Download Username: Password: Help Join Now (Advanced) American

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Discovery and development of proton pump inhibitors wikipedia, lookup

Psychopharmacology wikipedia, lookup

Neuropsychopharmacology wikipedia, lookup

Clinical trial wikipedia, lookup

Bad Pharma wikipedia, lookup

Theralizumab wikipedia, lookup

Pharmacognosy wikipedia, lookup

Bilastine wikipedia, lookup

Transcript
Username:
Password:
Join
Now
Help
(Advance
d)
American Botanical Council > Herbal Information > Expanded Commission E > Expanded
Commission E Online >
Echinacea Angustifolia herb and root/Pallida herb
Latin Name: Echinacea angustifolia/E. pallida
Pharmacopeial Name: Echinaceae angustifoliae/pallidae herba;
Echinaceae angustifoliae radix
Other Names: Kansas snake root, narrow-leaved echinacea, narrow-leaved
purple coneflower











Overview
Description
Chemistry and Pharmacology
Uses
Contraindications
Side Effects
Use During Pregnancy and Lactation
Interactions with Other Drugs
Dosage and Administration
References
Additional Resources
Overview
One of the most popular herbs in the United States marketplace is the
native American medicinal plant echinacea. The term refers to several
plants in the genus Echinacea, derived from the aboveground parts and
roots of Echinacea purpurea (L.) Moench, E. angustifolia D.C., and E.
pallida (Nutt.) Nutt. [Fam. Asteraceae]. Herbalists and pharmacognosists
point out the irony that almost all of the scientific research on this
medicinal plant has been conducted not in the United States but in
Germany. Echinacea preparations have become increasingly popular in
Germany since the early 1900s. The herb was first analyzed and tested for
homeopathic purposes in Germany and its medical use was later
investigated by Dr. Gerhard Madaus in 1938. Echinacea was formerly used
in the United States by native Americans and by Eclectic physicians in the
late 1800s and early 1900s. Preparations made from various plants and
plant parts of the genus Echinacea constituted the top-selling herbal
medicine in health food stores in the United States from 1995 to 1998, with
an estimated 9.6% of the total health-food dollar spent on herbs, according
to a survey of about two hundred independent stores in 1996 (Richman and
Witkowski, 1996, 1997, 1998).
Echinacea is used for preventing and treating the common cold, flu, and
upper respiratory tract infections (URIs). It is also used to increase general
immune system function and to treat vaginal candidiasis. The clinical
literature tends to support the treatment for symptoms of colds, the flus, and
URIs. Recent studies do not support its use to prevent URI.
Of the four echinacea monographs published by Commission E, two are
positive (i.e., approved) (E. pallida root and E. purpurea herb) and two are
negative (i.e., unapproved) (E. purpurea root and E. angustifolia root). The
latter were given negative assessments due to lack of clinical trials for the
specific plant parts. Work on the chemistry of vouchered Echinacea species
from 1988 onward by Rudolf Bauer and Hildebert Wagner at the Institute
for Pharmaceutical Biology in Munich revealed clear chemical profiles for
E. angustifolia and E. pallida (Bauer and Wagner, 1991). It became
obvious that earlier pharmacological studies of E. angustifolia actually
involved E. pallida. Historically, E. pallida and E. angustifolia have been
offered to the trade in mixed lots as "Kansas snake root." Therefore, lack of
current pharmacological and clinical studies on E. angustifolia root and E.
angustifolia/E. pallida aerial parts resulted in the issuance of a negative
monograph until further supporting scientific information becomes
available (Leung and Foster, 1996).
However, despite previous problems concerning the botanical identity of
Echinacea species in commercial preparations and research materials,
another reason for the disparity in approvals by Commission E is based on
the availability of the research on the respective species. According to Prof.
Heinz Schilcher, vice president of Commission E, at the time the
monographs were being considered for publication, experimental and
clinical studies were available only on the flowering tops and roots of E.
purpurea, roots of E. pallida, and roots of E. angustifolia. The Commission
decided that only the results from the research conducted on the fresh plant
juice from the flowering herb of E. purpurea and from the water-alcohol
extract of E. pallida roots were adequate for a positive monograph. In the
meantime, there have been additional studies based on the alcoholic extract
of the roots of E. purpurea that in Schilcher's opinion should support a
positive monograph (Schilcher, 1997). A clinical trial was carried out in
1992 on an extract of the root of E. purpurea, suggesting therapeutic
benefits in patients with colds and flu (Br‰unig et al., 1992). The same
year Commission E published a monograph on E. purpurea root as an
Unapproved Component Characteristic, based on the lack of research of
this species and part, although not all members of the Commission
supported this decision (Schilcher, 1997).
Since there is a variety of echinacea preparations derived from either one
plant or plant part or a variety of plant parts (root, leaf, flower, seed) from
various species (E. purpurea, E. pallida, E. angustifolia), it is necessary to
clarify which plants and plant parts were used in each clinical trial.
Professor R. Bauer of the Institute for Pharmaceutical Biology at HeinrichHeine University in D sseldorf, Germany, has evaluated echinacea
preparations and determined that they should be grouped according to the
species, the part of the plant, and the mode of processing. Based on a
review of 23 clinical and pharmacological studies, he determined that
significant pharmacological effects have been found in vitro and in vivo for
the expressed juice of the aboveground parts of E. purpurea (i.e.,
Echinacin®) and for alcoholic extracts of the roots of E. pallida, E.
angustifolia, and E. purpurea (Bauer, 1996). The effects act mainly on the
nonspecific cellular immune system. He reports several active constituent
groups: polysaccharides, glycoproteins, caffeic acid derivatives (cichoric
acid), and alkamides.
A review of 26 controlled clinical studies (18 randomized, 11 double-blind)
that investigated the immunomodulatory activity of preparations containing
echinacea extracts (Melchart et al., 1994). Six of the trials used echinacea
alone, and 20 tested echinacea in combination with other ingredients. The
methodological quality of the trials was assessed and deemed low.
However, the authors concluded that existing controlled clinical trials
indicated that preparations containing the juice or extracts of echinacea can
be efficacious immunomodulators. Further methodologically sound,
randomized clinical trials were recommended. Commenting on this study,
Professor H. Wagner, a leading figure in European pharmacognosy,
commented, "Of the investigated criteria the most striking effects were the
reduction in susceptibility to infection and in the incidence of catarrh and
pharyngeal inflammation" (Wagner, 1997). In reviewing clinical studies on
echinacea, he has written, "The conclusion that can be drawn Ö is that
remedies containing echinacea can effect an improvement in immune
defense systems where those systems are temporarily weakened." He
pointed out that there is not yet sufficient evidence to give "clear
therapeutic recommendations as to which preparation in which dosage and
type of application has the optimal effect" (Wagner, 1997).
Many clinical studies on echinacea used fresh stabilized E. purpurea juice,
in the injectable form, and others have been conducted with oral
applications or an externally applied salve (Hobbs, 1994). The E. purpurea
aerial parts preparations are usually a proprietary fresh-pressed leaf juice
(22% ethanol by volume as a preservative), marketed as Echinacin®
(manufactured by Madaus AG of Cologne, Germany). Echinacea is often
used in combination products such as Esberitox® (Schaper and Br mmer,
Germany), which also contains extracts of Baptisia tinctoria (wild indigo)
and Thuja occidentalis (arbor vitae). Clinical studies conducted with this
combination product are not reviewed here due to the presence of these
presumably active additional ingredients.
In the most recent literature review of clinical trials conducted on various
echinacea preparations for prevention or treatment of URIs, focusing on 9
trials designed for treatment and 4 trials for prevention, the authors found
that 8 of the 9 treatment trials reported generally positive results, while 3 of
the prevention trials reported "marginal benefit" (Barrett et al., 1999). The
authors assessed the methodological quality of the trials as "modest." They
concluded that various types of preparations from various species of
Echinacea may be beneficial for the early treatment of URIs, but that there
was little evidence to support the extended use of echinacea for prevention
of URI. They found it difficult to make specific dosage recommendations
due to the variation in composition of commercial preparations. The
authors emphasized that the highest quality trials suggest that early dosing
of sufficient doses is important.
Another recent review of echinacea (Melchart and Linde, 1999) has found
seven placebo-controlled, double-blind, randomized clinical trials testing
the efficacy of two different echinacea monopreparations and three
combination products in the treatment of non-specific URIs. Combination
products are not reviewed in this monograph.
Several studies have examined echinacea's usefulness in the prevention and
treatment of colds. A double-blind, placebo-controlled study was conducted
with 108 volunteers who had chronic URIs (more than three occurrences in
a half year) (Schˆneberger, 1992). Half of the patients received a dose of 8
ml/day of fresh-pressed juice of E. purpurea (Echinacin®) for eight weeks,
with the other half receiving placebo. Compared to the placebo group, in
the echinacea group there was a tendancy for more patients (36%) to suffer
no infections, or the time between infections increased, the duration of
illness shortened, and severity of symptoms lessened. The echinacea
preparation was well tolerated, and patients with diminished immune
response (expressed by a low T4/T8 cell ratio) seemed to benefit most from
the treatment. This same study was recently re-interpreted and re-published
with a less positive assessment given by the authors (Grimm and M ller,
1999).
In a more recent randomized, double-blind, placebo-controlled study on
this fresh juice preparation (Hoheisel et al., 1997), the clinical efficacy of
the proprietary E. purpurea expressed juice preparation (Echinagard®,
Echinacin's trade name in the United States) was tested on 120 patients with
initial symptoms of common cold. The preparation was effective in that
significantly fewer patients developed full disease symptoms (40% versus
60%); recovery was much quicker with the echinacea preparation than with
placebo (four days versus eight days).
A third study highlighted the importance of dosage in the expected
effectiveness of echinacea preparations (Br‰unig et al., 1992). This
double-blind, placebo-controlled trial examined the effectiveness of an
ethanolic extract made from the root of E. purpurea (1:5, 55% ethanol) in
relieving the symptoms and duration of flu-like infections in 180
volunteers. Subjects were divided into three groups of 60 each and
administered the echinacea at 450 mg/dose, 900 mg/dose, or placebo.
Those who received only 450 mg/dose showed improvement only
comparable to the placebo. Those receiving 900 mg/dose showed a
statistically significant improvement. An effect from the higher dose was
seen after three to four days, but the full effect was not seen for 8 to 10
days. It is possible that the availability of this study to the Commission E at
the time the E. purpurea root monograph was given a negative assessment
(published in August, 1992) may have influenced a positive (approved)
assessment.
In a recent Swedish placebo-controlled double-blind study conducted over
eight days with tablets (daily dose, 3x2) made from a proprietary wateralcohol extract of the fresh herb (95%) and roots (5%) of E. purpurea
(extract ratio 5.9:1; Echinaforce®, Bioforce, Switzerland), 55 patients were
given the herbal preparation and 64 received placebo. Thirteen of the
echinacea group were allowed to use additional approved medication, such
as nose drops and the fever-reducing drug paracetamol. The examining
physician concluded that the echinacea preparation was effective in 68% of
the patients in reducing several of 12 symptoms (nasal catarrh and/or stuffy
nose, sore throat, headache/dizziness, muscle pain, fever, cough, etc.);
patients self-assessed the efficacy of the echinacea at 78% of the cases
(Brinkeborn et al., 1998). The preparation evoked little concern about
safety.
A critical summary of studies on the immunomodulatory activity of
preparations of echinacea reported on five randomized trials conducted
between 1984 and 1992 (Melchart et al., 1995). A total of 134 healthy,
mostly male, volunteers between the ages of 18 and 40 were studied in
Germany, using five different echinacea preparations. The results were
mixed; not only were different preparations administered, but methods for
analyzing the activity of targeted immune cells varied as well, making
interpretation difficult. Two of the five studies showed activity of the
measured immune cells to be significantly stimulated, while three did not.
In a highly publicized study, researchers ran a clinical study on 302 healthy
people (revised to a total of 289 after dropouts) who were divided into three
groups. Each group received either an alcoholic extract of E. purpurea root,
E. angustifolia root, or a placebo. Neither echinacea preparation helped
prevent the onset of the common cold; cold symptoms appeared within 69
days in the E. purpurea group (29.3% with infection), 66 days for the E.
angustifolia group (32.0%), and 65 days for the placebo group (36.7%).
The participants were instructed to take 50 drops (about 20 microliters per
drop) twice per day from Monday through Friday for 12 weeks. The two
ethanolic echinacea root extracts were prepared at a 1:11 ratio and were
dissolved in 30% ethanol. The conclusion was that the study could not
show that echinacea helps to prevent the common cold. The study states,
"Based on the results of this and two other studies, one could speculate that
there might be an effect of echinacea products in the order of magnitude of
10% to 20% relative risk reduction" (Melchart et al., 1998). The conclusion
to be drawn from this research is that the study could not show preventive
activity with the specific preparation according to the particular study
design; the authors acknowledged the need for a larger population of
subjects upon which to test for potential preventive activity.
Some new research findings have come from a recent placebo-controlled
trial testing the exercise-induced immunological effects of E. purpurea
aboveground fresh plant juice (Echinacin®) on 42 male athletes (Berg et al.,
1998). The echinacea group had marked changes in concentration of the
cytokines interleukin 6 (IL-6) and soluble interleukin 2 receptor (sIL-2R),
proteins that stimulate various immune functions, in serum and urine and
significantly increased serum. Exercise-induced cortisol usually lowers
natural killer (NK) cell levels and inhibits macrophage activity, two
variables of immune function. The echinacea group did not demonstrate a
significant decrease in NK cells one hour after competition, suggesting that
echinacea may counteract the immune suppressant effect of cortisol.
However, another result of this study was that none of the echinacea group
experienced URI, while 3 of 13 in the magnesium group and 4 of 13 in the
placebo group developed URI. A total of six in both the magnesium and
placebo groups reported symptoms of other infections, while none on
echinacea did. The authors concluded that preventive treatment of athletes
with the E. purpurea juice preparation counteracts the immunosuppressant
effects of exhaustive exercise and reduces risk of URI in athletes.
There is evidence to suggest that echinacea is a reliable supportive therapy
for people with recurring candidiasis, particularly when antifungal therapy
is failing (Brown, 1996). The positive effect of E. purpurea leaf juice was
demonstrated in a study of 203 women with recurrent vaginal yeast
infections (Coeugniet and K hnast, 1986). All the women were being
treated with a topical econazole nitrate cream (a commonly prescribed
antifungal/antiyeast medication). Women using the econazole nitrate alone
experienced a 60.5% recurrence rate, while the women taking echinacea
(oral Echinacin®) had a recurrence rate lowered to 16.7%.
In a study in the United States the pharmacological basis for the
immunological activity of echinacea was investigated by researchers at the
Department of Medicine, University of California at Irvine Medical Center
at Orange (See et al., 1997). Extracts of both E. purpurea (plant part not
noted) and Panax ginseng root were tested for their capacity to stimulate
cellular immune function by peripheral blood mononuclear cells (PBMC)
from normal individuals and patients with either chronic fatigue syndrome
or acquired immunodeficiency syndrome. Results indicated that the extracts
enhanced cellular immune function of PBMC from both normal individuals
and patients with depressed cellular immunity.
Bauer and Wagner note that various preparations of echinacea enhance
leukocyte activity, have antibacterial properties, inhibit the enzyme
hyaluronidase (thus retarding breakdown of hyaluronic acid, a gelatinous
component of intercellular spaces), provide an interferon-like effect on
viruses, and have (relatively mild) anti-inflammatory properties (Bauer and
Wagner, 1991). Another potential use of echinacea preparations is for the
treatment of otitis media in small children, an application that is gaining a
small number of adherents among some pediatricians and naturopathic
physicians in the United States (Blumenthal, 1993).
The monograph on E. pallida root is an example of a case where
specifications based on a proprietary extract of an herb were approved. This
preparation consists of a tincture (1:5) with 50% (v/v) ethanol from native
dry extract (50% ethanol, 7–11:1) corresponding to 900 mg of the herb, i.e.,
dried root. A placebo-controlled, double-blind trial conducted on 160 adults
indicated that a daily dose of 900 mg of the extract of E. pallida root was
effective in shortening the duration of URIs (sinusitis, cough, pharyngitis)
in infected adults, whether of bacterial or viral origin (Dorn et al., 1997).
There has been some confusion regarding the contraindications and side
effects listed in the monographs, most of which are for injectible
preparations. The contraindications noted below for echinacea preparations
in cases of HIV and AIDS, tuberculosis, leukosis, collagenosis, and
multiple sclerosis have been misinterpreted to mean that echinacea use can
exacerbate such conditions; however, there is no clinical evidence to
support this concern. The reason for the Commission's caution was based
on theoretical concerns and because such conditions are not amenable to
self-medication. A cogent argument by an Australian phytotherapist
suggests that there is no rational basis for this contraindication and in fact,
current clinical practice, previous prolonged use by Eclectic physicians in
the United States in the latter nineteenth and early twentieth centuries, and
proper evaluation of modern scientific data support long-term use of
echinacea preparations for autoimmune disorders (Bone, 1997–1998).
Regarding the issue of Commission E's contraindication of echinacea
preparations for various types of autoimmune disorders, Professor Bauer,
the world's leading researcher on echinacea, writes, "As far as I know, these
contraindications have only been included because of theoretical
considerations. There is a paper by Shohan (1985) in which the possible
risks of immunostimulating agents in general are discussed. These
recommendations for Echinacea are as far as I know not based on any
reported adverse effect in such indications. There is a recent paper by
Parnham (1996) which reports that long-term treatment, e.g., with the
expressed juice of E. purpurea, is well-tolerated" (Bauer, 1999b).
It should also be noted that in Germany, physicians previously had access
to injectable (parenteral) drug products made from either a
monopreparation of E. purpurea herb juice or a fixed combination that
contained E. pallida. Thus, the monographs for E. purpurea herb and E.
pallida root both note adverse side effects associated with injectable forms
of these echinacea products.
Despite safety concerns with injectable echinacea, there are few significant
adverse events reported for echinacea products taken orally. One such event
was a case of anaphylaxis reported with ingestion of an echinacea
preparation made of E. angustifolia (whole plant) and E. purpurea root
(Mullins, 1998). Animal toxicology studies indicate a high degree of safety
for echinacea: in experiments using oral (greater than 15 g per kg) or
intravenous (greater than 5 g per kg) administration, it was impossible to
kill rats or mice (Hoheisel et al., 1997). Thus, an average lethal dose has not
been determinable. Rats and mice given prolonged (4 weeks) doses of an E.
purpurea preparation up to 8 g per kg did not exhibit adverse effects on
numerous end points measured (blood lipids, liver enzymes, weight loss,
etc.) (Mengs et al., 1991).
Based on the data presented above, there are sufficient pharmacological and
clinical research studies to support the safety and probable efficacy of
preparations made from both the aerial parts of E. purpurea and the roots of
at least two and possibly three species of echinacea (E. pallida and E.
purpurea, and possibly, E. angustifolia).
Description
The fresh or dried roots, or the fresh or dried aboveground parts collected at
the time of flowering, of Echinacea angustifolia D.C. [Fam. Asteraceae]
and their preparations in effective dosage. The fresh or dried aboveground
parts, collected at the time of flowering, of E. pallida (Nutt.) Nutt., and
their preparations in effect dosage. On the market, preparations of E.
pallida are to some extent incorrectly labeled as "Echinacea angustifolia."
Chemistry and Pharmacology
Echinacea angustifolia herb contains caffeic acid derivatives such as
cichoric acid, echinacoside, verbascoside, chlorogenic acid, and
isochlorogenic acid; flavonoids of the quercetin and kaempferol type in free
and glycoside forms, including rutoside, luteolin, kaempferol, quercetin,
apigenin, and isorhamnetin; alkamides, mainly of the undeca-2,4-diene type
with the isomeric mixture of dodeca-2E,4E,8Z,10E/Z-tetraenoic acid
isobutylamides; polysaccharides; and < 0.1% essential oil (Bauer, 1998;
Bauer and Liersch, 1993; Leung and Foster, 1996; Pietta et al., 1998);
trideca-1-en-3,5,7,9,11-pentayne and ponticaepoxide have been detected in
the flowerbuds (Bauer and Liersch, 1993).
Echinacea angustifolia root contains caffeic acid derivatives, mainly
echinacoside (0.3–1.7%) followed by chlorogenic acid, an isochlorogenic
acid, and its characteristic constituent cynarin (1.5-O-Dicaffeoyl-quinic
acid); polysaccharides, including inulin (5.9%) and fructans; glycoproteins
comprised of approximately 3% protein of which the dominant sugars are
arabinose (64–84%), galactose (1.9–5.3%) and glucosamines (6%); 0.01–
0.15% alkamides, mainly derived from undeca- and dodeca-noic acid,
primarily the isomeric dodeca-2E,4E,8Z,10E/Z-tetraenoic acid
isobutylamides; and <0.1% essential oil (Bauer, 1998; Bauer, 1999a; Bauer
and Liersch, 1993; Pietta et al., 1998).
Echinacea pallida herb contains caffeic acid derivatives, including cichoric
acid, caftaric acid, echinacoside, verbascoside, chlorogenic acid, and
isochlorogenic acid; flavonoids mainly rutoside; alkamides, mainly of the
2,4-diene type with the isomeric mixture of dodeca-2E,4E,8Z,10E/Ztetraenoic acid isobutylamides; and <0.1% essential oil (Bauer, 1998; Bauer
and Liersch, 1993; Leung and Foster, 1996; Pietta et al., 1998).
Animal experiment: In the carbon clearance test, alcoholic root extracts as
well as extracts of the aboveground herb show a rate increase in elimination
of carbon particles. In vitro: Alcoholic root extracts show an increase in
phagocytic elements of 23% when tested in granulocyte smears.
Experiments reported in older publications cannot be definitely assigned to
either of these species.
Uses
Preparations of E. angustifolia are used to support and promote the natural
powers of resistance of the body, especially in infectious conditions
(influenza and colds, etc.) in the nose and throat, as an alterative in
influenza, inflammatory and purulent wounds, abscesses, furuncles,
indolent leg ulcers, herpes simplex, inflammation of connective tissue,
wounds, headaches, metabolic disturbances, and as a diaphoretic and
antiseptic. According to the Commission E, when the monograph was
published in August, 1992, efficacy for the uses listed above has not been
documented scientifically, although, as noted previously, recent
investigations suggest possible beneficial activity of E. angustifolia root
preparations (Galea and Thacker, 1996), although published studies are not
available. The Commission E noted that since the activity of the various
parts of the herbs for the conditions listed above has not been substantiated,
their therapeutic use could not be recommended. Because of the risks, the
use of parenteral (i.e., injectable) preparations is not justified. Parenteral
preparations of echinacea species are no longer approved in Germany.
However, the World Health Organization (WHO) conducted a more recent
review of the literature, including new research conducted since the
Commission E monograph was published in 1992, and concluded that the
following uses for E. angustifolia root (not aerial parts) are supported by
clinical data: supportive therapy for colds and infections of the respiratory
and urinary tracts (WHO, 1999).
Contraindications
Internal use: Commission E cautioned that echinacea preparations are not to
be used in systemic diseases such as tuberculosis, leukosis, collagenosis,
multiple sclerosis, AIDS, HIV infection, and other autoimmune diseases.
(As noted above, these cautions were made based on theoretical
considerations and not on any reports of adverse findings.)
Side Effects
Parenteral use: Depending upon the dosage, chills, short-term fever
reactions, and nausea and vomiting may occur. In rare cases immediate
allergic reactions may occur. If there is a tendency for allergy, especially
against Asteraceae, and during pregnancies, do not apply parenterally.
(Parenteral use of echinacea preparations is no longer approved in
Germany.)
Warning: The metabolic condition in diabetics can decline upon parenteral
application.
Use During Pregnancy and Lactation
No restrictions known.
Interactions with Other Drugs
None known.
Dosage and Administration
Echinacea angustifolia root:
Unless otherwise prescribed: 1 g cut root several times daily, for teas and
other galenical preparations for internal use.
Decoction: Boil 1 g root in 150 ml water for 10 minutes, three times daily
(Bradley, 1992).
Infusion: Steep 1 g root in 150 ml boiled water for at least 10 minutes,
several times daily between meals (Bauer and Liersch, 1993; Wichtl and
Bisset, 1994).
Fluidextract 1:1 (g/ml), 45% ethanol: 0.5–1.0 ml, three times daily
(Bradley, 1992).
Tincture 1:5 (g/ml), 45% ethanol: 2–5 ml, three times daily (Bradley,
1992).
References
Barrett, B., M. Vohmann, C. Calabrese. 1999. Echinacea for upper
respiratory tract infection. J Fam Pract 48(8):628–635.
Bauer, R. 1999a. Chemistry, analysis and immunological investigations of
Echinacea phytopharmaceuticals. In: Wagner, H. (ed.). Immunomodulatory
Agents from Plants. Basel, Switzerland: Birkh‰user Verlag. 41–88.
———. 1999b. Personal communication to M. Blumenthal. Jan. 21; Feb. 4.
———. 1998. Echinacea: Biological Effects and Active Principles. In:
Lawson, L. and R. Bauer (eds.). Phytomedicines of Europe: Chemistry and
Biological Activity. Washington, D.C.: American Chemical Society. 140–
157.
———. 1996. Echinacea-Drogen—Wirkungen und Wirksubstanzen
[Echinacea drugs—effects and active ingredients (Review). Z Arztl Fortbild
(Jena) 90(2):111–115.
Bauer, R. and R. Liersch. 1993. Echinacea. In: H‰nsel, R., K. Keller, H.
Rimpler, G. Schneider (eds.). Hagers Handbuch der Pharmazeutischen
Praxis, 5th ed. Vol. 5. Drogen E–O. New York: Springer Verlag. 1–34.
Bauer, R. and H. Wagner. 1991. Echinacea species as potential
immunostimulatory drugs. In: Wagner, H. and N.R. Farnsworth (eds.).
1991. Economic and Medicinal Plants Research, Vol. 5. New York:
Academic Press. 253–321.
Berg, A. et al. 1998. Influence of Echinacin (EC31) treatment on the
exercise-induced immune response in athletes. J Clin Res 1:367–380.
Blumenthal, M. 1993. Echinacea Highlighted as Cold and Flu Remedy.
HerbalGram 29:8–9.
Bone, K. 1997–1998. Echinacea: When Should it be Used? Eur J Herb
Med 3(3):13–17.
Bradley, P.R. (ed.). 1992. British Herbal Compendium, Vol. 1.
Bournemouth: British Herbal Medicine Association.
Br‰unig, B., M. Dorn, E. Knick. 1992. Echinacea purpurea radix for
strengthening the immune response in flu-like infections. Z Phytotherapie
13:7–13.
Brinkeborn, R.M, D.V. Shah, S. Geissbuhler, F.H. Degenring. 1998.
Echinaforce in the treatment of acute colds. Schweiz Zschr Ganzheits Med
10:26–29.
Brown, D.J. 1996. Herbal Prescriptions for Better Health. Rocklin, CA:
Prima Publishing. 63–68.
Coeugniet, E. and R. K hnast. 1986. Recurrent candidiasis: Adjutant
immunotherapy with different formulations of Echinacin . Therapiewoche
36:3352–3358.
Dorn, M., E. Knick, G. Lewith. 1997. Placebo-controlled, double-blind
study of Echinacea pallidae radix in upper respiratory tract infections.
Complement Ther Med 5:40–42.
Galea, S. and K. Thacker. 1996. Double-blind prospective trial
investigating the effectiveness of a commonly prescribed herbal remedy in
altering the duration, severity and symptoms of the common cold.
Unpublished.
Grimm, W. and H.H. M ller. 1999. A randomized controlled trial of the
effect of fluid extract of Echinacea purpurea on the incidence and severity
of colds and respiratory infections. Am J Med 106(2):138–143.
Hobbs, C. 1994. Echinacea: A literature review. HerbalGram 30:33–48.
Hoheisel, O., M. Sandberg, S. Bertram, M. Bulitta, M. Sch‰fer. 1997.
Echinagard treatment shortens the course of the common cold: a doubleblind, placebo-controlled clinical trial. Eur J Clin Res 9:261–269.
Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural
Ingredients Used in Food, Drugs, and Cosmetics, 2nd ed. New York: John
Wiley & Sons, Inc.
Melchart, D. and K. Linde. 1999. Clinical investigations of Echinacea
phytopharmaceuticals. In: Wagner, H. (ed.). Immunomodulatory Agents
from Plants. Basel: Birkhauser Verlag.
Melchart, D. et al. 1995. Results of five randomized studies on the
immunomodulatory activity of preparations of Echinacea. J Altern
Complement Med 1(2):145–160.
Melchart, D., K. Linde, F. Worku, R. Bauer, H. Wagner. 1994.
Immunomodulation with Echinacea—A systematic review of controlled
clinical trials. Phytomed 1:245–254.
Melchart, D., E. Walther, K. Linde, R. Brandmaier, C. Lersch. 1998.
Echinacea root extracts for the prevention of upper respiratory tract
infections: a double-blind, placebo-controlled randomized trial. Arch Fam
Med 7(6):541–545.
Mengs, U., C.B. Clare, J.A. Poiley. 1991. Toxicity of Echinacea purpurea.
Arzneimforsch/Drug Res 41(10): 1076–1081.
Mullins, R.J. 1998. Echinacea-associated anaphylaxis [letter]. Med J Aust
168(4):584.
Parnham, M.J. 1996. Benefit-risk assessment of the squeezed sap of the
purple coneflower (Echinacea purpurea) for long-term oral immunostimulation. Phytomed 3(1):95–102.
Pietta, P., P. Mauri, R. Bauer. 1998. MEKC analysis of different Echinacea
species. Planta Med 64:649–652.
Richman, A. and J.P. Witkowski. 1996. A Wonderful Year for Herbs.
Whole Foods Oct:52–60.
———. 1997. HerbsÖBy the Numbers. Whole Foods Oct:20–28.
———. 1998. Herb Sales Still Strong. Whole Foods Oct:19–26.
Schilcher, H. 1997. Personal communication to M. Blumenthal, Dec. 30.
Schˆneberger, D. 1992. The influence of immune-stimulating effects of
pressed juice from Echinacea purpurea on the course and severity of colds.
Forum Immunol 8:2–12.
See, D.M., N. Broumand, L. Sahl, J.G. Tilles. 1997. In vitro effects of
echinacea and ginseng on natural killer and antibody-dependent cell
cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired
immunodeficiency syndrome patients. Immunopharmacology 35(3):229–
235.
Shohan, J. 1985. Specific safety problems of inappropriate immune
responses to immunostimulating agents. TIPS 6:178–182.
Wagner, H. 1997. Herbal immunostimulants for the prophylaxis and
therapy of colds and influenza. Eur J Herbal Med 3(1).
WHO. See World Health Organization.
Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and
Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.
World Health Organization (WHO). 1999. "Herba Echinaceae Purpureae
Radix Echinacea" and "Radix Echinaceae." WHO Monographs on Selected
Medicinal Plants, Vol. 1. Geneva: World Health Organization. 136–144;
125–135.
Additional Resources
Bauer, R. 1997. Echinacea—Pharmazeutische Qualit‰t und
therapeutischer Wert. Z Phytother 18:207–214.
———. 1993. Neue Ergebnisse zur frage der wirksubstanzen von
Echinacea-drogen. Natur und G Med 6:32–40.
Bauer, R. and H. Wagner. 1990. Echinacea: Ein Handbuch f r ƒrtze,
Apotheker, und andere Naturwissenschaftler. Stuttgart: Wissenschaftliche
Verlagsgesellschaft.
———. 1988. Echinacea—Der Sonnenhut—Stand der Forschung. Z
Phytother 9(5):151–159.
Bauer, R., I.A. Khan, H. Wagner. 1988. TLC and HPLC analysis of
Echinacea pallida and E. angustifolia roots. Planta Med 54:426–430.
Bauer, R., P. Remiger, H. Wagner. 1988. Echinacea-vergleichende DCund HPLC-analyse der Herba-Drogen von Echinacea purpurea, Echinacea
pallida und Echinacea angustifolia. DAZ 128:174–180.
Bauer, R., K. Jurcic, J. Puhlmann, H. Wagner. 1988. Immunologische invivo und in-vitro untersuchungen mit Echinacea extrakten [Immunologic in
vivo and in vitro studies on Echinacea extracts]. Arzneimforsch 38(2):276–
281.
Bauer, R. et al. 1987. Two acetylenic compounds from Echinacea pallida
roots. Phytochem 26:1198–1200.
Bodinet, C., I. Willigmann, N. Beuscher. 1996. Host-resistance increasing
activity of root extracts from Echinacea species. Poster: Schaper and Br
mmer, D-38251 Salzgitter, F.R.G.
Bone, K. 1999. Echinacea: Fact and Mythology. HerbalGram 49 (in press).
Bradley, P.R. (ed.). 1992. British Herbal Compendium, Vol. 1.
Bournemouth: British Herbal Medicine Association. 81–83.
Brinkeborn, R.M., D.V. Shah, F.H. Degenring. 1999. Echinaforce and other
Echinacea fresh plant preparations in the treatment of the common cold. A
randomized, placebo-controlled, double-blind clinical trial. Phytomedicine
6(1):1–6.
Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants.
Paris: Lavoisier Publishing.
Burger, R.A., A.R. Torres, R.P. Warren, V.D. Caldwell, B.G. Hughes.
1997. Echinacea-induced cytokine production by human macrophages. Int J
Immunopharmacol 19(7):371–379.
Der Marderosian, A. (ed.). 1999. The Review of Natural Products. St.
Louis: Facts and Comparisons.
Dorn, M., E. Knick, G. Lewith. 1997. Placebo-controlled, double-blind
study of Echinaceae pallidae radix in upper respiratory tract infections.
Complement Ther Med 3:40–42.
Dorn, M. 1989. Mitigation of flu-like effects by means of a plant
immunostimulant. Natur und Ganzheitsmedizin 2:314–319.
Dorsch, W. 1996. Klinische anwendung von extrakten aus Echinacea
purpurea oder Echinacea pallida. Kritische wertung kontrollierter
klinischer studien. Z Arztl Fortbild (Jena) 90(2):117, 122.
Gallo, M., W.A. Koren, G. Koren. 1998. The safety of Echinacea use
during pregnancy: a prospective controlled cohort study. Proceedings of the
11th International Conference of the Organization of Teratology: San Diego,
June 19–21. Teratology 57:283.
H‰nsel, R., K. Keller, H. Rimpler, G. Schneider (eds.). 1992–1994.
Hagers Handbuch der Pharmazeutischen Praxis, 5th ed. Vol. 4–6. BerlinHeidelberg: Springer Verlag.
List, P.H. and L. Hˆrhammer (eds.). 1973–1979. Hagers Handbuch der
Pharmazeutischen Praxis, Vols. 1–7. New York: Springer Verlag.
McGuffin, M., C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal
Product Association's Botanical Safety Handbook. Boca Raton: CRC Press.
Schulthess, B.H., E. Giger, T.W. Baumann. 1991. Echinacea: anatomy,
phytochemical pattern, and germination of the achene. Planta Med
57(4):384–388.
Shalaby, A.S. et al. 1997. Response of Echinacea to some agricultural
practices. J Herbs Spices Med Plants 4(4):59–67.
Skwarek, T., Z. Tynecka, K. Glowniak, E. Lutostankska. 1996. Echinacea
L. Inducer of interferons. Herba Polonica 42(2):110–117.
Snow, J.M. 1997. Echinacea (Moench) spp. Asteraceae. Protocol J Botan
Med 2(2):18–24.
Wichtl, M. (ed.). 1997. Teedrogen, 4th ed. Stuttgart: Wissenschaftliche
Verlagsgesellschaft.
Wood, H.C. et al. The Dispensatory of the United States of America,
Centennial (22nd) ed. Philadelphia: J.B. Lippincott Co. 1:402.
Note
This material was adapted from The Complete German Commission E
Monographs—Therapeutic Guide to Herbal Medicines. M. Blumenthal,
W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister
(eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical
Council; Boston: Integrative Medicine Communications.
1) The Overview section is new information.
2) Description, Chemistry and Pharmacology, Uses, Contraindications,
Side Effects, Interactions with Other Drugs, and Dosage sections have been
drawn from the original work. Additional information has been added in
some or all of these sections, as noted with references.
3) The dosage for equivalent preparations (tea infusion, fluidextract, and
tincture) have been provided based on the following example:
Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or
whole] [plant part]
Infusion: 2 g in 150 ml of water
Fluidextract 1:1 (g/ml): 2 ml
Tincture 1:5 (g/ml): 10 ml
4) The References and Additional Resources sections are new sections.
Additional Resources are not cited in the monograph but are included for
research purposes.
This monograph, published by the Commission E in 1994, was modified
based on new scientific research. It contains more extensive
pharmacological and therapeutic information taken directly from the
Commission E.
Excerpt from Herbal Medicine: Expanded Commission E Monographs
Copyright 2000 American Botanical Council
Published by Integrative Medicine Communications
Available from the American Botanical Council.
This material is not intended as a guide to self medication by consumers.
The lay reader is advised to discuss the information contained herein with a
doctor, pharmacist, nurse or other authorized health care practitioner.
Neither the editors nor the publisher accepts any responsibility for the
accuracy of the information itself or the consequences from the use or
misuse of the information contained herein.
Home | Contact Us | Privacy Policy | Sponsors
American Botanical Council, 6200 Manor Rd, Austin, TX 78723
Phone: (512) 926-4900 | Fax: (512) 926-2345 | Email: [email protected]
American Botanical Council, 6200 Manor Rd, Austin, TX 78723
Phone: 512-926-4900 | Fax: 512-926-2345 | Email: [email protected]
The information on this site is intended for educational purposes only and is not a substitute for the advice of a qualified healthcare
professional. The American Botanical Council does not endorse or test products, nor does it verify the content or claims made, either
implicit or explicit. ABC does not accept responsibility for the consequences of the use of this information or its most up-to-date accuracy.
ABC is a nonprofit, tax-exempt research and education organization under IRS section 501(c)(3). All text, images and content Copyright ©
2005 American Botanical Council, unless otherwise noted.