Echinacea Side Effects, Interactions and Warnings

Echinacea Side Effects, Interactions and Warnings

  • There is some possibility that pharmaceuticals containing Echinacea purpurea might influence fetal development in humans also, because they may interfere with embrional angiogenesis, and should not be recommended for pregnant women.

    – Folia Histochem Cytobiol. 2007;45 Suppl 1:S35-9. — Influence of Echinacea purpurea intake during pregnancy on fetal growth and tissue angiogenic activity. — Barcz E, Sommer E, Nartowska J, Balan B, Chorostowska-Wynimko J, Skopinska-Rózewska E.

  • Five cases of adverse reactions to echinacea were personally evaluated by the authors. Two patients suffered anaphylaxis and a third had an acute asthma attack 10 minutes after their first ever dose of echinacea. The fourth patient suffered recurrent episodes of mild asthma each time echinacea was ingested, and the fifth developed a maculopapular rash within 2 days of ingestion which recurred when rechallenged. Three of the patients had positive SPT results. Three reported repeated spontaneous “challenges” and symptoms after further ingestion of echinacea. Fifty-one Australian adverse drug reports implicating echinacea were also reviewed. There were 26 cases suggestive of possible immunoglobulin E-mediated hypersensitivity (4 anaphylaxis, 12 acute asthma, 10 urticaria/angioedema).
    – Ann Allergy Asthma Immunol. 2002 Jan;88(1):42-51.

  • If used beyond 8 weeks, Echinacea could cause hepatotoxicity and therefore should not be used with other known hepatoxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole.
    – Arch Intern Med 1998 Nov 9;158(20):2200-11 — Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. — Miller LG.

  • People are more likely to experience allergic reactions to echinacea if they are allergic to related plants in the daisy family, which includes ragweed, chrysanthemums, marigolds, and daisies. Also, people with asthma or atopy (a genetic tendency toward allergic reactions) may be more likely to have an allergic reaction when taking echinacea.

  • Incidences of hepatotoxicity and nephrotoxicity may be augmented by acetaminophen when concomitantly used with the potentially hepatotoxic herbs Echinacea and kava kava, and with herbs containing salicylate (willow, meadowsweet), respectively.
    – J Clin Pharm Ther 2002 Dec;27(6):391-401 — Herbal medication: potential for adverse interactions with analgesic drugs. — Abebe W.

  • There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines used in pregnancy and lactation. This study tried to systematically review the literature for evidence on the use, safety, and pharmacology of echinacea focusing on issues pertaining to pregnancy and lactation. They concluded that there is good scientific evidence from a prospective cohort study that oral consumption of echinacea during the first trimester does not increase the risk for major malformations. Low-level evidence based on expert opinion shows that oral consumption of echinacea in recommended doses is safe for use during pregnancy and lactation. Echinacea is non-teratogenic (A non-teratogenic agent is one which does not cause birth defects) when used during pregnancy. Caution with using Echinacea during lactation is recommended until further high quality human studies can determine its safety.

    – Can J Clin Pharmacol. 2006 Fall;13(3):e262-7. Epub 2006 Nov 3. — Safety and efficacy of echinacea (Echinacea angustafolia, e. purpurea and e. pallida) during pregnancy and lactation. — Perri D, Dugoua JJ, Mills E, Koren G.

  • Currently there are no verifiable reports of drug-herb interactions with any echinacea product. However, further pharmacokinetic testing is necessary before conclusive statements can be made about echinacea drug-herb interactions.
    – Mol Nutr Food Res. 2008 Jul;52(7):789-98. — A critical evaluation of drug interactions with Echinacea spp. — Freeman C, Spelman K.

last update: February 2014

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