Meta Information
ID:echinacea
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-21T22:30:00Z
Model
phase-a-upgrade-claude-sonnet-4.6
Interactions
Target id:
/class/immunosuppressants
Target name:
Immunosuppressant Medications
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Echinacea stimulates the immune system, which can directly counteract the intended effects of immunosuppressant drugs (e.g., cyclosporine, tacrolimus) used to prevent organ transplant rejection or treat autoimmune diseases.
Actionable advice:
Echinacea should not be used at all when taking any immunosuppressant medication.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Purified polysaccharides (EPS) prepared from the plant Echinacea purpurea are shown to strongly activate macrophages.
Label source:
PubMed: Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. (PMID 6389368)
Action type:
avoid
Target id:
/condition/autoimmune-disease
Target name:
Autoimmune Diseases
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
By stimulating the immune system, Echinacea may potentially worsen the activity of autoimmune diseases such as rheumatoid arthritis, lupus, multiple sclerosis, or type 1 diabetes.
Actionable advice:
Echinacea should not be used with an autoimmune condition, unless approved by a doctor.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Several in vitro and in vivo studies have shown that Spirulina platensis, Aphanizomenon flos-aqua, Chlorella, Echinacea, and alfalfa activate immune cells via certain cytokines and chemokines. Case reports suggest the association of ingesting immunostimulatory herbs and the clinical onset or flares of diseases characterized by an exaggerated immune response such as lupus erythematosus, dermatomyositis, and autoimmune blistering disorders.
Label source:
PubMed: Journal of the American Academy of Dermatology (2021)
Source url:
Exact phrase from label:
These herbs were widely marketed for 'immune support' and shared proinflammatory mechanisms, including toll-like receptor activation, NF-κB/MAPK signalling and increased production of inflammatory cytokines including IL-1β, IL-6, TNF-α, IL-12 and IFN-γ.
Label source:
PubMed: Lupus science & medicine (2025)
Source url:
Exact phrase from label:
Safety issues include the possibility of allergic reactions, the use of echinacea by patients with autoimmune diseases and the potential for echinacea preparations to interact with conventional medicines.
Label source:
PubMed: The Journal of pharmacy and pharmacology (2005)
Action type:
avoid
Target id:
/condition/asteraceae-allergy
Target name:
Allergy to Asteraceae/Compositae Family Plants
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Echinacea is a member of the daisy (Asteraceae) family. Individuals with allergies to related plants like ragweed, chrysanthemums, marigolds, or daisies are at high risk for an allergic reaction.
Actionable advice:
Echinacea should not be taken with an allergy to ragweed, daisies, or related plants.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Regular ingestion of echinacea by up to 5% of surveyed patients with atopy, combined with detection of echinacea-binding IgE in atopic subjects (19% by skin testing; 20% with moderate to strong reactivity by RAST testing), raises the possibility of severe allergic reactions, even with first-time use, due to cross-reactivity with other structurally similar allergens.
Label source:
PubMed: The Medical journal of Australia (1998)
Source url:
Exact phrase from label:
The possibility that cross-reactivity between echinacea and other environmental allergens may trigger allergic reactions in "echinacea-naïve" subjects is supported by the Australian data. Given its widespread (and largely unsupervised) community use, even rare adverse events become inevitable.
Label source:
PubMed: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology (2002)
Source url:
Exact phrase from label:
The Compositae (Asteraceae) family of plants is currently an important cause of allergic plant contact dermatitis in Europe. The family comprises some of the oldest and most valued medicinal plants, and the increasing popularity of herbal medicine and cosmetics may theoretically result in a growing number of Compositae sensitizations from these sources. According to the literature at least 15 species, including among others arnica (Arnica montana), German and Roman chamomile (Chamomilla recutita and Chamaemelum nobile), marigold (Calendula officinalis), Echinacea and elecampane (Inula helenium), have been suspected of sensitization or elicitation of Compositae dermatitis.
Label source:
PubMed: Contact dermatitis (2002)
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
The safety of Echinacea during pregnancy has not been well-established, and it is generally recommended to avoid use due to unknown risks to the fetus.
Actionable advice:
Echinacea should not be used at all during pregnancy.
Validation status:
anecdotal
Evidence tier:
tier_d
Evidence basis:
anecdotal_summary
Evidence anchors:
Exact phrase from label:
Many herbs and herbal products have not been studied, or well-studied, for use in human pregnancy.
Label source:
Anecdotal: MotherToBaby
Action type:
avoid
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
It is unknown if components of Echinacea pass into breast milk or what effects they might have on a nursing infant; therefore, its use is not recommended.
Actionable advice:
Echinacea should not be used while breastfeeding.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Action type:
avoid
Target id:
/class/cyp3a4-substrates
Target name:
Medications Metabolized by CYP3A4
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Echinacea can inhibit the CYP3A4 enzyme, which may increase the concentration and risk of side effects from many common medications, including some statins, calcium channel blockers, and benzodiazepines.
Actionable advice:
It is a good idea to consult a pharmacist or doctor to check for interactions when taking any prescription medications.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Weak effects in terms of either induction or inhibition were found for GB (presystemic/hepatic CYP3A4 induction/inhibition, CYP2C19 induction at high doses), milk thistle/silymarin (CYP2C9 inhibition), GS/berberine (CYP3A4 and CYP2D6 inhibition), Echinacea (presystemic/hepatic CYP3A4 inhibition/induction, CYP1A2 and CYP2C9 inhibition at high doses).
Label source:
PubMed: Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. (PMID 22855269)
Action type:
informational_none
Target id:
/class/corticosteroids
Target name:
Corticosteroids
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Echinacea's immune-stimulating properties may oppose the immune-suppressing action of corticosteroids like prednisone, potentially reducing their effectiveness.
Actionable advice:
Echinacea is best avoided while on long-term or high-dose corticosteroid therapy.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Immunostimulants (eg, Echinacea and zinc) should not be given with immunosuppressants (eg, corticosteroids and cyclosporine).
Label source:
PubMed: Archives of internal medicine (1998)
Source url:
Exact phrase from label:
Moreover, IMU significantly increased protection rates post-challenge, HI antibody titers and heterophil phagocytic activity and decreased DEX-induced stress and virus shedding titers.
Label source:
PubMed: Comparative immunology, microbiology and infectious diseases (2019)
Source url:
Exact phrase from label:
Our findings suggest that Echinacea might have beneficial effects on restraint stress-induced immunosuppression by increasing splenocyte proliferation and NK cell activity, while modulating T lymphocyte subsets and cytokine levels in the blood.
Label source:
PubMed: Journal of medicinal food (2018)
Action type:
avoid
Target id:
/condition/hepatic-impairment
Target name:
Liver Disease or Impairment
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Although rare, there are case reports of liver inflammation associated with long-term Echinacea use. Caution is advised in individuals with pre-existing liver conditions.
Actionable advice:
It is important to talk to a doctor before using Echinacea with a history of liver problems.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
If used beyond 8 weeks, Echinacea could cause hepatotoxicity and therefore should not be used with other known hepatoxic drugs, such as anabolic steroids, amiodarone, methotrexate, and ketoconazole.
Label source:
PubMed: Archives of internal medicine (1998)
Source url:
Exact phrase from label:
A case of medicinal damage to the liver with an immunomodulatory herbal preparation Immunostimulating collection, which included St. John's wort, Elecampane, Kopeichnik, Echinacea, Licorice, Rosehip, is presented.
Label source:
PubMed: Terapevticheskii arkhiv (2021)
Source url:
Exact phrase from label:
Further, the incidences of hepatotoxicity and nephrotoxicity may be augmented by acetaminophen when concomitantly used with the potentially hepatotoxic herbs Echinacea and kava, and with herbs containing salicylate (willow, meadowsweet), respectively.
Label source:
PubMed: Journal of clinical pharmacy and therapeutics (2002)
Action type:
informational_none
Target id:
/class/cyp1a2-substrates
Target name:
Medications Metabolized by CYP1A2
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Some evidence suggests Echinacea may induce (speed up) the CYP1A2 enzyme, potentially decreasing the effectiveness of drugs it metabolizes, such as caffeine and theophylline.
Actionable advice:
The effects of substances like caffeine may be reduced when taking Echinacea.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Echinacea preparations potentiated up-regulation of CYP1A2, CYP3A4 and MDR1 via PXR activation.
Label source:
PubMed: Echinacea purpurea up-regulates CYP1A2, CYP3A4 and MDR1 gene expression by activation of pregnane X receptor pathway. (PMID 25377539)
Action type:
informational_none
Target id:
/intervention/caffeine
Target name:
Caffeine
Severity:
minor
Interaction type:
diminishing
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Echinacea may increase the activity of the CYP1A2 enzyme, leading to faster breakdown of caffeine and potentially reducing its stimulant effects.
Actionable advice:
You may notice a reduced effect from your usual amount of coffee or other caffeinated products.
Validation status:
validated_via_primary_literature
Evidence tier:
tier_b
Evidence basis:
primary_literature_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Echinacea preparations potentiated up-regulation of CYP1A2, CYP3A4 and MDR1 via PXR activation.
Label source:
PubMed: Echinacea purpurea up-regulates CYP1A2, CYP3A4 and MDR1 gene expression by activation of pregnane X receptor pathway. (PMID 25377539)
Action type:
informational_none
Target id:
/class/anticoagulants-antiplatelets
Target name:
Anticoagulant and Antiplatelet Drugs
Severity:
minor
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
There is a theoretical risk that Echinacea could affect platelet function, potentially increasing the risk of bleeding when combined with drugs like warfarin or aspirin, though evidence is limited.
Actionable advice:
This is best used with caution, and it is worth monitoring for signs of increased bruising or bleeding when taking blood-thinning medications.
Validation status:
validated_via_pubmed
Evidence tier:
tier_b
Evidence basis:
pubmed_abstract_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Pharmacodynamic (INR, platelet activity) and pharmacokinetic (warfarin enantiomer concentrations) end points were evaluated. RESULTS: The apparent clearance of (S)-warfarin (90% CI of ratio; 1.01, 1.18) was significantly higher during concomitant treatment with echinacea but this did not lead to a clinically significant change in INR (90% CI of AUC of INR; 0.91, 1.31). Policosanol did not significantly affect warfarin enantiomer pharmacokinetics or warfarin response. Neither echinacea nor policosanol had a significant effect on platelet aggregation after 2 weeks of pre-treatment with the respective herbal medicines.
Label source:
PubMed: British journal of clinical pharmacology (2010)
Source url:
Exact phrase from label:
Cordyceps sinensis, echinacea, and aloe vera are loosely associated with surgical bleeding independent of anticoagulants.
Label source:
PubMed: Proceedings (Baylor University. Medical Center) (2022)
Source url:
Exact phrase from label:
The aim of our study was to assess if macromolecular glycoconjugates from selected herbal plants of Asteraceae family: Achillea millefolium L., Arnica montana L., Echinacea purpurea L., Solidago virgaurea L., Chamomilla recutita (L.) Rauschert., and Conyza canadensis L. protect platelet proteins against nitrative and oxidative damage induced by peroxynitrite, which is responsible for oxidative/nitrative modifications of platelet proteins: the formation of 3-nitrotyrosine and carbonyl groups.
Label source:
PubMed: International journal of biological macromolecules (2010)
Action type:
monitor