Echinacea, efficacy

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

There are several botanicals that have purported immunostimulating effects. These include Panax ginseng and Echinacea purpurea (74), which have both been used as an immune stimulant. Any potential adverse effect on the pharmacological activity of immunosuppressants has not been reported in patients or evaluated in clinical studies. Given the lack of data, it would be prudent to advise against concurrent intake of these botanicals, and closely monitor changes in efficacy in patients who self-administer these botanicals. 

Lindenmuth GF, Lindenmuth EB. The efficacy of Echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms a randomized, double-blind placebo-controlled study. J Altern Complement Med 2000 6(4) 327-334. 

Two recent reviews have assessed the efficacy of echinacea for this primary indication. A review by the Cochrane Collaboration involved 16 randomized trials with 22 comparisons. Trials were included if they involved monopreparations of echinacea for cold treatment or prevention. Prevention trials involving rhinovirus inoculation versus natural cold development were excluded. Overall, the review concluded that there was some evidence of efficacy for the aerial (above ground) parts of E purpurea plants in the early treatment of colds but that efficacy for prevention and for other species of echinacea was not clearly shown. Among the placebo-controlled comparisons for cold treatment, echinacea was superior in nine trials, showed a positive trend in one trial, and was insignificant in six trials. 

Turner et al. (2005) evaluated the efficacy of Echinacea angustifolia in experimental rhinovirus infections. The results of this study indicate that extracts of E. angustifolia root, either alone or in combination, did not have clinically significant effects on the infection or on the clinical illness that results from it. Be that as it may, many believe in echinacea and used it routinely to avert the common cold. 

Wiistenberg, P., Kohler, G., and Stammwitz, U. 1999. Efficacy and mode of action of an immunomodulator herbal preparation containing Echinacea, wild indigo, white cedar. Adv. Ther. 16, 51-70. 

Echinacea species (coneflower, black Sampson hedgehog, Indian head, snakeroot, red sunflower, scurvy root) have become increasingly popular, particularly for the prophylaxis and treatment and prevention of cold and flu symptoms. However, the claimed efficacy of Echinacea in the common cold has not been confirmed in a randomized, double-blind, placebo-controlled trial (20) or a systematic review (21). Echinacea is claimed to have antiseptic and antiviral properties and is under investigation for its immunostimulant action. The active ingredients are glycosides (echinacoside), polysaccharides, alkamides, and flavonoids. 

The focus of Echinacea research most recently has been for the treatment and prevention of URIs of varying causes. There are a number of studies using Echinacea products in the treatment of URI. Many of these show positive results with reduction of symptoms and duration of URI. Studies evaluating the preventative role of Echinacea in URI have shown less impressive results. A few reasons for the differences in efficacy may have to do with the quality of the Echinacea used in the study and study design. The treatment studies demonstrating effectiveness tend to start treatment early in the course of a URI (9). 

Phase III trials K23 Bruce Barrett/ University of Wisconsin Test the efficacy of echinacea as early treatment for upper respiratory infection explore dose dependency, compare specific preparations, investigate mechanisms of action... 

Some of the most popular nutraceutical products marketed today are botanicals such as St. John s wort, echinacea, ginkgo biloba, saw palmetto, and ginseng. Unfortunately, manufacturers are not required to prove their safety or efficacy before marketing them. Dosages are not standardized. The quality of the raw source and the plant parts used are not regulated. And, unlike prescription drugs or over-the-counter medicines, there is no federal quality... 

The use of botanical or herbal medications has increased markedly in the past decade. Popular botanical products in the USA include echinacea, garlic, ginseng, gingko, Ma-huang, psyllium, St. John s wort, and saw palmetto. These natural medicinals are available without prescription and, unlike over-the-counter medications, are considered to be nutritional supplements rather than drugs. As such, these substances are marketed without FDA review of efficacy or safety and there are no mandated require-... 

Erhst E The risk-benefit profile of commonly used herbal therapies ginkgo, St. John s Wort, ginseng, echinacea, saw palmetto, and kava. Ann Intern Med 2002 136 42-53. [PMID 11777363] (A detailed analysis of the available scientific evidence on six popular herbal products, including information on efficacy, dosage, and safety.)... 

Perri, D., J.J. Ehigoua, E. Mills, and G. Keren. 2006. Safety and efficacy of echinacea (Echinacea angustifolia, E. purpurea and E. pallida) during pregnancy and lactation. Can. J. Clin. Pharmacol. 13(3) e262-e267. 

Taylor, J. A., W. Weber, L. Standish, et al 2003. Efficacy and safety of echinacea in treating upper respiratory tract infections in children A randomized controlled trial. /. Am. Med. Assoc. 290(21) 2824-2830. 

Scaglione F, Lund B (1996) Efficacy in the treatment of the common cold of a preparation containing an Echinacea extract. Int J Immunotherapy 11 163-166... 

The purple coneflower (Genus Echinacea), indigenous only to North America, was widely used for many medicinal purposes by the American Indians of the Great Plains and subsequently adopted by white settlers. An extract of . angustifolia (narrow-leaved purple coneflower) was made available to medical practitioners by Lloyd Brothers Pharmacists Inc., at the end of the nineteenth century, and became widely used in the USA by eclectic physicians for infectious and inflammatory diseases [5]. With the introduction by the FDA of stricter requirements for testing of drugs, the use of Echinacea declined in the 1930 s, but its use in self-medication has seen a renaissance in recent years. Since 1994, herbal remedies have been defined as dietary supplements in the USA which has allowed manufacturers to make general claims about their efficacy. 

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