Dosage and Administration of Echinacea Purpurea extracts.
- Botanical Information of Echinacea Purpurea.
- Botanical Description of Echinacea Purpurea.
- Native and Species of Echinacea Purpurea.
- Medicinal Parts of Echinacea Purpurea:Roots,flowerheads.
- Phytochemistry and constituents of Echinacea Purpurea.
- Narrative History of Echinacea Purpurea.
- Archeology and traditional application of Echinacea Purpurea in Old Native Indian Tribes.
- Application,health benefits and uses of Echinacea Purpurea:Super antibiotics and more.
- Echinacea Purpurea extracts as herb Remedies.
- Dosage and Administration of Echinacea Purpurea extracts.
- Dosage of related Echinacea extracts.
- Safety Profile:Echinacea Purpurea extracts.
- Precautions of Echinacea Purpurea.
- Photo Gallery of Echinacea purpurea.
Dosage and Administration of Echinacea Purpurea extracts.:
Echinacea has an excellent safety record and is very well tolerated by most people. There is no known toxicity. Echinacea should not be used in progressive systemic and auto-immune disorders such as tuberculosis, leicosis, connective tissue disorders, collagenosis and related diseases such as lupus, according to the German Kommission E. Its use in AIDS or opportunistic infections in AIDS patients is controversial.
Capsule Suggestions:250 mg of Echinacea angustifolia and Purpurea flower and stem powder extracts standardized (4%) to supply 10 mg of echinosides.
Dosage and use:
- 500mgs extracts daily for healthy people.
- 500mgs extracts night and morning if exposed to an infection.
- 500mgs extracts every three to four hours at the first sign of a cold, flu, fever, or infection.
- Echinacea is thought to work best if cycled by taking it 10 to 14 days on and 4 to 7 days off.
- Powder - 15 - 30 grains - three to six times daily
- Tincture - 10 - 60 drops
- Fluid extract - 1/2 - 1 tsp (2.5 - 5 ml) - three to six times daily.
- Smaller doses such as are included in Life Extension Herbal Mix or Thymic Immune Factors may be taken continuously.
Since various constituent are soluble in different mentrums, variation in preparation can often determine therapeutic effect. I use powder herb (capsule and tablet) for a immune prophylactic and other chronic conditions (long term) and as a tincture for short periods of time to boost the immune system at the first stage of a cold flue. (See discussion above under constituents) To get around solubility problems of the constituents, some practitioners make a decoction first, then add concentrated alcohol to the hot decoction (carefully), thus getting more of the active ingredient into the resulting extract. Some phytochemists feel that doing the opposite, making a tincture first and then a decoction of the resulting marc to be better.
A number of controlled clinical trials have been conducted with Echinacea species for various indications. Some of the key studies are summarized below. Although in European phytotherapy standardized preparations of Echinacea extract are commonly given via injection (i.m., i.v., s.c.), there is preponderant evidence that oral administration is also effective.
Immune Disorders; Inflammation and Disease:
Melchart et al. (1994) provided a systematic review of controlled clinical trials in which Echinacea was used as an immunomodulator. Out of 26 trials (11 double-blind, 18 randomized), 19 concerned the efficacy of Echinacea against infections; 4 investigated the chance of reducing side effects of cancer therapies; and 3 concerned the modulation of immune system cells. While 30 of the 34 primary authors claimed that the treatments provided greater efficacy compared to the control groups, Melchart et al. determined that most of the studies scored low on quality of methodology. Only 8 studies received a score of over 50% of the maximum score points possible. Melchart et al. concluded that the clinical evidence available clearly shows that preparations containing Echinacea can be effective as immunomodulators. There is still insufficient evidence, however, to recommend individual preparations for therapeutic use, and what proper doses to give in specific conditions. The authors cited the need for further, well-designed clinical studies to resolve these issues.
Jurcic et al. (1989) administered an ethanolic extract of E. purpurea root (30 drops p.o. 3 X daily) to a treatment group of 12 healthy males for 5 consecutive days and compared immunological changes to a placebo group of 12 men. Compared to readings taken at the start, granulocytic phagocytosis (modified Brandt test) on day 5 showed a maximal increase of 120% in the Echinacea group. Granulocytic phagocytosis increased in the placebo group maximally by 30% compared to initial activity levels. Cessation of treatment in the Echinacea group resulted in a gradual decrease in phagocytosis over 3 days to normal levels. Immunoglubulin and leukocyte levels, as well as the erythrocyte sedimentation rate, showed no change from their normal ranges. The treatment as well tolerated by all participants. In this study, oral administration resulted in a considerably higher rate of immune stimulation than from parenteral administration (Jurcic et al., 1989).
In a study on the counteraction of exercise-induced immunosuppression, Berg et al. (1998) examined the immunoprotective effects of an E. purpurea extract (Madaus AG, Cologne, Germany, Echinacin EC31) in a double-blind, placebo-controlled, parallel group study. The extract was used as a pre-exercise treatment in 42 male tri-athletes (ages 18-47) while they underwent regular competitive sprint training. Randomized into 3 treatment groups using a double-dummy technique, the athletes received the extract (120 drops or 8 mL 3 X/day 28 days), a magnesium supplement (Madaus AG, Biomagnesin, 3 X/day for 28 days, equivalent to 43 mg magnesium), or placebo (flavored tablets and flavored drops of ethanol). The results showed that although the magnesium supplement-treated group responded much as the placebo-treated subjects, the Echinacea-treated subjects showed a significantly enhanced exercised-induced decrease in levels of soluble IL-2 receptor (sIL-2R), a significantly greater exercise-induced increase in urine levels of IL-6, a significantly greater exercise-induced increase in cortisol concentrations (but not one hour after the competition exercise). Three of the subjects in the magnesium group and 4 in the placebo group developed upper respiratory tract infections, previously known to be associated with strenuous exercise, but there were no such cases in the Echinacea group. The authors note that the most consistently reported cytokine responses in athletes from exhaustive or strenuous exercise are increases in the release of IL-6 and sIL-2R, and IL-6 in the acute phase response to injury or infection. The absence of a significant decrease in NK cells in the Echinacea groups suggested a counteraction of the effect of cortisol on these cells. Adverse effects were only reported in the placebo and magnesium groups who collectively lost 37 days of training time as a result, not counting two subjects who lost all their training time due to upper respiratory tract infection. The authors concluded that further clinical trials are needed to confirm the results of this pilot study.
In an open-label comparative study, Coeugniet and Kuhnast (1986) used the fresh expressed juice of Echinacea (Echinacin) as an adjuvant immunotherapy in a 10-week treatment of 203 women with recurrent vaginal candidiasis. It was used in combination with a locally applied antimycotic (econazol nitrate cream) alone, or in addition to the extract administered s.c., i.v., i.m., or p.o. The condition recurred in 60.5% of the patients using antimycotic cream alone. With the antimycotic cream plus i.v. Echinacea (2 mL/week), recurrence was reduced to 15% and to 5% in the i.m. Echinacea group. With the antimycotic plus s.c. Echinacea (2 mL/week), the rate of recurrence was 15% and for the group taking Echinacea p.o. (3 mL/day) in addition to the antimycotic recurrence was 16.7%. A cutaneous test for cell-mediated immunity of the patients (Multitest-Merieux) showed that within two weeks, normalization of immunity reached statistical significance in all the patients receiving Echinacea, whether administered p.o. (p less tan 0.05) or parenterally (p less than 0.01) (Coeugniet and Kuhnast, 1986).
Early uncontrolled studies showed that Echinacea may be useful as an anti-inflammatory in rheumatoid arthritis. Fifteen drops of the fresh-pressed juice of Echinacea purpurea 3 X daily was reported to decrease in inflammation by 21.8%. Improvement was comparatively less than with cortisol or prednisone (42% and 49.2%, respectively); however, no side effects were noted with Echinacea extract, while the side effects of the steroidal anti-inflammatories are well-documented (Seidel and Knobloch, 1957).
Echinacea is reputed to enhance wound healing. In a large 5-month uncontrolled clinical study involving 4,598 patients, a salve prepared from the juice of the aerial portion of Echinacea purpurea was reported to produce an 85% overall success rate in the treatment of the following inflammatory skin conditions: abscesses, wounds, folliculitis, burns, eczema, Herpes simplex, and varicose ulcers of the leg (Bauer and Wagner, 1991).
Respiratory and Pulmonary Disorders:
Rhinovirus Infections (Colds):
A comparative study of 4 different Echinacea preparations was conducted by Brinkeborn et al. (1999) in 246 healthy adult volunteers who easily caught colds. The preparations were compared in a randomized, placebo-controlled, double-blind trial in which patients were randomly assigned to groups given different treatments: a) an E. purpurea crude extract consisting of 5% root and 95% above ground parts (Echinaforce?, 6.78 mg/tablet, two tablets 3 X/day); b) the latter crude extract in higher concentration (48.27 mg/tablet, two tablets 3 X/day); c) a "special" crude extract of the root (E. purpurea, 29.60 mg/tablet, two tablets 3 X/day); and d) placebo. Patients were instructed to take their medication at the prescribed dosage immediately after noticing the earliest symptoms of the common cold and until they felt "healthy". The medicating period was not to exceed 7 days. An index of 12 symptom complaints recorded by the patients and the attending physicians was used to evaluate the results. According to physician records of the 12 symptom complaints, the "special" root extract was no better than placebo in reducing symptoms (by 44.8% and 29.3%, respectively), whereas the concentrated and simple extract were significantly effective, ameliorating symptoms of the common cold by 64.3% and 62.7%, respectively. In reducing the symptoms, the concentrated extract showed somewhat better per protocol results than the simple extract according to the symptom record of the patients (55.9% versus 50.6%), and the patient and physician judgements of efficacy, compared to placebo. Overall, the physicians judged the Echinacea preparations to be 70% effective, while the patients judged them as 80% effective. Adverse events were noted for 13% of the patient population, but were not significantly greater than in the placebo group. Only in one case (mild and transient nausea) was the event definitely or likely due to treatment. Brinkeborn et al. concluded that both the concentrated and simple crude extracts of Echinacea were as effective and low-risk alternatives to the medications available for treating symptoms of the common cold.
Hoheisel et al. (1997) used a Swedish product made from the expressed juice of the aerial parts of Echinacea purpurea (Echinagard) in a double-blind, placebo-controlled clinical trial in 120 adult patients who presented with the first signs of common cold symptoms. All patients had experienced at least 3 respiratory infections during the 6 months leading up to the trial. The dosage was 20 drops of juice or placebo in half a glass of water every two hours on day one, followed by 20 drops 3 X daily for no longer than the next 10 days. After randomly assigning patients to placebo and E. purpurea groups, 50% of the patients were found to have a "real" cold (36 on placebo and 24 on E. purpurea). While the other half showed less severity of symptoms, they were still experiencing the first indications of the common cold. All 120 patients completed the study and recorded their subjective symptoms in addition to undergoing interviews with an attending physician concerning the course of their illness and individual symptoms. The median amount of time required before patients improved was zero days for the E. purpurea group and 5 days for the placebo group, a highly significant (p less than 0.0001) difference. Among those in the subgroup of patients with "real" colds, the time to improvement was 4 days versus 8 days in the placebo group. In the subgroup, those on E. purpurea drops discontinued the treatment after a median time of 6 days versus 10 days in the placebo drops group. Curiously, there were no reported no side effects in either treatment group (Hoheisel et al., 1997).
Scaglione and Lund (1995) conducted a randomized, single blind, placebo-controlled clinical study of an Echinacea preparation against the common cold in 32 patients (15 female and 17 male, ages 18-71). The preparation consisted of Echinacea purpurea root extract (25 mL), vitamin C (100 mg), fennel seed extract (10.3 mg), eucalyptus leaf extract (12.3 mg), and rosemary leaf extract (20.1 mg) in the form of effervescent tablets. The addition of the other herbs by the manufacturer was with the intention of providing expectorant and antiseptic properties. Patients were selected based on having the common cold and were excluded in the following instances: recently received a flu vaccine; taking glucocorticoids or any other investigational drug; nursing or pregnant women; and end-stage disease (e.g., end-stage liver disease or terminal AIDS). Both the placebo group (16 patients given glucose tablets) and the Echinacea preparation group received 4 tablets daily for 44 days. Patients were evaluated based on the number of paper tissues they used daily and the discharge of thin nasal mucus (rhinorrhea). At the end of the trial, those on placebo had used 1,168 tissues and recovered from their colds in a mean number of 4.37+-1.57 days. The 16 patients given the Echinacea preparation recovered in a mean number of 3.37+-1.25 days and had used 882 tissues. The difference in length of illness between the two groups was statistically significant (p less than 0.01). The authors found no adverse effects or concurrent adverse events in the Echinacea preparation group. They also pointed out the need for further double-blind investigations of the preparation and the fact that the other ingredients in the preparation could have acted synergistically with E. purpurea root extract and vitamin C (Scaglione and Lund, 1995).
Schneberger (1992) studied the freshly pressed juice of Echinacea purpurea aerial parts (Echinacin 4 mL, twice daily for 8 weeks) in 108 patients (ages 13-84) during the winter season, and compared the results to a placebo-control group in a double-blind method. Patients were selected for the study on the basis of an increased susceptibility to colds; specifically, those who experienced a minimum of 3 cold-related infections during the winter before, whether pneumonia, catarrh, bronchitis, pharyngitis, tracheitis, tonsillitis, sinusitis, rhinitis, or lympadenitis. The results showed that 35.2% of the patients receiving Echinacea remained without infections versus 25.9% of the placebo group. The average length of time until contracting first infections in the Echinacea group was 40 days versus 25 days for the placebo group. Infections in the Echinacea group were of minor occurrence in 78%, and in the placebo group in 68% of patients. In total, the placebo group experienced 35 infections whereas the Echinacea group had 23. By comparison, this amounted to 36% more subjects who were free from infections in the Echinacea group versus the placebo group. Infections in the Echinacea group were of lesser duration than in the placebo group (155 versus 279 days), and on average appeared to be less severe and resolved more quickly than for those on placebo (5.34 days versus 7.54 days). The periods between infections were by comparison longer in the Echinacea group and they also experienced fewer lower respiratory tract infections (e.g., bronchitis). Infections in the placebo group were more severe in those who showed evidence of a weakened immune system (low ratio of T-cells, T4/T8 ratio less than 1.5) and the same participants also showed the most benefit from Echinacea.
Brunig et al. (1992) conducted a double blind, placebo-controlled trial with Echinacea purpurea root liquid extract in 180 patient volunteers (ages 18-60) with influenza-like infections of less than 3 days duration. Results were compared using an unstandardized liquid extract (1:5 ethanol; 50% volume %) of E. purpurea and a standardized liquid extract in two dosages: 450 mg (90 drops or two dropperfuls) of root extract/dose and 900 mg (180 drops or 4 dropperfuls) per dose. Standardization was made to both hydrophilic (chicoric acid and other caffeic acid derivatives) and lipophilic constituents (isobutylamides). The placebo group received drops of a colored mixture of water and ethanol. Brunig et al. reported highly significant differences between each of the study groups and dosages on days 3-4 (p less than 0.05) and 8-10 (p less than 0.0001) of the treatment period. The unstandardized extract group and the group receiving the low dose of standardized extract showed no significant improvement compared to the placebo group. However, the patients taking the high dose of standardized extract showed significant reduction of flu-like symptoms at 3-4 days, and in the clinical rating of the seriousness of their disease. Compared to the other groups and to pre-treatment symptoms, the flu-like symptoms included: nasal inflammation, sneezing, nasal secretions, stuffed nasal passages, low energy/weakness, muscle/limb pains, sore eyes/tearing, frontal headache/hot head/head pressure, sore throat, difficulty swallowing, earaches, swollen lymph glands, and sweating/chills. At 8-10 days, tongue coating was also significantly improved compared to the other groups (p less than 0.0001). The investigators also noted that in those subjects with a strictly viral infection (influenza), granulocyte levels increased faster than in subjects with bacterially related disease (colds).
A placebo-controlled, double blind study of an Echinacea-based extract formula on prophylaxis of influenza in 609 subjects was conducted by Schmidt et al. (1990). For 8 weeks, subjects received 12 mL/day of a standardized liquid extract (Resistan) containing 12 g Echinacea angustifolia, 2.9 g Eupatorium perfoliatum, and 2 g Baptisia tinctoria, and Arnica D2 (a homeopathic concentration) per 100 mL. Assessments were based on typical symptoms, including cough, sore throat, difficulty swallowing, runny nose, headache, painful limbs, and lassitude. In the formula-treated group, 132/303 subjects fell ill, significantly less than the placebo group at 155/306. The Echinacea formula group showed 14.8% fewer initial infections and 27.3% fewer recurrent infections compared to the placebo group. Of the "particularly susceptible" subjects in the formula group, significantly fewer (47.2% became ill versus those in the placebo group (57.7%) (Schmidt et al., 1990).
Bacterial Respiratory Infections:
Grimm and Muller (1999) reported no significant decrease in respiratory infection or colds and their severity and duration in patients receiving a fluid extract of E. purpurea (Madaus AG, 4 mL twice daily for 8 weeks) compared to placebo. The placebo-controlled, double-blind, randomized study was conducted in 109 patients who more than 3 colds or upper respiratory tract infections in the 12 months prior to the trial. The liquid extract, described as the fresh expressed juice of whole flowering E. purpurea without the roots, contained alcohol (22%) and was described as indistinguishable from the placebo in flavor, color, and appearance. Their analysis of the data found 65% in the Echinacea group developed one or more colds or respiratory infections during the 8-week treatment period, compared to 74% in the placebo group. Illness duration in the placebo group was 6.5 days and in the Echinacea group 4.5 days. Half of those in the Echinacea group stated at the end of the follow-up portion of the trial that they preferred to continue taking the extract they had received, compared to 43% of those on placebo stating the same. Adverse effects were reported in 20% of the Echinacea group and in 13% of the placebo group. In the Echinacea group, there were 4 reports of central nervous system symptoms, 4 of gastrointestinal complaints, and one report each for eczema, an increase in hair loss, and an increased urge to micturate. In the placebo group one subject reported an increased urge to micturate, none reported central nervous system symptoms (aggressive tendency, tiredness, headache, dizziness, somnolence), while 4 had gastrointestinal complaints. A few patients dropped out of the trial before its completion owing to complaints of either side effects, the taste of the medication, or for no stated reason; 4 in the Echinacea group and 3 in the placebo group. Other adverse effects were matched in each of the groups and all side effects reported were reversible and mild. The authors identified certain limitations of the trial: lack of prior proof that the placebo was indistinguishable from the active preparation; a study size too small to detect moderate and small differences in severity of respiratory infections and colds; and unknown effects of the alcohol in the preparations on patient symptoms (Grimm and Muller, 1999).
A double blind, placebo-controlled randomized clinical trial of Echinacea (root extract of E. angustifolia, E. purpurea, or placebo) by Melchart et al. (1998) found no significant difference in results compared to placebo with either plant extract taken 5 days/week for 12 weeks as a prophylactic treatment for upper respiratory tract infections. This trial was flawed, however, by the fact that participants (n=302) were able to guess correctly that they were receiving Echinacea in 53% of cases, versus 22% who guessed wrong, and 25% who felt they could not make a guess. Coupled with the fact that 45% of the participants reported previous use of Echinacea, as Melchart et al. (1998) point out, this trial emphasizes the need for a suitably indistinguishable Echinacea placebo to obtain meaningful data.
Dorn et al. (1997) entered 160 patients ages 18 and over into a placebo-controlled, double blind clinical study of Echinacea pallida root liquid extract (uncharacterized). Subjects had a symptom score meeting their criteria for upper respiratory tract infection; sufficient symptoms of headache, sore throat, sweating, burning sensation in the eyes, tearing, weakness, earache and pain in the extremities. Patients were randomly assigned to a placebo group (42 males and 38 females) and a treatment group (39 females and 41 males) who would take 90 drops (900 mg) of the medications daily for 8-10 days. At 9-10 days, the score for overall symptoms of upper respiratory tract infection were significantly better for the E. pallida group (p less than 0.0004) compared to placebo. Symptoms and signs of infection diminished rapidly in the Echinacea group compared to the placebo group and correlated with neutrophil and lymphocyte count changes. Four major symptoms in the E. pallida extract-treated group significantly decreased compared to the placebo group (p less than 0.0001): headache, pain in the arms and legs, weakness, and cold. Compared to the corresponding placebo groups with bacterial and viral infections, patients treated with E. pallida extract showed a significantly shortened length of illness by 3.2 days, and among those with viral infections significantly shortened the length of illness by 3.8 days (each p>0.0001) (Dorn et al., 1997).
In a placebo-controlled, double blind study on 160 patients of either sex suffering from upper respiratory tract infections, Brunig and Knick (1993) evaluated the response to a standardized Echinacea pallida preparation (Pascotox 100, 90 drops/day, equivalent to 900 mg extract). Response criteria were based on reduction of flu-like symptoms and a reduction in the duration of the disease. Duration of the disease was significantly reduced from 13 to 9.8 days in patients with chiefly bacterial infections, and from 13 to 9.1 days in those with chiefly viral infections. Strongest effects were seen in those with chiefly viral infections after 8-10 days of treatment and improvements in clinical symptoms corresponded well with the reduced duration of the disease. The relative percentage of lymphocytes in patients with viral infections and the relative percentage of granular leukocytes in those with bacterial infections, which were elevated in response to the infections, were, however, only slightly reduced after the patients received the Echinacea preparation.
Several studies support the role of echinacea as an immune stimulant. In vitro research demonstrates increased phagocytosis, NK cell activity, and increased antibody-dependent cellular cytotoxicity, mediated by TNF-a.
Echinacea also appears to have a mild antibiotic effect most likely due to its caffeic acid constituent, and bacteriostatic effects against E. coli and P. aeruginosa.
Data supporting the use of echinacea as treatment for URI are limited by the heterogeneity of preparations and the poor quality of many of the studies. A Cochrane review was carried out, and the quantitative meta-analysis of 16 trials reported a positive effect.
Three studies in 1997 and 1999 show that echinacea reduced severity of symptoms on URI symptom scoring instruments and reduced the duration of illness by one to two days.
- 1.What is Echinacea Purpurea?Good function and application of Polyphenols and Chicoric acid from Echinacea Purpurea Extract?
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