Echinacea (E purpurea, E angustifolia, E pallida)
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Introduction
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.
- rheumatism
- migraine
- pain
- wounds
- skin conditions
- rattlesnake bites
- infections
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:
- treatment & prevention of cold & flu (influenza)*
- supportive treatment of recurrent 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
- patients on immunosuppressive therapy
- autoimmune disease
- pregnancy (safety NOT demonstrated)
Dosage
- 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
- dried root as tea: 1-2 g/day
- freeze-dried plant: 325-650 mg TID
- tincture (1:5): 3-4 mL TID
- fluid extract (1:1): 1-3 mL TID
- duration of therapy < 8 weeks; <= 10 days[15]
- discontinue >= 2 weeks before surgery[15]
- juice is prepared from the leaves & flowers
- Herbal preparations from the roots of E purpurae & E angustifolia are also sold
Pharmacokinetics
- may induce cyt P450
Adverse effects
- no reported toxicity
- hypersensitivity reactions
- rash
- pruritus
- dizziness, vertigo[5]
- dysgeusia (unpleasant taste)[16]
- dyspepsia[16]
- diarrhea[16]
- no data of chronic effects
- due to immunostimulatory properties, it is not recommended for patients with autoimmune disorders
- no data on safety during pregnancy
- tachyphylaxis make occur with administration for more than 8 weeks
- hepatotoxicity may occur with administration for more than 8 weeks
- long term use may suppress immunity; not recommended for patients with HIV infection
Drug interactions
- none known
- should not be taken in combination with hepatotoxic agents
- immunosuppressive agents[5]
Mechanism of action
- active ingredients:
- polysaccharides
- flavonoids
- caffeic acid derivatives
- echinacosides
- essential oils
- pyrrolizidine alkaloids
- in vitro stimulating of phagocytic activity of human neutrophils by fat-soluble components
- Echinacea polysaccharides bind to T-lymphocyte receptor
- in vitro release of IL-1, TNF, interferon
- Echinacea polysaccharides, fat soluble components & caffeic acid derivatives stimulate monocytes
- caffeic acid derivative & echinacosides have antibacterial activity
- in vitro inhibition of influenza, herpes virus & vesicular stomatitis virus
More general terms
Component of
References
- ↑ Victoria Rand, UCSF Fresno Lecture, 10/7/98
- ↑ Melchart et al, Phytomedicine, 1994
- ↑ Kaiser Permanente, Northern California Regional Pharmacy & Therapeutics Committee
- ↑ Kaiser Permanente, Northern California, Drug Bulletin, Sept-Oct, 2000
- ↑ Jump up to: 5.0 5.1 5.2 5.3 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 - ↑ Prescriber's Letter 10(2):12 2003
- ↑ Jump up to: 7.0 7.1 Journal Watch 23(4):35, 2003 Barrett BP et al, Ann Intern Med 137:939, 2002
- ↑ Jump up to: 8.0 8.1 Prescriber's Letter 11(1):1 2004
- ↑ Jump up to: 9.0 9.1 Journal Watch 24(2):19, 2004 Taylor JA et al, JAMA 290:2824, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14657066
- ↑ Jump up to: 10.0 10.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15156472
- ↑ Echinacea Not Effective in Treating Children's Colds http://nccam.nih.gov/health/alerts/echinacea/index.htm
- ↑ Jump up to: 12.0 12.1 Prescriber's Letter 12(9): 2005 Echinacea for the Common Cold Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210911&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Jump up to: 13.0 13.1 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: https://www.ncbi.nlm.nih.gov/pubmed/16049208
Sampson W. Studying herbal remedies. N Engl J Med. 2005 Jul 28;353(4):337-9. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16049207 - ↑ Jump up to: 14.0 14.1 14.2 Barrett B et al. Echinacea for treating the common cold: A randomized trial. Ann Intern Med 2010 Dec 21; 153:769. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21173411 <Internet> http://www.annals.org/content/153/12/769.long
- ↑ Jump up to: 15.0 15.1 15.2 15.3 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Jump up to: 16.0 16.1 16.2 16.3 16.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.