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Avoid with known allergy or hypersensitivity to Echinacea , its constituents, or any members of the Asteraceae (Compositae) family (including ragweed, chrysanthemum, marigold, and daisy).
Individuals with asthma may be predisposed to allergic reactions to echinacea.
Anaphylaxis (a life-threatening allergic reaction), bronchospasm, hives, itching, elevated blood pressure, rash, swelling of both hands, and swelling under the skin have been reported.
Side Effects and Warnings
Echinacea has been well tolerated in clinical practice and in trials, with few, primarily gastrointestinal, adverse events reported.
Echinacea may cause abdominal pain, acute kidney failure, allergic rash, atrial fibrillation (irregular heartbeat), dizziness, drowsiness, ear infection (in children), headache, hives, low white cell count, mild nausea, rash, sore throat, tender red nodules under the skin, thrombotic thrombocytopenic purpura (a blood clotting disorder) and vomiting.
Use cautiously in patients with asthma or those prone to allergic skin reactions, due to a high likelihood of allergic reactions with oral or topical echinacea.
Use injectable preparations of echinacea (no longer approved for use in Germany) cautiously. Safety has not been established, and in diabetics, injectable administration may worsen blood sugar control.
Use tinctures cautiously with alcoholic patients or in patients taking disulfiram or metronidazole, as many tinctures contain significant concentrations of alcohol (range: 15-90%). This combination may elicit a disulfiram (strong nausea and vomiting) reaction.
The German Commission has warned against the use of echinacea in patients with AIDS/HIV, collagen vascular diseases, multiple sclerosis, or tuberculosis, due to theoretical adverse effects on immune function.
Some natural medicine experts also discourage the use of echinacea by people with conditions affecting the immune system, such as HIV/AIDS, some types of cancer, multiple sclerosis, tuberculosis, and rheumatologic diseases (such as rheumatoid arthritis or lupus).
Use cautiously in patients with hemochromatosis (iron storage disease), based on a lack of reports on liver function. Numerous reports of hepatitis have been associated with echinacea use.
Patients consuming large amount of echinacea have experienced elevations in their transaminases (liver function tests).
Use cautiously in patients who are taking amoxicillin, because there is one poorly described case of rhabdomyolysis and shock, followed by death.
Use cautiously in patients who are taking anticancer agents.
Echinacea may interfere with the way the body processes certain drugs, herbs, or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of these agents may change in the blood, and may cause increased or decreased effects or potentially serious adverse reactions. Patients taking any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Use cautiously in those taking immunostimulants or immunosuppressants, as echinacea may have immunostimulant effects.
Use cautiously in patients who are taking agents that damage the liver (e.g., anabolic steroids, amiodarone, methotrexate, or ketoconazole), due to a possible risk of hepatitis.
Use cautiously in patients who are taking kava, due to a possible risk of liver damage. The German Commission Expert panel considers echinacea in recommended doses safe for use (by mouth) during pregnancy and breastfeeding. However, most experts do not recommend injection or infusion of echinacea during pregnancy. Tinctures may not be advised due to their 15-90% alcohol content.
Avoid using echinacea in patients undergoing anesthesia. Avoid with known allergy or hypersensitivity to Echinacea , its constituents, or any members of the Asteraceae (Compositae) family (including ragweed, chrysanthemum, marigold, and daisy). Anaphylaxis (a life-threatening allergic reaction), bronchospasm, hives, itching, elevated blood pressure, rash, swelling of both hands, swelling under the skin have been reported.
Pregnancy and Breastfeeding
The German Commission Expert panel considers oral echinacea in recommended doses safe for use in pregnancy and lactation. However, most experts do not recommend injection or infusion of echinacea during pregnancy. Tinctures may not be advised due to their 15-90% alcohol content.