Since we are now into the cold and flu season, it is a good time to provide a description of Echinacea, an herbal medication that might be beneficial for some people.  

Plant source:  There are three species of Echinacea used in phytomedicine.  Echinacea angustifolia and E. pallida come from the fresh or dried roots, and E. purpurea is derived from the fresh or dried above the ground parts harvested at blooming.  E. purpurea is the main type used today in the United States.  It is also referred to as purple coneflower because of the plant’s appearance.  

Modern uses:  It is important to know that echinacea is considered a dietary supplement in the United States, meaning that it is not regulated by the strict standards of the Food and Drug Administration (FDA).  There have been numerous studies conducted on the use of echinacea, most of them conducted in Germany.  There is debate about whether echinacea is effective for its many uses due to the variability of data.  Many studies have concluded that it is useful but it has been said that some of them are weak studies (meaning that they were not designed or controlled well enough to prove anything).  There have also been some studies that conclude that echinacea doesn’t actually work, but as data is increasing and more studies are being conducted, the trend is heading toward showing that echinacea does have a positive influence on the immune system.  

Echinacea is commonly used orally for treating or preventing colds and other respiratory infections (e.g. reducing the duration and severity).  People also use it as an antiseptic, antiviral (e.g. influenza, herpes), immune stimulant, for urinary tract infections, yeast infections, prostatitis, and other infections.  It is also used topically (externally) for skin wounds, chronic skin ulcers, psoriasis, and herpes simplex.  Echinacea has been shown to exert its effects by stimulating various parts of the human body’s own immune system.  It is said to have antibacterial, antiviral, and anti-inflammatory properties, among others.  The plant’s activity seems to come from the combination of ingredients in it.  There has not been one single compound isolated that has been shown to be solely responsible for echinacea’s actions.  

Contraindications:  Echinacea should not be used by people that are allergic to daisy-like plants of the Asteraceae family (e.g. ragweed, chrysanthemums, marigolds).  It is not recommended for use during pregnancy or by people that have autoimmune diseases, or that are on immunosuppressive medications.  It should also be avoided by people with progressive systemic diseases such as tuberculosis or multiple sclerosis.  

Side effects:  Although echinacea is not tested by the FDA and approved as safe and effective, it has been shown in many studies that it is usually safe.  Side effects are rare  when it is used externally and internally except when the patient is allergic to echinacea and other plants of the Asteraceae family.  Nausea and other mild GI effects have been noted in some clinical trials.  
 

Dose:  There are different forms of echinacea available over-the-counter.  Echinacea comes in tablets and capsules of the dried root/herb, and as a liquid hydroalcoholic extract.  Because of the variability of data in studies that have been conducted with echinacea and the variability in extraction methods, there is no definitive dose recommended.  When referring to Echinacea purpurea some propose that, unless otherwise recommended, people should use an internal daily dosage of 6-9 ml of expressed juice, 1 gram three times a day of the dried root/herb, or 15-30 drops 2-5 times daily of the hydroalcoholic solution.  It is important to follow the manufacturers instructions that are provided on the label of the product.
External semi-solid preparations should contain at least 15% pressed juice to use on the skin.  

Helpful hints:

• Echinacea should only be used for a maximum of 8 consecutive weeks and then wait a month before starting again.
• If the echinacea extract is used and it doesn’t tingle when the drops are placed in the mouth, then it is decomposed (not fresh) and will probably not be effective.
• Echinacea should be started immediately after flu or cold symptoms appear.  It might be effective to take it regularly to prevent colds but there is a lack of definitive data when it comes to prevention.
• There are various combination products that contain echinacea.  One that is logical is the combination of echinacea and vitamin C.  These are both used to fight the common cold and other infections and are both drugs that are reported to be safe.
• The combination of echinacea and goldenseal should be avoided.  Goldenseal is another herbal medication that might be useful in topical infections, but there is little evidence that supports its use for cold and flu.  It also contains substances that could be harmful to people with high blood pressure and possibly other heart problems.  Also, the active substances in goldenseal are poorly absorbed when taken orally.