to compared to placebo (p=0.0001).The infection type was
years) respiratory 900 mg/day) determined by lymphocyte and neutrophil counts in the
symptoms blood. Echinacea appears to shorten the duration of
URTIs.

Hoheisel et URTI R, DB, PC 10 days from 20 drops, Echinaguard® Of the echinacea group, 40% developed a “real cold”
al., 1997 symptoms n=120 the first sign every 2 hours extract compared to 60% in the placebo group (p=0.044), while
with at least 3 of URTI, on day 1, in 4 days symptoms improved for echinacea group com-
infections in before full 20 drops, pared to 8 days for the placebo group. Echinacea
the past 6 development 3x/day showed more rapid recovery in the intention-to-treat
months thereafter population (p<0.0001).

Galea and URTI R, DB, PC, P From the first 250 mg E. angustifolia 8 symptoms were assessed and no measurable benefits
Thacker, 1996 symptoms n=190 sign of URTI capsule root dried were reported, attributed to the relatively low dose and
through 10 (brand not lack of severity of the symptoms being measured.
days stated)

Bräunig et al., Flu-like R, DB, PC From onset of 90 drops E. purpurea Echinacea patients receiving 180 drops (900 mg) dose
1992 symptoms n=180 flu-like respi- (450 mg)/day root extract displayed statistically significant improvement (p<0.05)
one group of ratory symp- or (1:5, 55% compared with placebo group in relieving symptoms
60 per toms until 180 drops ethanol) and decreasing the duration of symptoms.The study
preparation symptoms (900 mg)/day (brand not suggests that dosage influences effectiveness.
subsided stated)

Combination Preparations (Treatment)

Author/Year Subject Design Duration Dosage Preparation Results/Conclusion

Lindenmuth Cold, flu-like, R, DB, PC From first sign 5–6 cups tea Echinacea Based on questionnaire on effectiveness of echinacea,
and URTI n=95 of flu-like first day of Plus® tea vs. duration of symptoms, and time taken for subjects to
Lindenmuth, symptoms with early symptoms symptoms and Traditional notice any changes in symptoms, echinacea group was
2000 symptoms of through 6 titrating down Medicinals shown to be statistically significant in effectiveness
cold or flu, days 1 cup of Eater’s (p<0.001); duration (p<0.001); and in noticeable change
primarily tea/day for Digest® in symptoms (p<0.001). Authors concluded that treat-
females next 5 days herbal tea ment with echinacea compound tea, given at early onset
(mean age (equivalent of (placebo) of symptoms was effective in relieving cold or flu symp-
39.7 years) 1,275 mg toms in noticeably fewer days compared to placebo.
dried herb
and root per
tea bag
serving)

Henneicke- Common cold R, DB, PC, MC 7–9 days once 3 tablets Esberitox® The echinacea combination product was significantly
von Zepelin et (acute viral (15 centers) identified as 3x/day N2 tablet vs. better than placebo (p=0.0497), with highly statistically
al., 1999 URTI) n=238 having a com- placebo significant results in overall well-being (p=0.0048), rhini-
patients (ages mon cold tis, and bronchitis scores.This study suggests this is a
18–70 years) safe and effective treatment and notes the greatest ben-
efits would be experienced if treatment is started as
soon as possible after onset of the cold.

KEY: C – controlled, CC – case-control, CH – cohort, CI – confidence interval, Cm – comparison, CO – crossover, CS – cross-sectional, DB – double-blind, E – epidemiological, LC – longitudinal
cohort, MA – meta-analysis, MC – multi-center, n – number of patients, O – open, OB – observational, OL – open label, OR – odds ratio, P – prospective, PB – patient-blind, PC – placebo-controlled,
PG – parallel group, PS – pilot study, R – randomized, RC – reference-controlled, RCS – retrospective cross-sectional, RS - retrospective, S – surveillance, SB – single-blind, SC – single-center,
U – uncontrolled, UP – unpublished, VC – vehicle-controlled.

94 The ABC Clinical Guide to Herbs

Clinical Studies on Echinacea (Echinacea spp.) (cont.)

Combination Preparations (Treatment) (cont.)

Author/Year Subject Design Duration Dosage Preparation Results/Conclusion

Reitz,1990 URTI R, DB, PC 8 weeks One, 22.5 mg Esberitox® Majority of symptoms and signs at 7 and 14 days were
symptoms n=150 initially, with tablet 3x/day N1 tablet vs. significantly better than placebo; nasal symptoms were
and signs monitoring or placebo placebo most affected. No difference in result from blood work
for an addi- (vitamin C) was reported.
tional year

Dorn, 1989 URTI R, DB, PC From 2 days Day 1–2: Resistan® vs. Echinacea patients experienced a decrease in the length
symptoms n=100 of URTI onset 30 ml/day placebo of illness and severity in 7 of 7 self-assessed symptoms
and signs Day 3–6: compared to 4 of 7 in placebo group (p=0.001).The
15 ml/day study suggests that taking the preparation as soon as
symptoms first appear shortens duration of URTI.

Vorberg and URTI R, DB, PC 10 days 15–30 ml/day Resistan® vs. Most symptoms were significantly better in the echi-
Schneider, symptoms n=100 beginning 2 placebo nacea group compared to placebo at both 2 to 3 days
1989 and signs days after and at 8 to 10 days.The results indicate echinacea has
onset of URTI efficacy for the prevention and treatment of URTIs.

Vorberg, 1984 URTI R, DB, PC 10 days 15 mg tablet Esberitox® Echinacea group reported significant superiority com-
symptoms n=100 3x/day tablet vs. pared to placebo group in all examined parameters of
and signs in placebo common cold (p<0.001) including fatigue, reduced
patients suf- performance, runny nose, and sore throat.
fering from
common cold

Cold/Flu/URTI Prevention
Author/Year Subject Design Duration Dosage Preparation Results/Conclusion
Grimm and URTI R, PC 2 months 4 ml E. purpurea During 8-week treatment period, 35 (65%) of 54
Müller, 1999 occurrence n=108 expressed fluid patients in echinacea group and 40 (74%) of 54 patients
with history juice 2x/day (expressed in placebo group had at least one cold or respiratory
of 3 colds or juice of aerial infection (relative risk [RR]=0.88; 95% confidence inter-
respiratory parts, brand val [CI] [0.60, 1.22]). Average number of colds and res-
infections in not stated, piratory infections per patient was 0.78 in echinacea
the preceding though test group, and 0.93 in placebo group (difference=0.15; 95%
year material was CI [-0.12, 0.41], p=0.33). Median duration of colds and
(mean age provided by respiratory infections was 4.5 days in echinacea group
echinacea Madaus AG and 6.5 days in placebo group (95% CI [-1, +3 days];
group 42 and it presum- p=0.45). There were no significant differences between

Echinacea
years; mean ably is treatment groups in number of, duration, or severity of
age placebo Echinacin®) colds. Side effects were observed in 11 patients (20%)
group 38 of echinacea group and in 7 patients (13%) of placebo
years) group (p=0.44).

Melchart et URTI R, DB, PC 12 weeks 50 drops E. angustifolia Participants in treatment group believed they had more
al., 1998 occurrence n=289 (M-F only) E. angustifolia and E. pur- benefit than placebo group (p=0.04). URTIs (at least
(ages 18–65 2x/day purea roots one) were experienced by 32%, 29%, and 37% of E.
years) or 50 drops extracts (1:11 angustifolia, E. purpurea, and placebo groups respectively,
E. purpurea in 30% and onset was at 66, 69, and 65 days, respectively, with
2x/day ethanol) no significant differences in duration, incidence, or
or placebo (brand not severity of URTIs. Noncontinuous administration of
stated) treatment was not addressed in the conclusion.

Monograph
Schöneberger, URTI R, DB, PC, MC 2 months 4 ml 2x/day Echinacin® Echinacea group experienced decreased in URTI inci-
1992 occurrence n=108 dence in 35% (vs. 26%), decrease in duration of 5.34
patients with days (vs. 7.54 days), increase in interval between infec-
increased sus- tions of 40 days (vs. 25 days), and decreased severity of
ceptibility to symptoms calculated as 78% (vs. 68%) compared with
colds (suffered placebo. Patients with weakened defense (calculated as
at least 3 a T4/T8-ratio of less than 1.5) benefited most.
colds in previ-
ous year)
(ages 13–84
years)

KEY: C – controlled, CC – case-control, CH – cohort, CI – confidence interval, Cm – comparison, CO – crossover, CS – cross-sectional, DB – double-blind, E – epidemiological, LC – longitudinal
cohort, MA – meta-analysis, MC – multi-center, n – number of patients, O – open, OB – observational, OL – open label, OR – odds ratio, P – prospective, PB – patient-blind, PC – placebo-controlled,
PG – parallel group, PS – pilot study, R – randomized, RC – reference-controlled, RCS – retrospective cross-sectional, RS - retrospective, S – surveillance, SB – single-blind, SC – single-center,
U – uncontrolled, UP – unpublished, VC – vehicle-controlled.

The ABC Clinical Guide to Herbs 95

Clinical Studies on Echinacea (Echinacea spp.) (cont.)

Combination Preparations (Prevention)

Author/Year Subject Design Duration Dosage Preparation Results/Conclusion
Schmidt et al., URTI R, DB, PC 2 months 12 ml/day Resistan® vs. Echinacea patients experienced 15% fewer primary
1990 occurrence n=609 placebo infections, and relapses decreased by 27%, or relative
college risk reduction of 12%. Due to potential immuno-
students stimulant activity of other botanicals, the results could
not be attributed to echinacea alone.

Forth and URTI R, PC 16 weeks 25 drops Esberitox® Patients had relative risk reduction of 49% overall, even
Beuscher, occurrence (not fully (November 3x/day though no apparent difference for other 7 symptoms
1981 double-blind) through or 1 mg tablet was observed in all groups compared to placebo.
n=95 February) or placebo However, improvement of nasal symptoms was
significant.

Other
Author/Year Subject Design Duration Dosage Preparation Results/Conclusion
Vonau et al., Effect on SC, P, DB, PC, 1 year 800 mg 2x/day Echinaforce® No statistically significant benefit was shown for use of
2001 clinical course CO (6 months tablet echinacea to treat frequently recurring genital herpes.
of genital n=50 placebo, 6
herpes (mean age months
36.5 years) echinacea)

Gallo et al., Safety of P, C Until birth or Range of Primarily E. Of 206 subjects who used echinacea during pregnancy,
2000 gestational n=206 termination of 250–1,000 angustifolia there were 195 live births, 13 spontaneous abortions,
exposure to patients who the pregnancy mg/day cap- and E. pur- and one therapeutic abortion, compared to the control
echinacea used n=112 sule or tablets purea; only group giving 198 live births, 7 spontaneous abortions,
echinacea (echinacea taken by 114 one reported and 1 therapeutic abortion.These results indicated no
during used during females using E. pallida statistical differences between the 2 groups in terms of
pregnancy first or range of (brand not pregnancy outcome, delivery method, maternal weight
trimester) 5–10 to 30 stated) gain, gestational age, birth weight, or fetal distress. Rates
drops of major malformation between study and control
maximum/day groups were not statistically different.
taken by 76
females con-
tinuously for
5–7 days

Berg et al., Exercise- R, PC, PG 28 days (prior 40 drops Echinacin® Echinacea facilitated IL-6 release and reduced SIL-2R
1998 induced n=42 to triathlon) 3x/day release in serum and urine, significantly increased serum
immunological male athletes, (8 ml/day) cortisol (one hour after the event), and may exert slight
effects 3 groups (n=14) effects on natural killer cells and T-cells. Echinacea group
(mean age or magnesium did not report any URTIs compared to 7 total from 2
27.5 years) (n=13) or other groups, along with 6 reporting other infections.
placebo
(n=13)

Coeugniet and Chronic OL, Cm 10 weeks 30 drops Echinacin® Use of echinacea as adjunct therapy reduced recurrence
Kuhnast, 1986 candidiasis in (5-arm) 3x/day with and econazole rate 5–16% compared to women using only cream,
females n=203 cream for nitrate cream who experienced a recurrence rate of 60.5%.
6 days (n=60) (antimycotic
or cream treatment)
alone (6 days
only) (n=43)

KEY: C – controlled, CC – case-control, CH – cohort, CI – confidence interval, Cm – comparison, CO – crossover, CS – cross-sectional, DB – double-blind, E – epidemiological, LC – longitudinal
cohort, MA – meta-analysis, MC – multi-center, n – number of patients, O – open, OB – observational, OL – open label, OR – odds ratio, P – prospective, PB – patient-blind, PC – placebo-controlled,
PG – parallel group, PS – pilot study, R – randomized, RC – reference-controlled, RCS – retrospective cross-sectional, RS - retrospective, S – surveillance, SB – single-blind, SC – single-center,
U – uncontrolled, UP – unpublished, VC – vehicle-controlled.

96 The ABC Clinical Guide to Herbs