ECHINACEA
Patient Counselling
Patient Counselling
- Echinacea is widely used in North America for the treatment of the common cold symptoms, including sore throat. Although evidence surrounding the use of echinacea for the treatment of sore throat alone is largely lacking, that which does exist is promising and demonstrates echinacea may be beneficial for symptomatic relief/treatment.
- Most of the evidence surrounding echinacea’s therapeutic effect for sore throat and immune stimulatory properties is demonstrated with Echinacea purpurea <1>. As such, patients should be advised to use products containing an extract of E. purpurea for the treatment and symptomatic relief of acute sore throat.
- Natural Standard evidence rating of echinacea for the treatment of upper respiratory tract infections including the common cold is C; Unclear scientific evidence <1>. Although no evidence rating specifically for sore throat is available, given that sore throat is commonly a symptom of the common cold, one could extrapolate that the evidence rating for sore throat alone would also be C; Unclear scientific evidence.
- Echinacea has been demonstrated to possess antimicrobial, antioxidant and immunostimulatory properties <1>. However, the exact mechanism of action by which echinacea acts for the treatment and/or symptomatic relief of sore throat is unclear.
- Echinacea may work synergistically with other herbal ingredients such as sage for the treatment of sore throat.
- Echinacea is considered safe when used orally or topically in recommended doses for a maximum of 8 consecutive weeks <1>.
- The use of echinacea should be AVOIDED in patients with allergies to members of the Asteraceae/Compositae plant family (i.e. ragweed, chrysanthemum, marigold and daisy) due to the potential of causing cross-reactivity allergic reactions <1,2>.
- The exact optimal dose of echinacea for the treatment and symptomatic relief of the common cold and acute sore throat is unclear <1>. Patients should also be advised that formulations of products vary from manufacturer to manufacturer which may influence effectiveness for sore throat treatment. Doses may be based on those most commonly used in available clinical trials or on historical practice <1>.
- Recommended Dosage (Adults ≥ 18 yrs): If taking echinacea orally, a dose of 500 to 1000 mg three times a day for 5 to 7 days starting when sore throat symptoms first onset is thought to be effective for treatment <1>. If using a tincture, a dosage of 0.75 to 1.5 mL, gargled and then swallowed, 2 to 5 times daily for 5 to 7 days (the daily dose equivalent to 900 mg of dried echinacea root) is recommended by most experts <1>. An echinacea tea may also be used at the dose of 2 tsp. (4g of echinacea) of coarsely powdered herb simmered in one cup of boiling water for 10 minutes, daily for 5-7 days, according to most experts <1>. It is important to note various doses have been used in clinical trials. Eight doses of 5mL of Echinacea purpurea extract (Echinilin®) diluted with half a glass of water were given on day 1; three doses were given on days 2-7 were found to significantly reduce the severity and duration of cold symptoms, including sore throat <1>. If using the A.Vogel Sore Throat Spray, two sprays every 2 hours up to 10 times daily for a maximum of 5 days is recommended <3>.
- Recommended Dosage (Adults ≤ 18 yrs): The recommended daily dose of echinacea in children is unclear <1>. It is important to note though that in a study of echinacea for the treatment of cold symptoms in children ages 2-11, an increased incidence of rash was reported, without significant measured benefits <1>. As such, echinacea is something that should be used with caution in children and dosages based on weight according to manufacturer product recommendations. Tinctures should be AVOIDED in children due to their alcohol content <1>.
- The use of echinacea in pregnancy and lactation is considered likely safe according to Natural Standard although evidence in these patient populations is largely lacking <1>. Of note, oral echinacea does not appeared to pose a teratogenic risk <1,2>. Given this, echinacea should be used with CAUTION in these patient populations, for short term treatment only and avoided if possible.
- Echinacea appears to be safe and well tolerated in most patients <1>. There are few adverse events associated with its use. Gastrointestinal upset (i.e. mild nausea, vomiting) and rashes are the adverse effects that most commonly occur <1>. In rare cases, echinacea has been shown to cause allergic reactions <1>.
- Individuals with asthma or atopy may be predisposed to allergic reactions from oral or topical use of echinacea, consistent with IgE-mediated hypersensitivity <1>. CAUTION should be exercised when using echinacea in these patients.
- CAUTION should be exercised in patients with liver conditions, taking antibiotics, taking antineoplastics or on immunostimulants or immunosuppressants as echinacea may enhance or mitigate the these conditions and or medications <1>.
Reference
1. Natural Standard. Echinacea http://www.naturalstandard.com.proxy.lib.uwaterloo.ca/databases. Accessed March 5, 2013.
2. Micromedix. Echinacea. http://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch. Accessed March 28, 2013.
3. Schapowal A, Berger D, Klein P, Suter A. Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: A randomized double-blind trial. Eur J Med Res 2009; 14: 406-412.
- Echinacea is widely used in North America for the treatment of the common cold symptoms, including sore throat. Although evidence surrounding the use of echinacea for the treatment of sore throat alone is largely lacking, that which does exist is promising and demonstrates echinacea may be beneficial for symptomatic relief/treatment.
- Most of the evidence surrounding echinacea’s therapeutic effect for sore throat and immune stimulatory properties is demonstrated with Echinacea purpurea <1>. As such, patients should be advised to use products containing an extract of E. purpurea for the treatment and symptomatic relief of acute sore throat.
- Natural Standard evidence rating of echinacea for the treatment of upper respiratory tract infections including the common cold is C; Unclear scientific evidence <1>. Although no evidence rating specifically for sore throat is available, given that sore throat is commonly a symptom of the common cold, one could extrapolate that the evidence rating for sore throat alone would also be C; Unclear scientific evidence.
- Echinacea has been demonstrated to possess antimicrobial, antioxidant and immunostimulatory properties <1>. However, the exact mechanism of action by which echinacea acts for the treatment and/or symptomatic relief of sore throat is unclear.
- Echinacea may work synergistically with other herbal ingredients such as sage for the treatment of sore throat.
- Echinacea is considered safe when used orally or topically in recommended doses for a maximum of 8 consecutive weeks <1>.
- The use of echinacea should be AVOIDED in patients with allergies to members of the Asteraceae/Compositae plant family (i.e. ragweed, chrysanthemum, marigold and daisy) due to the potential of causing cross-reactivity allergic reactions <1,2>.
- The exact optimal dose of echinacea for the treatment and symptomatic relief of the common cold and acute sore throat is unclear <1>. Patients should also be advised that formulations of products vary from manufacturer to manufacturer which may influence effectiveness for sore throat treatment. Doses may be based on those most commonly used in available clinical trials or on historical practice <1>.
- Recommended Dosage (Adults ≥ 18 yrs): If taking echinacea orally, a dose of 500 to 1000 mg three times a day for 5 to 7 days starting when sore throat symptoms first onset is thought to be effective for treatment <1>. If using a tincture, a dosage of 0.75 to 1.5 mL, gargled and then swallowed, 2 to 5 times daily for 5 to 7 days (the daily dose equivalent to 900 mg of dried echinacea root) is recommended by most experts <1>. An echinacea tea may also be used at the dose of 2 tsp. (4g of echinacea) of coarsely powdered herb simmered in one cup of boiling water for 10 minutes, daily for 5-7 days, according to most experts <1>. It is important to note various doses have been used in clinical trials. Eight doses of 5mL of Echinacea purpurea extract (Echinilin®) diluted with half a glass of water were given on day 1; three doses were given on days 2-7 were found to significantly reduce the severity and duration of cold symptoms, including sore throat <1>. If using the A.Vogel Sore Throat Spray, two sprays every 2 hours up to 10 times daily for a maximum of 5 days is recommended <3>.
- Recommended Dosage (Adults ≤ 18 yrs): The recommended daily dose of echinacea in children is unclear <1>. It is important to note though that in a study of echinacea for the treatment of cold symptoms in children ages 2-11, an increased incidence of rash was reported, without significant measured benefits <1>. As such, echinacea is something that should be used with caution in children and dosages based on weight according to manufacturer product recommendations. Tinctures should be AVOIDED in children due to their alcohol content <1>.
- The use of echinacea in pregnancy and lactation is considered likely safe according to Natural Standard although evidence in these patient populations is largely lacking <1>. Of note, oral echinacea does not appeared to pose a teratogenic risk <1,2>. Given this, echinacea should be used with CAUTION in these patient populations, for short term treatment only and avoided if possible.
- Echinacea appears to be safe and well tolerated in most patients <1>. There are few adverse events associated with its use. Gastrointestinal upset (i.e. mild nausea, vomiting) and rashes are the adverse effects that most commonly occur <1>. In rare cases, echinacea has been shown to cause allergic reactions <1>.
- Individuals with asthma or atopy may be predisposed to allergic reactions from oral or topical use of echinacea, consistent with IgE-mediated hypersensitivity <1>. CAUTION should be exercised when using echinacea in these patients.
- CAUTION should be exercised in patients with liver conditions, taking antibiotics, taking antineoplastics or on immunostimulants or immunosuppressants as echinacea may enhance or mitigate the these conditions and or medications <1>.
Reference
1. Natural Standard. Echinacea http://www.naturalstandard.com.proxy.lib.uwaterloo.ca/databases. Accessed March 5, 2013.
2. Micromedix. Echinacea. http://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch. Accessed March 28, 2013.
3. Schapowal A, Berger D, Klein P, Suter A. Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: A randomized double-blind trial. Eur J Med Res 2009; 14: 406-412.