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Echinacea
Off limits if you have an autoimmune disease, a transplant or a course of immunosuppressants. The reason is the mechanism our file records: a plant mixture that acts non-specifically on the innate immune system. It carries no authorised EU health claim. It sits in two of our formulas, and the EMA monograph behind it sets a hard ten-day limit that one of those two does not yet respect. We have written that down rather than tidied it away.
WHAT WE ARE ALLOWED TO SAY
Nothing. There is no authorised claim.
Regulation (EU) 432/2012 lists no authorised health claim for echinacea. Most botanical claims have sat on the European Commission's "on hold" list since 2010, waiting for EFSA to assess them, so there is nothing on the register for us to quote here and we are not going to write something that reads like one. Neither of the two formulas that carry echinacea leans on it for a claim: the wording they use comes from the vitamin C, zinc, selenium and vitamin D next to it.Regulation (EU) 432/2012 lists no authorised health claim for echinacea, so there is nothing for us to quote here. The claims on the two formulas that carry it come from the vitamins and minerals next to it.
There is an EMA herbal monograph for the pressed juice of the aerial parts, under well-established use, and a Cochrane review from 2014 on preventing and treating the common cold. Those are medicines assessments and a body of trials, not food health claims, and none of it lets us tell you what echinacea will do for you. What the monograph does give us is a limit, in its own words: "For prevention and treatment, do not use the medicinal product for more than 10 days." And: "If the symptoms persist for more than 10 days, a doctor or a pharmacist should be consulted."
WHAT WE USE
One species, and the phenols counted.
The species is Echinacea purpurea, the one with the best clinical evidence; E. angustifolia and E. pallida have different profiles and are not interchangeable with it. The parts used are the flowering tops, Echinaceae purpureae herba, as a pressed juice or a hydroalcoholic extract, and the root, Echinaceae purpureae radix. The form on file for our system is a root and herb extract standardised to 4% total phenols. What is inside it is a mixture rather than a single molecule: alkylamides, which interact with the CB2 receptor and are anti-inflammatory, polysaccharides that activate macrophages through TLR, caffeic acids such as echinacoside and cichoric acid, and an essential oil. Our file describes the result as a non-specific activation of innate immunity — NK cells, phagocytosis, interferon gamma — and, at the right doses, a modulation of pro-inflammatory cytokines. That is a description of mechanism, not a benefit we can claim, and it is the reason for the contraindications further down.
Standardised to 4% total phenols. It is stable in liquid and water-soluble, which is what a dosing system needs, it works between pH 5 and 7, it is sensitive to light, and it is frankly bitter. A concentrated version exists that takes about a third of the volume.
The pressed juice of E. purpurea is the preparation behind the EMA well-established use monograph, at 2.4 g a day. Our internal notes prefer it, or a tincture of the aerial parts standardised to at least 0.25% alkylamides and at least 2% cichoric acid.
E. angustifolia and E. pallida are sold as echinacea too. Their chemistry and their evidence are different, and our file specifies E. purpurea, so a page about echinacea in general would be a page about something we do not use.
No form of echinacea has an authorised claim, so the form is not a claim argument and we do not use it as one. Standardising to 4% total phenols tells you how much is in the bottle, not that it works. Our echinacea file is still a draft pending review by a clinical professional, its own confidence rating is inconsistent between the header and the record, and the pharmacokinetics we hold for it are thin: no half-life, no measured oral bioavailability, an onset that the file puts at hours in one field and at one to two weeks in another.No form of echinacea has an authorised claim, so the form is not a claim argument. Our file is still a draft pending clinical review, and the pharmacokinetics we hold are thin: no half-life, no measured bioavailability.
WHERE IT APPEARS
Two of the twenty-nine. One of them has a problem.
The acute formula uses it in a short course of up to ten days, as its file specifies: 2,400 mg, started at the first symptoms of a cold, and stopped. The daily immunity formula carries it at 600 mg, and that is where our own documentation records a conflict, in capitals: the EMA monograph limits echinacea to ten continuous days, and a CORE formula is meant to be taken for weeks. Both formulas are approved pending clinical validation. Neither is clinically validated.
THE CEILING
No EFSA limit. Ten days is the limit that counts.
EFSA has not set a tolerable upper intake level for echinacea, and it has not set one for botanical extracts of this kind in general. What we hold instead are durations and doses, and our own documents do not agree on them. The EMA monograph record and both formula files give a limit of ten days, for everyone. Our ingredient file attributes a maximum of eight to ten weeks to the EMA, gives the ten days only for ages 12 to 18, and its engine notes set eight weeks followed by a pause of at least two. Our documents have not resolved that, and this page does not pick one for you. The daily immunity formula is scheduled in 12-week cycles with a two-week pause, up to four a year, which goes beyond both the ten-day and the eight-week limits, and its file leaves that decision to a clinician. On dose, our engine notes carry a cap of 1,200 mg of dry extract a day, added up across everything you take. The acute formula serves 2,400 mg of extract. The 2.4 g a day in the monograph refers to pressed juice, a different preparation. For dry extract our file documents 400–1,200 mg a day, so 2,400 mg sits at twice the top of that range, and above that cap. None of our documents records that mismatch as a conflict, and we would rather print it than leave it out. So the limit that matters for echinacea is a duration rather than a number of milligrams, and today only the acute formula keeps to ten days.EFSA has not set an upper intake level for echinacea. The EMA monograph record and our formula files give ten days; our ingredient file gives ten days only for ages 12–18 and eight to ten weeks otherwise. The daily formula runs in 12-week cycles, beyond both, and its file leaves that to a clinician. The acute formula's 2,400 mg of extract is twice the 1,200 mg top our file documents for dry extract.
The acute formula runs for ten days and no longer, which is the limit in the EMA monograph record, and it is meant to start at the first symptoms of a cold. If symptoms last longer than ten days, the monograph says to see a doctor or a pharmacist, because it may be something other than a cold. The daily immunity formula does not keep to ten days: it runs in 12-week cycles, and its file leaves that decision to a clinician. Our file says to keep to one major immune-stimulating plant at a time and not to combine echinacea with astragalus, elderberry, andrographis or cordyceps in the same dose, yet the acute formula carries 600 mg of elderberry alongside it. That is a conflict in our own documents, and both the formula and the ingredient file are still awaiting review by a clinical professional.
An autoimmune disease — lupus, rheumatoid arthritis, multiple sclerosis, scleroderma, inflammatory bowel disease, vitiligo, active psoriasis — is an absolute contraindication, stated explicitly by the EMA monograph and by our own policy. So is an organ transplant, so is advanced HIV, so are active tuberculosis, leukaemia and lymphoma, and so is an allergy to the Asteraceae family. Any immunodeficiency or disease of the white blood cell system: contraindicated by the EMA monograph. Severe atopy: contraindicated in our acute formula; if you are atopic, ask a doctor first (risk of hypersensitivity). Immunosuppressants such as ciclosporin, tacrolimus, methotrexate or anti-TNF biologics: do not combine, because echinacea works against them and can cancel the treatment out. Under 12 years: contraindicated by the EMA. Between 12 and 18: not more than ten days in a row. Pregnancy and breastfeeding: not recommended, there is not enough data. Liver disease: caution with prolonged use. Cancer treatment: ask your oncologist first, which is the label warning we carry. In active cancer treatment our test profile excludes it: immune-stimulating plants may interfere with immunotherapy. Only with your oncologist's agreement. The two formulas that contain echinacea also exclude profiles on VKA anticoagulants, and the daily one excludes liver disease as well.
Mild stomach upset, a metallic taste and headache are the effects our ingredient file lists, and at the usual doses in that file it records no serious adverse effect. Allergic reactions are the real risk, because echinacea is an Asteraceae: rashes are the common form and anaphylaxis is rare but described. Rare reports of Stevens-Johnson syndrome, angioedema and anaphylaxis are recorded in the EMA monograph. It carries none of the 14 allergens EU law requires on a label and no documented lactose, fructose, histamine, gluten or FODMAP issue. The label warning on file: ask your oncologist before combining it with cancer treatment.
WHAT IT REACTS WITH
Four documented pairs, and one class of medicine it works against.
Echinacea is one of the 140 ingredients in our library, so it has 139 possible partners. Four of them have been entered in our interaction table so far, out of the 443 pairs on file. The medication flags below come from the ingredient's own file, not from a checked pair.
Charcoal adsorbs polyphenols specifically, rated high severity: never in the same dose, at least three hours apart. White clay adsorbs plant compounds too, rated medium: at least two hours apart. Neither lowers the dose, it simply moves it.
Echinacea inhibits CYP1A2 and raises caffeine exposure by about 30%, from a 2004 human study, so we do not put a high caffeine dose and echinacea in the same formula. Propolis adds mildly to the same immune stimulation: combinable, with a flag for autoimmune profiles.
Ciclosporin, tacrolimus, methotrexate and anti-TNF biologics: echinacea works against them and can cancel out the therapy, rated major in our file. That is not a caution, it is a reason not to take it. CYP3A4 substrates such as midazolam, etoposide and ciclosporin: a mixed, modest effect. CYP1A2 substrates such as caffeine and theophylline: mild inhibition. Azole antifungals and antiretrovirals: caution on the same enzymes. Liver-stressing medicines such as paracetamol, isoniazid, methotrexate and anabolic steroids: caution with prolonged use.
None of echinacea's medication interactions is in our drug interaction table yet — the list above lives in its ingredient file, and the two liver enzymes it names, CYP3A4 and CYP1A2, are held there as free text because they never made it into the structured field. Our pharmacokinetic record has no half-life, no measured oral bioavailability and two different onsets. Across the library, 443 of the 9,730 possible pairs are documented, which is 4.55%. The rest are not "safe", they are simply unchecked, and we would rather write that down than let the number look like a badge.None of echinacea's medication interactions is in our drug table yet, and its pharmacokinetic record has no half-life or measured bioavailability. 443 of the 9,730 possible pairs are documented, which is 4.55%. The rest are not safe, they are simply unchecked.
SOURCES
Everything on this page, with its reference.
Reviewed by VION nutrition team · last reviewed 16 September 2026Read the introduction to Echinacea →
140 INGREDIENTS · 64 IN USE TODAY
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What it is, what we are allowed to say about it, which formulas carry it, what it reacts with and where each of those statements comes from. Including the places where our own documents disagree with each other. No proprietary blends, no hidden amounts.