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Clinical use of echinacea

Robert B Saper, MD, MPH
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Echinacea species are commonly referred to as coneflowers, a group of native American wildflowers from the daisy family (Asteraceae/Compositae) (picture 1) [1]. Echinacea is indigenous to North America and was used by Native Americans in the Great Plains. Samples of echinacea have been found in archeological digs from the 1600s, thought to be the location of Lakota Sioux Indian village sites [2]. Native Americans were noted to use echinacea both topically and systemically for ailments such as burns, snakebites, pain, cough, and sore throat [3].

Various echinacea species including Echinacea purpurea, E. angustifolia, and E. pallida have been touted as "immune stimulants" by a number of investigators [4]. Medicinal preparations of root and above-ground parts of echinacea species have been the subject of in vitro, animal, and human studies to evaluate their possible mechanism(s), safety, and efficacy.

At present, echinacea is used by individuals mainly with the intention of treating or preventing uncomplicated upper respiratory tract infections (URI) such as the common cold [5]. Sales of echinacea in the United States in 2008 were estimated to be $15.1 million, a 4.5 percent increase from 2007 [6]. The National Health Interview Survey found that echinacea use decreased by about one-half from 2007 to 2012. Echinacea was the sixth most common non-vitamin, non-mineral supplement used by adults in the United States in 2012, used by 2.3 million adults [7]. Similarly, echinacea use by children fell from the most commonly used herbal product in 2007 to the fourth most common in 2012 [7]. (See "Overview of herbal medicine and dietary supplements" and "The common cold in adults: Treatment and prevention".)


Echinacea products contain a variety of bioactive ingredients including echinacosides, caffeic acids, alkylamides, polysaccharides, and glycoproteins [8]. Though several echinacea products are standardized to the amount of echinacosides, there is no general consensus on the active component(s) of echinacea responsible for its purported medicinal properties.

In vitro, echinacea causes macrophage activation and the release of tumor necrosis factor, interleukin 1, interleukin 6, and interferon [9-11]. Echinacea has been noted to have antiviral activity against influenza [12], herpes [13], and poliovirus. Phenolic compounds present in echinacea demonstrate antioxidant activity [14]. It has also been reported to have antiinflammatory activity through inhibition of lipoxygenase and cyclooxygenase [15] and is able to stimulate the anterior pituitary-adrenal cortex.

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Literature review current through: Nov 2017. | This topic last updated: Nov 22, 2016.
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