Herbal immunomodulators (local classification)
ATC code: L03AX-ECHINACEA (Echinacea purpurea – local code)
Brand names
Echinacin, Echinaforce
Preparations based on juice or extract of aerial parts (Echinacea purpurea) or root (E. pallida/angustifolia). Contain alkylamides, caffeic acid, and polysaccharides. Laboratory models describe phagocytosis activation and cytokine release. Controlled human trials yield conflicting clinical effects. Echinacea is one of the most popular «for immunity» herbal supplements in pharmacy retail.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
The 2014 Cochrane review (Karsch-Völk et al., 24 RCTs, over 4,600 participants) concluded that convincing evidence for echinacea in cold prevention or symptom reduction is lacking. Some studies show a borderline effect, but methodological heterogeneity and risk of bias preclude a general conclusion. , , and guidelines do not list the product.
Not recommended
Echinacea is one of the most heavily marketed herbal supplements for immunity in retail pharmacies. Cochrane systematic reviews (Karsch-Volk 2014, 24 RCTs) in people with colds showed heterogeneous and overall modest effects: some echinacea preparations may slightly reduce cold risk or duration (by 10-20%), but evidence quality is low and different echinacea preparations differ in composition and standardization. International clinical guidelines do not include echinacea. The supplement is relatively safe but can cause allergic reactions in people allergic to Asteraceae plants. If echinacea was recommended, consider seeking a second opinion; any immunity effect is small.
Not recommended
For recurrent URI prevention in children with frequent infections, echinacea is absent from and ERS 2023 pediatric guidelines. Evidence-based prevention: influenza and pneumococcal vaccination, hand hygiene, secondhand-smoke removal, and normalising sleep and nutrition.
1 pair found. Sorted from critical to minor.
Mechanism
Echinacea purpurea modulates CYP1A2 and CYP3A4 in vitro, but the in vivo effect is minimal. No direct pharmacokinetic interaction with paracetamol has been described.
Symptoms
The combination usually causes no specific symptoms. Each drug's individual side effects remain.
Management
No dose adjustment needed. The combination is standard in over-the-counter use for acute respiratory infections. Echinacea's efficacy as an immunostimulant is not confirmed by large randomised trials (Cochrane Review 2014).
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Most international sources advise against use in pregnancy and breastfeeding due to limited safety data.
Most manufacturers and LactMed advise against use during breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Echinacea purpurea (juice/extract) is evaluated for the following indications with varying evidence strength: Immune support and respiratory infection care (evidence tier F), Prevention of recurrent respiratory infections (evidence tier F), Acute respiratory viral infection (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Echinacea purpurea (juice/extract) (≥ 1 in 100): Allergic reactions including urticaria and anaphylaxis, GI discomfort, Dry mouth. See the Safety section for uncommon and serious reactions.
FDA category N. Most international sources advise against use in pregnancy and breastfeeding due to limited safety data.
Most manufacturers and LactMed advise against use during breastfeeding.
Echinacea purpurea (juice/extract) is contraindicated in: Systemic autoimmune disease; Tuberculosis; Leukaemia; Hypersensitivity to Asteraceae (ragweed, chamomile); Age under 12 (for most dosage forms). Full list in the Safety section.