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Scientific Name:
Echinacea purpurea, E. angustifolia, E. pallida
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Safety Data
Adverse Effects & Toxicity
A review of the evidence of bleeding risks of the most popular herbal and dietary supplements, independent of anticoagulants, reported that echinacea is loosely associated with surgical bleeding. Hatfield 2022
Echinacea purpurea dietary supplements distributed on the Polish market, including sachets, dry raw material, tablets and capsules, contained an average 1012 cfu/g molds with the most common Aspergillus, Phoma, and Eurotium and the most common mycotoxins ZEN, DON, and T-2 toxin. Pilarska 2022
Echinacea is included in a review of possible associations of herbal supplements in the onset or exacerbation of dermatomyositis, an autoimmune disease that affects the skin, muscles, and lungs. Bax 2021
The European Food Safety Authority Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) was unable to conclude on the safety or efficacy of dried extracts of Echinacea angustifolia dried roots or E. purpurea dried aerial parts as feed additives for cats and dogs, due to lack of data, insufficient product specification, and possible skin/eye irritant effects. EFSA Panel on Additives and Products or Substances used in Animal Feed (FEEDAP) 2021
Safety data for 20 common herbal supplements such as echinacea, including precautions, possible adverse reactions, and herb-drug interactions, is reviewed. Williams 2021
A lectin protein purified from the roots of Echinacea purpurea and administered via an injection (5 µg four times/week, for 4-5 weeks) induced kidney glomerular vacuolization and kidney tubular necrosis in mice. Balciunaite 2020
An article describes the process of the selection and characterization of an Echinacea purpurea root extract for the National Toxicology Program testing studies, including chemical and DNA authentication. Waidyanatha 2020
An expert review found Echinacea purpurea and its extract generally well tolerated, with isolated reports of serum enzyme elevations and clinically apparent liver injury attributed to its use. [No authors listed] 2019
A study presents data from animal experiments relating to the safety of Echinacea when used in maternal nutrition during pregnancy and lactation. Lewicka 2019
Analysis of spontaneous adverse drug reactions (ADRs) from echinacea, black cohosh, valerian, and ginkgo reported to the Australian Therapeutic Goods Administration between 2000 and 2015 concluded most reactions were mild to moderate, although all were associated with life-threatening ADRs. Hoban 2019
Echinacea purpurea products were reported to be associated with 5.6% of cases of acute allergic-like reactions in children (following 51.4% for mixed herbal products, and 15.0% for Hedera helix), based on the WHO individual case safety report VigiBase® database. Meincke 2017
The potential of Echinacea spp. to cause anaphylaxis reactions in patients with asthma and allergy is discussed. Gunawardana 2017
A case of acute disseminated encephalomyelitis in a 25-year-old male, developed following intake of a polyherbal preparation containing echinacea for increase of sexual potency, is presented. Kaymakamzade 2016
The available literature on drug interactions, contraindications, adverse events, duration of use, and safety of use in pregnant and nursing women for Echinacea purpurea, E. angustifolia, and E. pallida was reviewed. Ardjomand-Woelkart 2016
Echinacea-associated acute cholestatic hepatitis. [No abstract] Gabranis 2015
The evidence for any opinion regarding the safety of echinacea use in lactating women is found to be insufficient. Amer 2015
The potential of Echinacea purpurea and Lavandula angustifolia to induce contact dermatitis was assessed. Gangemi 2015
Herbal medicine as a cause of recurrent facial oedema. [No abstract] Engebretsen 2015
Echinacea-induced acute liver failure in a child. [No abstract] Lawrenson 2014
Herbalists surveyed in Italy reported low level of risks associated with the use of Echinacea spp., according to their perception assessed by a visual analogic scale. Gallo 2014
Evidence concerning safety of echinacea use in pregnancy, comprising one prospective human study and two small animal studies, was assessed. Although no increase in risk of major malformations was observed in the human study, the evidence was considered insufficient to conclude on the safety. Holst 2014
Only minor adverse events are associated with the use of Echinacea spp., according to the review of 50 systematic reviews. Posadzki 2013
Completeness of safety information provided with commercial echinacea products in the UK was assessed. Raynor 2011
A case of hypereosinophilia in a patient whose condition improved after cessation of an echinacea supplement, suggesting an IgE-mediated allergic reaction to echinacea, is presented. Maskatia 2010
The most reported complementary and alternative medicine substances with adverse reactions includes purple coneflower (Echinacea purpurea) (8.1%), purple coneflower + siberian ginseng (Eleutherococcus senticosus) + malabar nut (Adhatoda vasica) (7.3%) and ginkgo leaf (Ginkgo biloba) (6.7%). Jacobsson 2009
An observational study intended to provide a systematic overview of prescribing patterns & adverse drug reactions (ADR) for Asteraceae-containing remedies inclg. Echinacea spp., in the German primary-care sector found that Asteraceae-containing remedies are not associated with a high risk of ADR. Jeschke 2009
Reports of adverse effects associated with 6 most frequently used dietary botanical supplements: Echinacea, ginseng, garlic, Ginkgo biloba, St. John's wort & peppermint was obtained from the Food & Drug Administration's Center for Food Safety & Applied Nutrition's Adverse Event Reporting System. Wallace 2008
Changes in accumulation of Cadmium (Cd) in tissues and the effects of Echinacea purpurea (EP) extract on Cd-induced changes in mice were investigated showing that when combined with EP there is significant increase of Cd concentration in blood and in various organs of experimented mice. Zitkevicius 2007
Poison control centers were contacted regarding 406 exposures involving Echinacea and 356 exposures involving St. John's wort (SJW) during 2001. Intentional exposures accounted for 21% of SJW cases and 3% of Echinacea cases, with 13% of SJW exposures reported as 'suspected suicidal'. Gryzlak 2007
A study to establish whether alcoholic extracts of Echinacea purpurea (AEP) given to pregnant mice influence angiogenic activity & tissue VEGF & bFGF production of their fetuses found there is some possibility of pharmaceuticals containing AEP may also influence fetal development in human. Barcz 2007
Several herbal medications including canthaxanthine, chamomile, datura, Echinacea purpurea, Ginkgo biloba and liquorice have been associated with several ocular adverse effects. Santaella 2007
Echinacea is non-teratogenic when used during pregnancy. Caution has to be exercised while using Echinacea during lactation until further high quality human studies can determine its safety. Perri 2006
Data from clinical studies and spontaneous reporting programmes suggest that adverse events with echinacea are not commonly reported. However, in rare cases, echinacea is associated with allergic reactions that may be severe. Huntley 2005
Review on Echinacea species revealed that the chemistry is well documented & the safety issues included the possibility of allergic reactions, the use of echinacea by patients with autoimmune diseases & the potential for echinacea preparations to interact with conventional medicines. Barnes 2005
Review of dietary supplements which can affect surgical outcomes and follow-up: including feverfew, ginkgo biloba, garlic, ginseng, ginger, valerian, kava, St. John's wort, ephedra (Ma huang or metabolite) & echinacea. Ciocon 2004
The National Registry of Drug-Induced Ocular Side Effects(OSE) received 263 spontaneous reports, in addition to 60 case reports from the literature. Canthaxanthine, chamomile, Datura, E. purpurea, Ginkgo biloba, licorice, niacin & vitamin A are all associated with clinically significant OSE. Fraunfelder 2004
use of some herbal supplements has been associated with oral manifestations, including tongue numbness with echinacea. Abebe 2003
[Chronic use of echinacea should be discouraged.]. Chua 2003
[Adverse reactions to complementary and alternative medicine: ragweed's cousin, the coneflower (echinacea), is "a problem more than a sneeze".]. Bielory 2002
[...And just how safe is Echinacea?]. [No authors listed] 2002
Possible leukopenia associated with long-term use of echinacea. Kemp 2002
Review on herbal medication potential for adverse interactions with analgesic drugs revealed incidences of hepatotoxicity which may be augmented by acetaminophen when concomitantly used with the potentially hepatotoxic herbs Echinacea and kava. Abebe 2002
Review on herbal-related calls to regional California Poison Control System, San Francisco to identify herbs most relevant to toxicology, indicated 12 herbs including St John's wort, ma huang, echinacea, guarana, ginkgo, ginseng, valerian, tea tree oil, goldenseal, arnica, yohimbe and kava kava. Haller 2002
Review on contact sensitization from Compositae-containing herbal remedies & cosmetics revealed that at least 15 species, including German and Roman chamomile, marigold, Echinacea and elecampane have been suspected of sensitization or elicitation of Compositae dermatitis. Paulsen 2002
A clinically oriented overview of the efficacy and safety of Ginkgo biloba, St. John's wort, ginseng, Echinacea, saw palmetto and kava were studied based on American experiences & none of them were found to be free of adverse effects. [Article in Swedish] Mattsson 2002
[Careful with herbal medicines!]. [Article in Spanish] Molina 2002
Among 233 adverse drug reactions (ADRs) of which 67 occurred in children, reported to the California Poison Control, the most common products involved in ADRs were zinc (38.2%), echinacea (7.7%), chromium picolinate (6.4%) and witch hazel (6%). Yang 2002
Some atopic subjects have positive skin prick test (SPT) results to echinacea in the absence of known exposure. Atopic subjects are overrepresented in those experiencing reactions. Cross-reactivity between echinacea and other environmental allergens is supported by the Australian data. Mullins 2002
We report a case of recurrent erythema nodosum that is temporally and perhaps causally associated with use of echinacea herbal therapy. Soon 2001
This review suggests that physicians should be familiar with the potential perioperative effects of the commonly used herbal medications to prevent, recognize, and treat potentially serious problems associated with their use and discontinuation. Ang-Lee 2001
A recent Motherisk study showed that use of echinacea during the first trimester of pregnancy was not associated with increased risk of major malformations. Gallo 2001
[Herbals--beware bleeding.]. Ananthanarayan 2000
The possible adverse health effects associated with prolonged use or higher doses of the most popular medicinal herbs, including Ginkgo biloba, Echinacea angustifolia are identified & characterized by National Toxicology Program which studies the substances to which the population may be exposed. [No authors listed] 1999
Echinacea lacks the 1,2 saturated necrine ring associated with hepatoxicity of pyrrolizidine alkaloids but people warned anyway that more than 8 weeks use could be hepatoxic; don't use with steroids, amiodarone, methotrexate, or ketoconazole Miller 1998
A woman with atopy experienced anaphylaxis after taking, with other supplements, an echinacea extract. Hypersensitivity was confirmed by skinprick and RAST. 5% of atopy patients take echinacea Mullins 1998
[Echinacea-associated anaphylaxis.] Myers 1998
302 healthy people randomly divided into taking ethanol extract of roots of E. purpurea or E angustifolia or placebo for 12 weeks. Incidence & days until first cold: 29.3% and 69, 32.0% and 66, 36.7% and 65 days (difference not statistically significant) Melchart 1998
Moderate mutagenicity in Salmonella reversion screening of Echinaceae angustifoliae (which does not contain quercetin) Schimmer 1994
4 weeks orally of many times the human therapeutic dose or single intravenous doses of expressed juice of E purpurea proved virtually non-toxic to rats and mice Mengs 1991
The National Toxicology Program (NTP) has announced that it will design and initiate studies to identify and characterize possible adverse health effects that may be associated with prolonged use or higher doses of some of the most popular medicinal herbs, including Echinacea angustifolia (NIEHS, NIH)
History of Record
May 1999
MAJOR REVISION BY: J. Mohanasundarum, MD, PhD
January 2010
January 2023