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Awaiting clinical review. This entry is sourced but has not yet been signed off by a pharmacist or clinician.

Echinacea purpurea/angustifolia

Echinacea

Echinacea has not been shown to reliably prevent or shorten colds, though the Cochrane review saw a consistent, small, non-significant lean towards fewer colds in prevention trials. Results depend heavily on the species, plant part and extraction method, so one product's trial does not vouch for another. The main caution is allergic reaction, which can be severe, particularly in people allergic to daisy-family plants or with hay fever, eczema or asthma.

Updated
29 September 2026
Purple echinacea coneflowers in a garden
At a glance
Last reviewed 29 September 2026
Evidence
Limited
Best for
Preventing colds
Typical form & use
E. purpurea juice, 6–9 ml a day
Onset
About a week
Safety
Allergy risk, esp. with daisy-family allergy. 1 known interaction, most serious with immunosuppressants.
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What it's used for

Evidence is rated per use. The same ingredient can be strong for one thing and traditional for another.

UseEvidenceWhat the research shows
Preventing coldsLimitedThe 2014 Cochrane review (24 double-blind trials, 4631 people) found that none of the 12 prevention comparisons reporting the number of people with at least one cold was statistically significant. A post hoc pooling of them suggested a 10% to 20% relative risk reduction, which the authors called of questionable clinical relevance. NCCIH says echinacea may slightly reduce your chances of catching a cold.1,4
Treating a cold once it startsLimitedOf the seven treatment trials in the Cochrane review that reported how long colds lasted, only one found a significant effect over placebo, and the review concluded echinacea has not been shown to help treat colds, while allowing a possible weak benefit from some products. NCCIH says it is unclear whether echinacea shortens a cold.1,4
Recurrent respiratory infectionsLimitedTwo meta-analyses report large reductions: 6 high-quality trials (2458 people) gave a relative risk of 0.65 for recurrent infections, and a 2024 analysis of 30 trials gave 0.60. Several authors of the 2024 paper declare honoraria from an echinacea manufacturer, and two of its authors also wrote the 2015 paper. The pooled trials use differing products, and the Cochrane review declined to pool for that reason. We rate this 2 rather than higher because the Cochrane review found no significant effect in the individual prevention trials.2,3,1
Small superficial wounds (applied to skin)TraditionalThe EU herbal regulator lists an ointment containing 10–20% expressed juice of E. purpurea for small superficial wounds on the basis of long-standing use alone, not clinical trials. It advises no more than one week of use.5

How much

Ranges below are what studies used and what supplements commonly contain. They are not a recommendation for you. Start at the low end.

EU monograph dose
1.5–4.5 ml juice per dose, 6–9 ml daily5
Expressed juice of fresh E. purpurea aerial parts, for adults and adolescents. The monograph's cold indication covers short-term prevention and treatment.
Duration
No more than 10 days5
The EU monograph says not to use the oral product for more than 10 days for prevention or treatment, and to see a doctor or pharmacist if symptoms persist beyond that. Trials in the meta-analyses ran longer for prevention, but we did not extract their durations.
Product choice
Extract type matters1,3
The Cochrane review found products differ appreciably in species, plant part, extraction method and added ingredients. The 2024 meta-analysis reported alcoholic extracts of freshly harvested E. purpurea performed best, but this comes from an industry-linked analysis.
Timing · The EU monograph says to start treatment at the first signs of a common cold. It gives no time-of-day advice.With food? · No source we read gave food guidance. NCCIH lists stomach pain and nausea as the commonest side effects, so if it upsets you, that is a reason to stop.How long to trial · Judge it over the length of one cold or up to 10 days. The EU monograph advises seeing a doctor or pharmacist if symptoms persist for more than 10 days.

How people take it

Expressed juice or dried juice1.5–4.5 ml per dose (EU monograph)Fresh E. purpurea aerial parts. This is the preparation the EU regulator recognises for colds.
Alcoholic extract (tincture or tablet)Follow the product labelStrengths and plant parts vary widely between brands, so labels are not interchangeable. NCCIH describes E. purpurea and some E. purpurea/E. angustifolia mixtures as likely safe for short periods in most adults.
Ointment (applied to skin)Small amount 2–3 times a day, up to 1 weekTraditional use only, for small superficial wounds. Not for use on the breast while breastfeeding.

Safety

Who should avoid
  • Allergy to daisy-family plants (Asteraceae) — EU monograph contraindication
  • Hay fever, asthma or eczema — risk of severe allergic reaction, ask first
  • Autoimmune disease, or weakened immunity — EU regulator does not recommend it
  • Children under 12 — EU regulator does not recommend, insufficient data
  • Pregnancy and breastfeeding — EU advises only on a doctor's say-so
  • Products used beyond 10 days — EU monograph limit for oral use
Known interactions
CautionImmunosuppressants — NCCIH says there are theoretical reasons to suspect an interaction, and the EU monograph does not recommend echinacea in immunosuppression; no clinical harm is documented in the sources we read.

Compare with

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Echinacea vs Elderberry

Questions people ask

Does echinacea prevent colds?

Possibly slightly. The Cochrane review found no individual prevention trial with a statistically significant result, but a post hoc pooling suggested a 10% to 20% lower risk, of questionable clinical relevance. It is not a reliable shield.

Does echinacea shorten a cold?

Not reliably. Only one of seven treatment trials in the Cochrane review that measured cold duration found a significant effect. NCCIH says it is still unclear.

Why do different echinacea products give different results?

Products vary in species, plant part (root or aerial parts), extraction method and added ingredients, and the Cochrane authors warned that many people are unaware of this. Only some have been trialled, so a result for one product may not apply to another.

Is echinacea safe if I have allergies or an autoimmune condition?

It carries a real allergy risk. NCCIH notes allergic reactions can be severe and that echinacea is related to daisies, sunflowers and ragweed, and the EU regulator contraindicates it in people allergic to the daisy family. The EU regulator also does not recommend it in autoimmune disease, saying an association with autoimmune disease cannot be excluded; ask your doctor first.

Sources

  1. Cochrane review Karsch-Völk M, Barrett B, Kiefer D, Bauer R, Ardjomand-Woelkart K, Linde K. Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev. 2014.
  2. Meta-analysis Schapowal A, Klein P, Johnston SL. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015.
  3. Meta-analysis Gancitano G, Mucci N, Stange R, et al. Echinacea Reduces Antibiotics by Preventing Respiratory Infections: A Meta-Analysis (ERA-PRIMA). Antibiotics (Basel). 2024.
  4. Regulator/health agency NCCIH. Echinacea: Usefulness and Safety. National Center for Complementary and Integrative Health.
  5. Regulator monograph European Medicines Agency HMPC. European Union herbal monograph on Echinacea purpurea (L.) Moench, herba recens (EMA/HMPC/48704/2014 Corr 1). 2015.

Last reviewed 29 September 2026 · Next review March 2027 · How we rate evidence