Echinacea

Are there any interactions with medications?

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Caffeine
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down caffeine to get rid of it. Echinacea might decrease how quickly the body breaks down caffeine. Taking echinacea along with caffeine might cause too much caffeine in the bloodstream and increase the risk of side effects. Common side effects include jitteriness, headache, and fast heartbeat.

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Medications changed by the body (Cytochrome P450 3A4 (CYP3A4) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the body. Echinacea might change how the body breaks down some medications. Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the body.

Some medications changed by the body include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and many others.

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Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Some medications are changed and broken down by the liver. Echinacea might decrease how quickly the liver breaks down some medications. Taking echinacea along with some medications might increase the effects and side effects of some medications. Before taking echinacea, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some of the medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others

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Medications that decrease the immune system (Immunosuppressants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Echinacea can increase the activity of the immune system. Taking echinacea along with some medications that decrease the immune system might decrease these medications' effectiveness.

Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

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Midazolam (Versed)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Taking midazolam (Versed) with echinacea increases how much midazolam (Versed) the body absorbs. This might increase the effects and side effects of midazolam (Versed), but more information is needed.

Dosing considerations for Echinacea.

The following doses have been studied in scientific research:

BY MOUTH:

For treatment of upper respiratory infections including the common cold and influenza, a wide variety of doses have been used depending on how the echinacea is prepared. These preparations include:

• A tablet containing 6.78 mg of Echinacea purpurea crude extract based on 95% herb and 5% root (Echinaforce, Bioforce AG): two tablets given 3 times daily.
• Freeze-dried echinacea juice extract capsules: 100 mg three times daily.
• Echinacea purpurea herb juice: a daily dose of 6-9 mL for up to a maximum of 8 weeks. Echinacea purpurea herb juice has also been used in a dose of 20 drops every 2 hours for the first day followed by 20 drops three times daily until cold or flu symptoms improve.
• An echinacea pallida root tincture equivalent to 900 mg herb daily.
• An echinacea herbal compound tea (Echinacea Plus, Traditional Medicinals), consisting of leaves, flowers, and stems of Echinacea purpurea and Echinacea angustifolia plus dried extract of Echinacea purpurea root, has been used by drinking 5-6 cups of tea on the first day of symptoms and titrating down to 1 cup per day over the next 5 days. The tea is prepared by pouring 8 ounces of boiling water over one tea bag and steeping, covered, for 10-15 minutes.
• Echinacea liquid (Echinagard): 20 drops every 2 hours for the first day of symptoms, then 3 times daily for up to 10 days.
• A tablet containing 100 mg of a proprietary Echinacea angustifolia root extract (Monoselect Echinacea, PharmExtracta, Italy): 2 tablets daily for 15 days, then 1 tablet daily for 15 days, then 1 tablet every other day for 60 days to help prevent colds and the flu.
• Echinacea purpurea liquid: 0.9 mL 3 times daily for 4 months to help prevent colds.