Echinacea
Echinacea is commonly used for colds and immune support. Evidence is mixed and depends on species, part used, and timing.
Overview
What is echinacea?
Echinacea refers to a group of flowering plants in the daisy family. Many common cold supplements contain echinacea.
Dosage
A typical dose is 900-1,500 mg per day, split into three doses.
Effect graph
Effect heatmap
SupplementDEX Database
14 conditions for and rated at least stars. All purchase bands. No minimum star filter.
Database Snapshot
Most echinacea research is concentrated in a handful of conditions.
- Common cold accounts for 22 of 68 studies (32%).
- Respiratory tract infections accounts for 13 of 68 studies (19%).
- Upper respiratory tract infection accounts for 10 of 68 studies (15%).
- Sparse coverage remains for Otitis media, Tonsillitis, Eczema.
Safety
Dose windows
Short-term
Echinacea is likely safe and well tolerated when used at typical doses in the short term.
Frequently Asked Questions
References
Sources53 references
SupplementDEX uses only high-quality sources to determine supplement effectiveness.
SupplementDEX Database · Common cold
22 references1.SupplementDEX Database: Common cold — Reduction of Viral Load in Patients with Acute Sore Throats: Results from an Observational Clinical Trial with Echinacea/Salvia Lozenges2023
In 74 patients with acute sore throat treated with Echinacea/Salvia lozenges for 4 days, throat pain fell 48% after one lozenge; in 18 virus-positive patients, viral load dropped 96% by day 4.
2.SupplementDEX Database: Common cold — Echinacea reduces antibiotic usage in children through respiratory tract infection prevention: a randomized, blinded, controlled clinical trial2021
In 103 children (ages 4–12) over two 2-month prevention periods, Echinacea purpurea 1,200 mg/day reduced respiratory infection episodes by 32.5%, antibiotic use by 76.3%, and influenza detections versus vitamin C control.
3.SupplementDEX Database: Common cold — Echinacea for preventing and treating the common cold2014
A Cochrane review of 24 RCTs (4,631 participants) found no individual prevention trial showed significant cold reduction, though pooled trends suggested a 10–20% relative risk reduction; treatment trials showed minimal benefit.
4.SupplementDEX Database: Common cold — Safety and Efficacy Profile of Echinacea purpurea to Prevent Common Cold Episodes: A Randomized, Double-Blind, Placebo-Controlled Trial2012
In 755 healthy adults over 4 months, E. purpurea extract was noninferior to placebo for safety and significantly reduced total cold episodes, episode days, and pain-killer use, especially preventing enveloped virus infections.
5.SupplementDEX Database: Common cold — Echinacea for treating the common cold: a randomized trial2010
In 719 patients (ages 12–80) with new-onset colds, echinacea at 10.2 g/day on day 1 did not significantly reduce illness severity (P = 0.089) or duration (P = 0.075) versus blinded placebo.
6.SupplementDEX Database: Common cold — Effects of echinacea on the frequency of upper respiratory tract symptoms: a randomized, double-blind, placebo-controlled trial2008
In 58 hospital workers over 8 weeks, E. purpurea 6 capsules/day did not significantly reduce sick days (9 vs 14 days per person) compared with parsley placebo (p = 0.67).
7.SupplementDEX Database: Common cold — Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis2007
A meta-analysis of 14 studies found echinacea decreased cold incidence by 58% (OR 0.42) and shortened cold duration by 1.4 days, though heterogeneity was high.
8.SupplementDEX Database: Common cold — Echinacea in the prevention of induced rhinovirus colds: a meta-analysis2006
A meta-analysis of 3 experimental rhinovirus challenge studies found echinacea reduced symptomatic cold odds by 55% (OR 1.55 for placebo vs echinacea) but did not significantly reduce total symptom scores.
9.SupplementDEX Database: Common cold — Echinacea for preventing and treating the common cold2006
A Cochrane review of 16 trials found no prevention benefit from echinacea, but aerial-part E. purpurea preparations showed some evidence for early treatment of colds in adults, with inconsistent results across preparations.
10.SupplementDEX Database: Common cold — An evaluation of Echinacea angustifolia in experimental rhinovirus infections2005
In 437 volunteers experimentally inoculated with rhinovirus, three E. angustifolia root extracts (prophylactic or treatment) showed no significant effects on infection rates, symptom severity, or nasal inflammatory markers.
11.SupplementDEX Database: Common cold — A proprietary extract from the echinacea plant (Echinacea purpurea) enhances systemic immune response during a common cold2005
In patients with naturally acquired colds treated with Echinilin echinacea or placebo for 7 days, echinacea reduced total symptom scores and increased circulating white blood cells and NK cells versus placebo.
12.SupplementDEX Database: Common cold — Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial2004
In 128 adults with colds treated with E. purpurea 300 mg/day or placebo for up to 14 days, echinacea did not significantly reduce total symptom scores or time to resolution (P = 0.73).
13.SupplementDEX Database: Common cold — Echinacea purpurea for prevention of experimental rhinovirus colds2004
In 48 healthy adults challenged with rhinovirus, prophylactic echinacea did not reduce infection rate (92% vs 95%) or cold incidence (58% vs 82%, P = 0.114) versus placebo.
14.SupplementDEX Database: Common cold — Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial2004
In 128 adults with naturally acquired colds, standardized echinacea (Echinilin) reduced total daily symptom scores by 23.1% versus placebo (P < 0.01) when taken at symptom onset for 7 days.
15.SupplementDEX Database: Common cold — Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial2003
In 407 children (ages 2–11) with URIs over 4 months, E. purpurea did not reduce URI duration (9 days both groups) or severity, and was associated with increased rash (7.1% vs 2.7%, P = 0.008).
16.SupplementDEX Database: Common cold — Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial2002
In 148 college students with colds, unrefined echinacea (1 g six times on day 1, then 3× daily) did not significantly reduce symptom duration (6.27 vs 6.01 days) or severity versus placebo.
17.SupplementDEX Database: Common cold — Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial2001
In 80 adults with common colds, EC31J0 echinacea significantly shortened time to complete cold picture (median 6 vs 9 days with placebo, one-sided p = 0.011) and was well tolerated.
18.SupplementDEX Database: Common cold — The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study2000
In 95 adults with early cold or flu symptoms over 5 days, Echinacea Plus tea (5–6 cups/day) significantly reduced symptom duration and severity versus placebo (p < 0.001), with no adverse effects reported.
19.SupplementDEX Database: Common cold — Ineffectiveness of echinacea for prevention of experimental rhinovirus colds2000
In an experimental rhinovirus challenge, echinacea did not significantly reduce infection rate (44% vs 57%) or illness rate (36% vs 43%) compared with placebo.
20.SupplementDEX Database: Common cold — A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections1999
In 108 adults with frequent colds over 8 weeks, E. purpurea fluid extract (8 mL twice daily) did not significantly reduce cold incidence (65% vs 74%), duration (4.5 vs 6.5 days), or severity versus placebo.
21.SupplementDEX Database: Common cold — Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial1999
In 246 adults with common colds treated for up to 7 days, Echinaforce and its concentrated preparation significantly reduced symptom scores versus placebo and a special radix extract, with good tolerability.
22.SupplementDEX Database: Common cold — Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial1998
In 302 healthy adults over 12 weeks, echinacea root extracts did not significantly delay time to first URTI (66–69 vs 65 days) or reduce infection rate (~29–32% vs 37% placebo), though subjects perceived greater benefit.
SupplementDEX Database · Anxiety
4 references23.SupplementDEX Database: Anxiety — The Effects of Echinacea (EP107TM) on Anxiety: A Comparison of Anxiety Measures in a Randomized, Double Blind, Placebo-Controlled Study2025
A double-blind RCT found Echinacea EP107 significantly reduced psychic anxiety on the HADS-A subscale versus placebo, though HAM-A total scores did not differ; psychic HAM-A items improved with echinacea.
24.SupplementDEX Database: Anxiety — An investigation into the anxiety-relieving and mood-enhancing effects of Echinacea angustifolia (EP107™): A randomised, double-blind, placebo-controlled study2021
In 104 adults with mild-to-moderate anxiety over 6 weeks, echinacea angustifolia 40–80 mg/day did not reduce anxiety scores more than placebo on the primary CUXOS scale, though positive affect and emotional wellbeing improved.
25.SupplementDEX Database: Anxiety — Double-blind placebo controlled trial of the anxiolytic effects of a standardized Echinacea extract2019
In a 7-day double-blind trial, standardized echinacea angustifolia 40 mg twice daily significantly reduced state anxiety scores by ~11 points versus ~3 points with placebo (p < 0.01), with no effect on depression scores.
26.SupplementDEX Database: Anxiety — The anxiolytic potential and psychotropic side effects of an echinacea preparation in laboratory animals and healthy volunteers2012
In healthy volunteers with high STAI anxiety scores, echinacea angustifolia 40 mg/day for 1 week significantly reduced state anxiety within 3 days, with no central nervous system side effects in animal models.
27.SupplementDEX Database: Respiratory tract infections — Efficacy and safety of Echinacea purpurea in treating upper respiratory infections and complications of otitis media in children: Systematic review and meta-analysis2025
A meta-analysis of 9 pediatric RCTs (1,651 placebo, 1,518 treatment) found E. purpurea reduced URTI duration (SMD −0.19), incidence (RR 0.81), and antibiotic use (RR 0.18), and lowered otitis media episodes (RR 0.56), with mildly increased adverse events.
28.SupplementDEX Database: Respiratory tract infections — Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA)2024
A meta-analysis of 30 trials (5,652 subjects) found echinacea reduced monthly RTI occurrence (RR 0.68), complications (RR 0.44), and antibiotic use (RR 0.60), with similar adverse event rates to control.
29.SupplementDEX Database: Respiratory tract infections — Evaluating the Efficacy and Safety of EZC Pak, a 5-Day Combination Echinacea-Zinc-Vitamin C Dose Pack with or without Vitamin D, in the Management of Outpatient Upper Respiratory Infections2024
In 360 outpatients with URIs, EZC Pak (echinacea-zinc-vitamin C) shortened illness by 1.39 days (p = 0.017) and reduced symptom severity by 17.4% (p = 0.029) versus placebo; adding vitamin D did not add benefit.
30.SupplementDEX Database: Respiratory tract infections — Therapeutic Potential of a Natural Blend of Aronia melancarpa, Lonicera caerulea, and Echinacea purpurea Extracts in Treating Upper Respiratory Tract Infections: Preliminary Clinical and In Vitro Immunomodulatory Insights2024
In 61 URTI-prone adults over 60 days, an ELA blend (echinacea, Lonicera, Aronia) reduced URTI episodes (2 vs 8; p = 0.044) and throat symptoms (8 vs 16; p = 0.038) versus placebo, with in vitro antiviral and immunomodulatory effects.
31.SupplementDEX Database: Respiratory tract infections — Novel Echinacea formulations for the treatment of acute respiratory tract infections in adults-A randomized blinded controlled trial2023
In 246 adults with acute RTI, high-dose novel echinacea formulations (16,800 mg/day days 1–3) achieved faster viral clearance than conventional 2,400 mg/day doses, with a trend toward faster clinical recovery by day 10.
32.SupplementDEX Database: Respiratory tract infections — Echinacea Purpurea For the Long-Term Prevention of Viral Respiratory Tract Infections During Covid-19 Pandemic: A Randomized, Open, Controlled, Exploratory Clinical Study2022
In 120 healthy adults over ~6 months, daily 2,400 mg E. purpurea reduced any viral RTI (RR 0.68) and SARS-CoV-2 positivity (RR 0.37, p = 0.03) versus control, with fewer fever days during acute treatment.
33.SupplementDEX Database: Respiratory tract infections — Randomised, double blind, placebo-controlled trial of echinacea supplementation in air travellers2011
In 175 long-haul air travelers, echinacea (standardized to 4.4 mg alkylamides) borderline significantly reduced respiratory symptom scores during travel (P = 0.05) versus placebo.
34.SupplementDEX Database: Respiratory tract infections — Echinacea purpurea and mucosal immunity2007
In 32 subjects over 4 weeks, echinacea attenuated exercise-induced salivary IgA suppression and shortened reported URTI duration (3.4 vs 8.6 days) versus placebo, without reducing URTI incidence.
35.Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections. See external sourceExternal source
Upper respiratory tract infection
1 reference36.Placebo-controlled, double-blind study of Echinaceae pallidae radix in upper respiratory tract infections. See external sourceExternal source
SupplementDEX Database · Athletic performance
4 references37.SupplementDEX Database: Athletic performance — Echinacea Supplementation Does Not Impact Aerobic Capacity and Erythropoiesis in Athletes: A Meta-Analysis2024
A meta-analysis of 6 RCTs (107 athletes) found echinacea supplementation did not significantly improve maximal oxygen uptake, erythropoietin, hemoglobin, or hematocrit, though small positive effect sizes for hemoglobin did not reach significance.
38.SupplementDEX Database: Athletic performance — Six weeks of oral Echinacea purpurea supplementation does not enhance the production of serum erythropoietin or erythropoietic status in recreationally active males with above-average aerobic fitness2019
In 24 recreationally active men given 8,000 mg/day E. purpurea or placebo for 6 weeks, echinacea did not change serum erythropoietin, hemoglobin, hematocrit, or other erythropoietic markers.
39.SupplementDEX Database: Athletic performance — Echinacea-Based Dietary Supplement Does Not Increase Maximal Aerobic Capacity in Endurance-Trained Men and Women2015
In 45 endurance-trained adults over 35 days, echinacea at 8,000 or 16,000 mg/day did not increase VO2max or alter blood markers compared with placebo, despite VO2max gains in the placebo and low-dose groups.
40.SupplementDEX Database: Athletic performance — Running economy and maximal oxygen consumption after 4 weeks of oral Echinacea supplementation2012
In 24 men given 8,000 mg/day echinacea or placebo for 4 weeks, the echinacea group had significantly higher EPO, VO2max (+1.47%), and improved running economy versus placebo.
SupplementDEX Database · COVID-19
2 references41.SupplementDEX Database: COVID-19 — Investigating the effect of echinacea extraction syrup on the outcomes of lower respiratory infections in patients with COVID-19: a randomized clinical trial study2024
In 40 hospitalized COVID-19 patients over 5 days, adding echinacea syrup to standard care did not significantly improve oxygen saturation, lung involvement, or cough versus control, though WBC fell in the echinacea group.
42.SupplementDEX Database: COVID-19 — Potential Anti-Inflammatory and Anti-Fatigue Effects of an Oral Food Supplement in Long COVID Patients2024
In long COVID patients over 2 months, an oral supplement with E. angustifolia, rosehip, propolis, royal jelly, and zinc significantly reduced inflammatory markers (NLR, MLR, CRP) and fatigue versus placebo.
SupplementDEX Database · Eczema
1 reference43.SupplementDEX Database: Eczema — Echinacea purpurea-derived alkylamides exhibit potent anti-inflammatory effects and alleviate clinical symptoms of atopic eczema2017
In three randomized trials, an E. purpurea alkylamide cream significantly reduced SCORAD scores and improved epidermal lipids in atopic eczema versus comparator, with good tolerability.
SupplementDEX Database · Genital herpes
1 reference44.SupplementDEX Database: Genital herpes — Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes?2001
In 50 patients with recurrent genital herpes over 1 year (6 months each of placebo and Echinaforce in crossover), no statistically significant benefit on recurrence frequency or severity was detected.
SupplementDEX Database · High blood pressure
1 reference45.SupplementDEX Database: High blood pressure — Effects of echinacea on electrocardiographic and blood pressure measurements2007
In 16 healthy adults, a single 350 mg dose of E. purpurea did not significantly change electrocardiographic intervals or systolic/diastolic blood pressure versus placebo over 8 hours.
46.SupplementDEX Database: Human papillomavirus (HPV) — Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial2009
In 261 patients after anal condyloma excision over 6 months, 30 days of postoperative immunostimulation (herbal blend including echinacea) reduced recurrence to 7.2% versus 27.1% with surgery alone (P < 0.0001).
SupplementDEX Database · Lichen planus
1 reference47.SupplementDEX Database: Lichen planus — Evaluation of the efficacy of Echinacea on clinical indices of Erosive Oral Lichen Planus: A randomized double-blind clinical trial2022
In 70 patients with erosive oral lichen planus over 35 days, systemic echinacea plus topical steroids significantly reduced pain (VAS), lesion size, and lesion number versus placebo.
SupplementDEX Database · Oral health
3 references48.SupplementDEX Database: Oral health — Localized reduction of gingival inflammation using site-specific therapy with a topical gingival patch2012
In 26 periodontitis patients, a topical gingival patch reduced gingival crevicular fluid beta-glucuronidase at 24 hours in 17/22 treated sites versus 3/14 controls (p = 0.002), suggesting localized anti-inflammatory benefit.
49.SupplementDEX Database: Oral health — Effect of an herbal mouth rinse in preventing periodontal inflammation in an experimental gingivitis model: a pilot study2012
In 62 adults in an experimental gingivitis model over 2 weeks, herbal mouth rinse HM-302 significantly reduced gingival index increase versus water control (p = 0.006), with no serious adverse events.
50.SupplementDEX Database: Oral health — A phase II trial of a transmucosal herbal patch for the treatment of gingivitis2011
In 53 gingivitis patients over 3 days, transmucosal herbal periodontal patches significantly reduced gingival index on days 4 and 15 and beta-glucuronidase on days 4 and 8 versus placebo patches.
SupplementDEX Database · Otitis media
1 reference51.SupplementDEX Database: Otitis media — Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial2008
In 90 otitis-prone children over 6 months, echinacea at cold onset increased acute otitis media risk (65% vs 41%; RR 1.59) versus placebo; osteopathic manipulation also did not significantly reduce risk.
SupplementDEX Database · Tonsillitis
2 references52.SupplementDEX Database: Tonsillitis — Echinacea can help with Azithromycin in prevention of recurrent tonsillitis in children2019
In 300 children with recurrent tonsillitis over 6 months, azithromycin plus echinacea (5 mL/day for 10 days/month) reduced attack frequency and severity more than azithromycin alone, though neither prophylaxis group differed from no prophylaxis overall.
53.SupplementDEX Database: Tonsillitis — Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial2009
In 154 adults (≥12 years) with acute sore throat over up to 5 days, echinacea/sage spray was as effective as chlorhexidine/lidocaine spray, with 63.8% vs 57.8% achieving ≥50% pain reduction by day 3.