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Printed from https://bottledhope.co/supplements/echinacea/. Last reviewed 2026-10-17. Check the site for the latest version.

Echinacea

Echinacea, or purple coneflower, is a North American plant related to daisies and sunflowers, sold mostly for the common cold and other respiratory infections.

Explained simply · Last reviewed

What it is

Echinacea is a group of flowering plants, also called purple coneflowers, closely related to sunflowers, daisies and ragweed. NCCIH, the US agency that studies complementary medicine, says they are native to areas east of the Rocky Mountains in the United States. It states that Native Americans used one species, Echinacea purpurea, for respiratory tract infections, tooth pain and snakebite.

More about Echinacea

NCCIH, the US agency that studies complementary medicine, says they are native to areas east of the Rocky Mountains in the United States. It states that Native Americans used one species, Echinacea purpurea, for respiratory tract infections, tooth pain and snakebite.

NCCIH names three species used today: Echinacea purpurea, Echinacea angustifolia and Echinacea pallida. It states that echinacea products are promoted mainly as dietary supplements for the common cold and other respiratory tract infections, “based on the idea that certain species of echinacea may stimulate the immune system.” LiverTox, the US National Institutes of Health’s reference on liver injury, states that extracts of these three species are found in hundreds of commercial herbal and dietary products.

What is sold as echinacea varies a great deal. The 2014 Cochrane review on colds explains that products use different species and different parts of the plant (herb, root or both), and are made in different ways: dried, extracted in alcohol, or pressed into juice from the fresh plant. Some also have other herbs added. The reviewers state that “the overwhelming majority of these products have not been tested in clinical trials.”

Europe’s medicines agency, EMA, assesses echinacea as an herbal medicine for the European Union. It accepts pressed juice of purple coneflower herb for short-term prevention and treatment of colds on published evidence, and accepts root preparations only as traditional medicines.

The ratings below cover preventing colds, treating colds, respiratory infections in children and eczema.

Also known as: purple coneflower, coneflower, American coneflower, Echinacea purpurea, Echinacea angustifolia, Echinacea pallida

At a glance

Safety: known risks, 7 groups who should avoid it or take extra care and 3 documented interactions. See Safety ↓

Claims made about Echinacea, and how strong the evidence is for each:

Each rating follows our published rules and the sources cited for it. We don’t add our own medical judgment. How we rate

Safety

Read this before the ratings below.

Risks

  • NCCIH, the US agency that studies complementary medicine, states that it is likely safe for most adults to take products with extracts of Echinacea purpurea, and some mixtures of Echinacea purpurea and Echinacea angustifolia, for short periods. It adds: “However, some people have allergic reactions to echinacea, which may be severe.” It names digestive symptoms, such as abdominal pain, nausea or stomach pain, as the most common side effects.
  • Europe’s medicines agency, EMA, lists allergic reactions in its monograph on purple coneflower herb: rash, hives, itching and swelling of the face. It states that cases of severe allergic reactions, “such as Stevens-Johnson Syndrome, angioedema of the skin, Quincke oedema, bronchospasm with airway obstruction, asthma and anaphylactic shock have been reported”, with frequency not known. It also states: “Association with autoimmune diseases cannot be excluded.”
  • The 2014 Cochrane review’s summary states that the number of people dropping out or reporting side effects did not differ significantly between echinacea and placebo. Its pooled analysis of the treatment trials, however, found side effects reported slightly more often with echinacea (34.1% against 32.6%), a statistically significant difference. In the prevention trials the reviewers describe a trend, not statistically significant, toward more people dropping out because of side effects with echinacea. One trial in children found more rashes with echinacea. The reviewers caution that trials like these “can only contribute limited knowledge on safety issues” and name allergic reactions as probably the most relevant potential harm.
  • LiverTox, the US National Institutes of Health’s reference on liver injury from medicines and supplements, states that echinacea has not been linked to liver injury in controlled trials, but that there have been “isolated case reports of clinically apparent liver injury with jaundice”. It rates echinacea a possible rare cause of clinically apparent liver injury.

Who should avoid it or take extra care

  • Allergy to the daisy family: EMA states that echinacea medicines must not be used by people who are allergic to echinacea or to other plants of the Asteraceae (Compositae) family. NCCIH describes echinacea species as closely related to sunflowers, daisies and ragweed.
  • Allergies in general (atopy): EMA’s herb monograph states that there is “a possible risk of severe hypersensitivity reactions in atopic patients”, and that atopic patients should consult their doctor before using echinacea.
  • Autoimmune and immune system conditions: EMA does not recommend echinacea medicines in “progressive systemic disorders, autoimmune diseases, immunodeficiencies, immunosuppression and diseases of the white blood cell system”. Its monograph on narrow-leaved coneflower root names conditions such as tuberculosis, multiple sclerosis, AIDS and HIV infection.
  • Children: EMA’s monograph on purple coneflower herb does not recommend its use in children under 12, “due to insufficient data”. NCCIH states that it is possibly safe for children to take Echinacea purpurea extract for short periods, but that some children in a clinical trial developed rashes and that “there is concern that allergic reactions could be severe in some children.” It advises talking with the child’s health care provider first.
  • Pregnancy and breastfeeding: NCCIH states that some studies of solid or liquid extracts of Echinacea purpurea and Echinacea angustifolia suggest it is possibly safe for up to 7 days during the first trimester, and that little is known about its safety while breastfeeding. EMA’s herb monograph states that limited data, from several hundred exposed pregnancies, indicate no adverse effects on pregnancy or the newborn, but that “in the absence of sufficient data, the use in pregnancy and lactation is not recommended unless advised by a doctor.” Its root monographs do not recommend use during pregnancy or breastfeeding.
  • Length of use: EMA’s herb monograph states, for prevention and treatment of colds, “do not use the medicinal product for more than 10 days.” It advises consulting a doctor or pharmacist if symptoms persist for more than 10 days, or if they worsen or a high fever occurs.
  • People taking medicines: NCCIH advises anyone who takes any type of medicine to talk to a health care provider before using echinacea, because “some herbs and medicines interact in harmful ways.”

Documented interactions

  • Medicines broken down by the liver: NCCIH states that there is conflicting evidence about whether echinacea interacts with some drugs metabolized by the liver. LiverTox states that some echinacea preparations interfere with the liver enzymes CYP1A2 and CYP3A4 in vitro and in vivo (in the laboratory and in the body), but that “the clinical significance of these interactions has not been shown.” EMA’s monographs report no interactions. Source [1]Source [2]Source [3]
  • Immunosuppressants: NCCIH states that there are theoretical reasons to suspect that echinacea might interact with immunosuppressants. EMA does not recommend echinacea medicines for people with immunosuppression. Source [1]Source [2]
  • Caffeine: NCCIH states that there are theoretical reasons to suspect that echinacea might interact with caffeine. Source [1]

Safety sources: Source [1]Source [2]Source [3]Source [4]Source [5]Source [6]Source [7]Source [8]

What the evidence says

Each claim is rated on its own evidence. Ratings follow the scale on our methodology page.

  • Taken regularly, lowers the chance of catching a cold Evidence rating: Limited

    People take echinacea through the winter hoping it will keep colds away.

    A 2014 Cochrane review pooled trials and found slightly fewer colds with echinacea, but no single trial was significant and the reviewers call the clinical relevance unclear.

    A 2014 Cochrane review found ten trials of echinacea taken to prevent colds, all in adults. None of the 12 comparisons that counted people catching a cold found a statistically significant difference from placebo. The reviewers then pooled them in an exploratory analysis across very different products. They write that it “suggests a relative risk reduction of 10% to 20%”. The results were highly consistent across the trials. They illustrate a 15% reduction this way: if 500 of 1,000 people on placebo caught a cold, 425 of 1,000 would with echinacea.

    The reviewers call this “clearly a small effect of unclear clinical relevance”. They add that they “cannot say which Echinacea products have an effect of this size”, and that their pooled figures should not be read as an average effect of echinacea products. They did not rate how sure they are (certainty).

    A 2022 systematic review of supplements in healthy people found three adult trials reporting who caught an infection. Each showed less risk with echinacea, but none reached statistical significance on its own. The reviewers say it is unknown whether any benefit “could be clinically meaningful”.

    NCCIH, the US agency that studies complementary medicine, states: “Taking echinacea may slightly reduce your chances of catching a cold.” Europe’s medicines agency, EMA, accepts pressed juice of purple coneflower herb for the short-term prevention of colds, on published evidence. The sources differ on how strong this is. This page takes the lower rating, on the reviews, which found no single trial significant and did not rate certainty.

    Sources: Source [1]Source [2]Source [3]Source [4]Source [5]

  • Taken once a cold starts, makes it shorter or milder Evidence rating: Insufficient

    People reach for echinacea at the first sniffle hoping to get over the cold sooner.

    A 2014 Cochrane review found echinacea has not been shown to benefit people with colds, though some products may have a weak benefit; NCCIH says it is still unclear.

    The 2014 Cochrane review found 15 trials of echinacea started once a cold had begun or at the first symptoms. Six could be included in the reviewers’ analysis of how long colds lasted. Two of those six found significantly shorter colds with echinacea, and the results varied widely between trials. A pooled measure of how bad and how long colds were was not statistically significant, and the reviewers say it must be interpreted “with great caution”. They did not rate certainty.

    They conclude that echinacea products “have not here been shown to provide benefits for treating colds, although, it is possible there is a weak benefit from some Echinacea products”. They see “some hints” of benefit for adults from alcohol extracts and pressed juices based mainly on the above-ground parts of Echinacea purpurea, but add that not all trials of such preparations “show even a trend towards an effect”. They note that a 2007 meta-analysis drew more favorable conclusions, especially on how long colds last. It used different inclusion criteria, included combination products and pooled very different preparations, and prevention and treatment trials, in one analysis.

    NCCIH, the US agency that studies complementary medicine, states: “It’s still unclear whether echinacea can shorten the length of a cold.” LiverTox, the US National Institutes of Health’s reference on liver injury, states that most systematic reviews have concluded “there is little evidence for its therapeutic effectiveness”.

    Europe’s medicines agency, EMA, reads the trials differently for one form. It accepts pressed juice of purple coneflower herb for treating colds on published evidence, stating that the most relevant adult trials indicated it can “improve the symptoms of cold more rapidly than placebo when taken early”. It accepts root preparations of all three species only as traditional medicines, on long-standing use. This page takes the lower rating, the Cochrane review’s: too little evidence to show that it helps, rather than evidence that it does not.

    Sources: Source [1]Source [2]Source [3]Source [4]Source [5]Source [6]Source [7]Source [8]

  • Helps prevent or ease colds and other respiratory infections in children Evidence rating: Insufficient

    Parents give echinacea hoping their children will catch fewer colds and get over them faster.

    NCCIH states there is not enough evidence to support a clear connection; reviews describe one prevention trial in children with less illness and one treatment trial with no difference.

    NCCIH, the US agency that studies complementary medicine, states: “One recent study found that echinacea might reduce the chance of respiratory tract infection and associated complications in children, but overall, there isn’t enough evidence to support a clear connection.”

    A 2022 systematic review of supplements in healthy people found one trial in children, with 203 children aged 4 to 12 who took an Echinacea purpurea extract through about four months of winter. The review calculated about 30% less risk of developing symptoms with echinacea, and shorter illnesses. It notes that this trial and the largest adult trial used the same product brand from the same manufacturer.

    The 2014 Cochrane review included one treatment trial in children, of pressed juice from Echinacea purpurea herb, and reports that it found more rashes with echinacea. LiverTox, the US National Institutes of Health’s reference on liver injury, describes that trial of 407 children: how long and how bad their infections were did not differ from placebo, while rash was more frequent with echinacea.

    Europe’s medicines agency, EMA, in its monograph on purple coneflower herb, does not recommend its use in children under 12 “due to insufficient data”. This page rates the claim on the NCCIH statement.

    Sources: Source [1]Source [2]Source [3]Source [4]Source [5]

  • Helps eczema Evidence rating: Insufficient

    People with eczema try echinacea creams hoping to calm itchy, inflamed skin.

    NCCIH states that it’s unclear whether echinacea is helpful for health conditions other than respiratory infections, including eczema.

    NCCIH, the US agency that studies complementary medicine, notes that some echinacea products may be promoted for use on the skin for skin problems such as eczema. It states that much less research has been done on echinacea for health purposes other than respiratory infections, and: “It’s unclear whether echinacea is helpful for other health conditions, including eczema.”

    This page rates the claim insufficient on that statement.

    Sources: Source [1]

Which form the evidence used

Supplements are sold in several forms. This is what the sources on this page say about them — which form the research used, and any comparison those sources themselves made. Where they made none, this page does not rank the forms.

  • Purple coneflower herb (the flowering above-ground parts of Echinacea purpurea), as pressed juice or extracts, What the sources supportDetails

    The 2014 Cochrane review found that preparations based on the aerial parts of Echinacea purpurea were tested in seven of its 24 trials. It reports “some hints” that alcohol extracts and pressed juices based mainly on these parts “have beneficial effects on cold symptoms in adults”, but calls the evidence for clinically relevant treatment effects weak. Europe’s medicines agency, EMA, accepts medicines made from the expressed juice of the fresh herb, taken by mouth, for the short-term prevention and treatment of the common cold on “well-established use”, which EMA explains means published data providing scientific evidence of effectiveness and safety. Source [1]Source [2]Source [3]

  • Echinacea root preparations (Echinacea purpurea, Echinacea pallida or Echinacea angustifolia root), What the sources supportDetails

    The Cochrane review included trials of root preparations from all three species; many of the preparations it found were tested in only one trial each. EMA accepts root medicines of all three species for common cold symptoms only as traditional herbal medicines, a use “exclusively based upon long-standing use” rather than on trial evidence. No cited source compared the forms with each other, so this page cannot say that any one works better. Source [1]Source [2]Source [3]Source [4]

Also documented elsewhere on this site

Other supplements we cover that document an interaction with the same thing. This is a pointer to what those pages say, not a statement about taking them together — we have no source reviewing these in combination.

Sources

  1. Echinacea for preventing and treating the common cold
    Cochrane Database of Systematic Reviews, 2014 · Systematic review · Primary source
  2. Select Dietary Supplement Ingredients for Preserving and Protecting the Immune System in Healthy Individuals: A Systematic Review
    Nutrients, 2022 · Systematic review · Primary source
  3. Echinacea
    National Center for Complementary and Integrative Health, NIH, 2024 · Health authority summary · Primary source
  4. European Union herbal monograph on Echinacea purpurea (L.) Moench, herba recens – Final
    European Medicines Agency, Committee on Herbal Medicinal Products (HMPC), 2015 · Health authority summary · Primary source
  5. Herbal medicine: summary for the public – Purple coneflower herb, Echinacea Purpurea (L.) Moench., herba recens
    European Medicines Agency, 2015 · Health authority summary · Primary source
  6. Echinacea
    LiverTox: Clinical and Research Information on Drug-Induced Liver Injury, National Institute of Diabetes and Digestive and Kidney Diseases, 2019 · Health authority summary · Primary source
  7. European Union herbal monograph on Echinacea purpurea (L.) Moench, radix – Final
    European Medicines Agency, Committee on Herbal Medicinal Products (HMPC), 2017 · Health authority summary · Primary source
  8. European Union herbal monograph on Echinacea pallida (Nutt.) Nutt., radix – Final
    European Medicines Agency, Committee on Herbal Medicinal Products (HMPC), 2018 · Health authority summary · Primary source
  9. Community herbal monograph on Echinacea angustifolia DC., radix – Final
    European Medicines Agency, Committee on Herbal Medicinal Products (HMPC), 2012 · Health authority summary · Primary source

Page history

Show all 2 changes to this page
  • — Published.
  • — Drafted. Lowering the chance of catching a cold rated limited; shortening colds, helping children with respiratory infections and helping eczema rated insufficient.