Ehinacea

Echinacea purpurea (L.) Moench =Rudbeckia purpurea L.,
Asteraceae

engl. eastern purple coneflower, purple coneflower; fr.échinacée pourpre, rudbeckie pourpre; njem. Purpurfarbener Sonnehut, Purpursonnenhut

Echinacea pallida (Nutt.) Nutt.

engl. pale coneflower, black sampson; fr. échinacée pallida; blasse Kegelblume, blasser Igelkopf

Echinacea angustifolia DC

engl. narrow leaved coneflower; fr. échinacée angustifolia; njem. schmalblätrige Sonnehut, schmalblätrige Kegelblume

BOTANIČKI PODACI

Ehinaceje su snažne višegodišnje zeljaste biljke visoke do 120 cm s razgranjenom hrapavo dlakavom stabljikom. Listovi su jajasto suličasti, šiljasti, pri bazi zaokruženi, pilastih rubova i hrapavi. Cvjetne glavice po rubu nose ružičastocrvene jezičaste cvjetove duge 2-4 cm koji su na početku stršeći, a kasnije viseći. U sredini cvata nalaze se mnogobrojni purpurni cjevasti cvjetovi. Biljka potječe iz južnih i središnjih dijelova SAD-a, a u Europi se uzgaja od 18-tog stoljeća.

OFICINALNI DIJELOVI BILJKE

Puno je konfuzije nastalo oko "ehinaceje" - koja se vrsta i koji dio koristi u fitoterapiji. Bilo je i nekoliko kritičkih osvrta koji se biljni materijal točno koristio u ranijim kliničkim ispitivanjima.

Prema ESCOP-u, oficinalna je vrsta E. purpurea, i to i zelen i korijen biljke. ESCOP navodi kao referencu identifikacije Europsku farmakopeju. Prema komisiji E, koristi se zelen vrste E. purpurea i korijen vrste E. pallida. Klinička istraživanja te proizvođači najčešće i prate ove sugestije.

KEMIJSKI SASTAV (AKTIVNE TVARI)

Echinacea purpurea zelen

Alkilamidi: izobutilamidi dodeka-2E, 4E, 8Z, 10 E/Z-tetraenska kiseline. Derivati kavene kiseline: cikorična kiselina 1,2-3,1%, 2-O-feruloi-tartarat, 2-O-kaveoil-3-O-kumaroil-tartarat. Polisaharidi: PS-1 (4-O-metil-glukurono-arabinoksilan, MW35000), PS-2 (arabinoramnogalaktan MW 450000), ksiloglukan MW 79500, fruktani slični inulinu, pektin slični polisaharidi. Glikoproteini: arabinogalaktan-protein MW 1 200 000. Flavonoidi (0,48%): kvercetin, kemferol, izoramnetin i njihovi glikozidi. Eterično ulje 0,08-0,32%. Poliacetileni.

Echinacea purpurea korijen

Cikorična kiselina 0,6-2,3%, alkilamidi 0,01-0,04% (izobutilamidi undeka-2E/Z-4E-dien-12,14-diinske i i dodeka-2E,4Zdien-8,10-diinske kiseline), poliacetileni, polisaharidi.

Echinacea angustifolia korijen

Alkilamidi (0,01-0,15%): izobutilamidi dodeka-2E, 4E, 8Z 10E/Z tetraenske kiseline (75mg/100g), dodeka-2E-en-8,10-diinske kiseline, undeka-2E-en-8,10 diiinske kiseline, pentadeka-2E,9Z-dien-12,14-diinske kiseline. Tragovi izobutilamida undeka-2E/Z-4E-dien-12,14-diinske i i dodeka-2E,4Zdien-8,10-diinske kiseline (za razliku od korijena vrste E. purpurea gdje su glavni spojevi). Poliacetileni: pentadeka-8Z,11Z-dien-2-on, pentadeka-8Z,13Z-dien-11-in-2-on, tetradeka-8Z-en-11,13-dien-2-on. Derivati kavene kiseline: ehinakozid (0,3-1,7%), cinarin. Polisaharidi tipa inulina; glikoproteini s arabinozom, galaktozom i glukozaminom. Eterično ulje (manje od 0,1%).

Echinacea pallida korijen

Ketoalkeni i ketoalkini: tetradeka-8Z-en-11,13-dien-2-on, pentadeka-8Z-en-11,13-diin-2-onpentadeka-8Z,13Z-dien-11-in-2-on, pentadeka-8Z,11E,13Z-trien-2-on, pentadeka-8Z,11Z-dien-2-on, ponekad hidroksilirani na 8 ugljikovom atomu (nastaju tijekom skladištenja suhe droge). Poliacetileni: trideka-1-en-3,5,7,9,11-pentain. Derivati kavene kiselina (oko 1%): ehinakozid (bez cinarina za razliku od E. angustifolia). Glikoproteini, alkilamidi su odsutni za razliku od prethodne dvije vrste. Eterično ulje (0,2-2%).

TIPOVI EKSTRAKATA

Ehinacea je tipična biljka koja je najdjelotvornija ukoliko se ekstrakt spravlja od svježe, nesušene biljke, a to je i sugestija Komisije E, te i ESCOP-a. Uglavnom u obliku svježeg soka, tinkure svježe biljke, SIPF-a, suhih standardiziranih ekstrakata.

Infuzi/dekokti suhih droga se ne smatraju ljekovitima.

POSOLOGIJA

Echinacea purpurea zelen

ESCOP/komisija E: 6-9mL svježeg soka biljke dnevno ili ekvivalentni preparati. Korekcija doze na temelju težine.

Echinacea purpurea korijen

ESCOP: 3x3mL tinkture svježeg korijena (1:5 w-v, 55% etanol). Ekvivalentni preparati.

Echinacea pallida korijen

Komisija E: tinktura 1:5 w/v 50% etanol u dozi koa odgovara 900mg suhog korijena (3x60kapi).

Ne koristiti duže od 8 tjedana (ESCOP).

KONTRAINDIKACIJE

Autoimune bolesti, tuberkuloza, leukemije (komisija E).

Autoimune bolesti, tuberkuloza, leukemije, HIV infekcije, alergije na Asteraceae (ESCOP).

INTERAKCIJE S LIJEKOVIMA

Nepoznate (ESCOP, Komisija E).

OSOBNA ISKUSTVENA PRAKSA

Ehinacea je uz crni kim i mravinac, biljka koju najčešće propisujem. To je i logično, jer su razne infektivne bolesti jedan od glavnih javnozdravstvenih problema. Statistički, najčešće ju propisujem kod:

• respiratornih infekcija, najčešće virusne
• KOPB-a
• urogenitalnih infekcija, najčešće HPV, HSV infekcije, ali i kod kroničnih ili rekurirajućih bakterijskih cistitisa

Dugo vremena nije bilo jasno koji je molekularni mehanizam djelovanja ehinaceje. U zadnjih nekoliko godina uvidjelo se kako su alkilamidi iz različitih vrsta ehinaceje agonisti kanabinoidnog receptora CB2, receptora koji učestvuje u imunološkim reakcijama. Za mene je to bilo dragocjeno otkriće - svi dosadašnji podaci (pojačanje lučenja citokina i fagocitoza, antibakterijski i antivirusno djelovanje upitnog značenja....) nisu dali plauzibilan mehanizam djelovanja. Smatra se da u tim reakcijama učestvuju alkilamidi kao jedni od karakterističnih sastojaka ehinaceja. To mi je objasnilo zašto često zamijetim pojačanje apetita kod djece oslabljelog apetita, jer i kanabinoidni receptori imaju utjecaj na apetit.

Van akademskih rasprava, ehinacea zaslužuje prvo mjesto među mnogim "imunostimulansima" koji su kasnije preplavili tržište. Ona je prvi odabir kod većine infektivnih bolesti. Klinička ispitivanja pokazuju katkad kontradiktorne rezultate jer je ehinacea tipična biljka koja se za puni učinak kombinira s drugim ljekovitim biljkama, čak i lijekovima. Primjerice, kod bakterijskih cistitisa s oleokapsulama s mravincem i infuzima biljaka prema infektu; kod HPV-a s vagitorijima s eteričnim uljem.

Nisam usamljen u stilu korištenja ehinaceje koji kaže: kratko i intenzivno. Primjerice, 5mL SIPF-a ili tinkture svježe biljke 4-6x dnevno, tijekom 7-10 dana. Ehinaceja se može koristiti i preventivno, ali treba imati na umu da se koristi kada je potrebno: sezone gripe i resiratornih infekcija. Premda imunostimulans, ehinaceja je vrlo korisna kod KOPB-a i astme, pogotovo egzacerbacijama astme zbog virusnih respiratornih infekcija.

Postoje i dileme oko korištenja ehinaceje kod autoimunih bolesti. Još uvijek prevladava dominantno mišljenje ESCOP-a i Komisije E, po mojem sudu s pravom. Stoga se kod autoimunih bolesti doista striktno držim tog pravila. To je posebice važno kod klasičnih autoimunih bolesti (lupus, kolagenoze, Hashimoto tireoiditis, autoimune bolesti jetre..). U korištenju kod drugačijih autoimunih bolesti poput upalnih bolesti crijeva sam manje restrikitivan, ali isključivo ako za to doista postoji potreba, stoga je moja sugestija da se i u takvim klasama bolesti izbjegava ehinaceja.

U praksi koristim gotovo isključivo tekuće ekstrakte (tinktura svježe biljke, SIPF).

Reference

Review/meta analize

Complementary and alternative medicine for prevention and treatment of the common cold. Nahas R, Balla A. Can Fam Physician. 2011 Jan;57(1):31-6.

Echinacea for prevention of the common cold: an illustrative overview of how information from different systematic reviews is summarised on the internet. Hart A, Dey P. Prev Med. 2009 Aug-Sep;49(2-3):78-82. Epub 2009 Apr 21. Review.

CB receptor ligands from plants. Woelkart K, Salo-Ahen OM, Bauer R. Curr Top Med Chem. 2008;8(3):173-86. Review.

Echinacea: an effective alternative to antibiotics. Tierra M. J Herb Pharmacother. 2007;7(2):79-89. Review.

[Phytoterapy: a glimmer of hope in the prevention of recurrent respiratory tract infections in children]. Miniello VL, Brunetti L, Cafagna R, Lieggi MS, Lippolis P, Natile M, Francavilla R, Armenio L. Minerva Pediatr. 2007 Aug;59(4):389-95. Review. Italian.

Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. Lancet Infect Dis. 2007 Jul;7(7):473-80. Review. Erratum in: Lancet Infect Dis. 2007 Sep;7(9):580.

Echinacea purpurea L. in children: safety, tolerability, compliance, and clinical effectiveness in upper respiratory tract infections. Saunders PR, Smith F, Schusky RW. Can J Physiol Pharmacol. 2007 Nov;85(11):1195-9.

Rationale and methods for a trial assessing placebo, echinacea, and doctor-patient interaction in the common cold. Barrett B, Rakel D, Chewning B, Marchand L, Rabago D, Brown R, Scheder J, Schmidt R, Gern JE, Bone K, Thomas G, Barlow S, Bobula J. Explore (NY). 2007 Nov-Dec;3(6):561-72.

The role of alkamides as an active principle of echinacea. Woelkart K, Bauer R. Planta Med. 2007 Jun;73(7):615-23. Epub 2007 May 31.

Safety and efficacy of echinacea (Echinacea angustafolia, e. purpurea and e. pallida) during pregnancy and lactation. Perri D, Dugoua JJ, Mills E, Koren G. Can J Clin Pharmacol. 2006 Fall;13(3):e262-7. Epub 2006 Nov 3.

Safety and efficacy of echinacea (Echinacea angustafolia, e. purpurea and e. pallida) during pregnancy and lactation. Perri D, Dugoua JJ, Mills E, Koren G. Can J Clin Pharmacol. 2006 Fall;13(3):e262-7. Epub 2006 Nov 3. Review.

The effect of Echinacea on upper respiratory infection symptom severity and quality of life. Gillespie EL, Coleman CI. Conn Med. 2006 Feb;70(2):93-7. Review.

Echinacea in the prevention of induced rhinovirus colds: a meta-analysis. Schoop R, Klein P, Suter A, Johnston SL. Clin Ther. 2006 Feb;28(2):174-83. Review.

Echinacea for preventing and treating the common cold. Linde K, Barrett B, Wölkart K, Bauer R, Melchart D. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD000530. Review.

The effect of Echinacea on upper respiratory infection symptom severity and quality of life. Gillespie EL, Coleman CI. Conn Med. 2006 Feb;70(2):93-7.

Echinacea purpurea for prevention of upper respiratory tract infections in children. Weber W, Taylor JA, Stoep AV, Weiss NS, Standish LJ, Calabrese C. J Altern Complement Med. 2005 Dec;11(6):1021-6.

Use of complementary and alternative medicine for the treatment of genital herpes. Perfect MM, Bourne N, Ebel C, Rosenthal SL. Herpes. 2005 Oct;12(2):38-41. Review.

An evidence-based systemic review Echinacea E. angustifolia DC, E. pallida, E. purpurea by the Natural Standard Research Collaboration. Basch E, Ulbricht C, Basch S, Dalton S, Ernst E, Foppa I, Szapary P, Tiffany N, Orlando CW, Vora M. J Herb Pharmacother. 2005;5(2):57-88. Review.

The safety of herbal medicinal products derived from Echinacea species: a systematic review. Huntley AL, Thompson Coon J, Ernst E. Drug Saf. 2005;28(5):387-400.

Use of Echinacea in upper respiratory tract infection. Islam J, Carter R. South Med J. 2005 Mar;98(3):311-8.

Echinacea treatment for the common cold. Knight V. Clin Infect Dis. 2005 Mar 15;40(6):811-2. Epub 2005 Feb 18.

Treatment of the common cold with echinacea: a structured review. Caruso TJ, Gwaltney JM Jr. Clin Infect Dis. 2005 Mar 15;40(6):807-10. Epub 2005 Feb 18.

Complementary and alternative interventions in asthma, allergy, and immunology. Bielory L. Ann Allergy Asthma Immunol. 2004 Aug;93(2 Suppl 1):S45-54. Review.

Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt.,Echinacea purpurea (L.) Moench): a review of their chemistry, pharmacology and clinical properties. Barnes J, Anderson LA, Gibbons S, Phillipson JD. J Pharm Pharmacol. 2005 Aug;57(8):929-54.

Complementary and alternative interventions in asthma, allergy, and immunology. Bielory L. Ann Allergy Asthma Immunol. 2004 Aug;93(2 Suppl 1):S45-54.

Echinacea fails to show efficacy in treating colds in a pediatric population. Le Tourneau M. Altern Ther Health Med. 2004 Jan-Feb;10(1):16.

Immune system effects of echinacea, ginseng, and astragalus: a review. Block KI, Mead MN. Integr Cancer Ther. 2003 Sep;2(3):247-67.

Echinacea: immune effects need more research. Glanville I. Adv Nurse Pract. 2003 Aug;11(8):25-6.

Medicinal properties of Echinacea: a critical review. Barrett B. Phytomedicine. 2003 Jan;10(1):66-86. Review.

The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ernst E. Ann Intern Med. 2002 Jan 1;136(1):42-53. Review. Erratum in: Ann Intern Med 2003 Jan 7;138(1):79.

Medicinal properties of Echinacea: a critical review. Barrett B. Phytomedicine. 2003 Jan;10(1):66-86.

[New knowledge regarding the effect and effectiveness of Echinacea purpurea extracts]. Bauer R. Wien Med Wochenschr. 2002;152(15-16):407-11.

Herbal medicines and perioperative care. Ang-Lee MK, Moss J, Yuan CS. JAMA. 2001 Jul 11;286(2):208-16. Review.

Echinacea for preventing and treating the common cold. Melchart D, Linde K, Fischer P, Kaesmayr J. Cochrane Database Syst Rev. 2000;(2):CD000530. Review.

Herbs and the common cold. Chichon PG. Adv Nurse Pract. 2000 Aug;8(8):31-2.

Evaluation of echinacea for treatment of the common cold. Giles JT, Palat CT 3rd, Chien SH, Chang ZG, Kennedy DT. Pharmacotherapy. 2000 Jun;20(6):690-7.

Use of echinacea in medicine. Percival SS. Biochem Pharmacol. 2000 Jul 15;60(2):155-8.

A strategic call to utilize Echinacea-garlic in flu-cold seasons. Abdullah T. J Natl Med Assoc. 2000 Jan;92(1):48-51.

Echinacea for preventing and treating the common cold. Melchart D, Linde K, Fischer P, Kaesmayr J. Cochrane Database Syst Rev. 2000;(2):CD000530. Review.

Echinacea for upper respiratory infection. Barrett B, Vohmann M, Calabrese C. J Fam Pract. 1999 Aug;48(8):628-35. Review.

[Clinical application of extracts of Echinacea purpurea or Echinacea pallida. Critical evaluation of controlled clinical studies]. Dorsch W. Z Arztl Fortbild (Jena). 1996 Apr;90(2):117-22. Review.

[Echinacea drugs--effects and active ingredients]. Bauer R. Z Arztl Fortbild (Jena). 1996 Apr;90(2):111-5.

Results of five randomized studies on the immunomodulatory activity of preparations of Echinacea. Melchart D, Linde K, Worku F, Sarkady L, Holzmann M, Jurcic K, Wagner H. J Altern Complement Med. 1995 Summer;1(2):145-60.

 

Klinička ispitivanja

Echinacea for treating the common cold: a randomized trial. Barrett B, Brown R, Rakel D, Mundt M, Bone K, Barlow S, Ewers T. Ann Intern Med. 2010 Dec 21;153(12):769-77.

Echinacea purpurea along with zinc, selenium and vitamin C to alleviate exacerbations of chronic obstructive pulmonary disease: results from a randomized controlled trial. Isbaniah F, Wiyono WH, Yunus F, Setiawati A, Totzke U, Verbruggen MA. J Clin Pharm Ther. 2010 Nov 10. doi: 10.1111/j.1365-2710.2010.01212.

A standardized Echinacea extract demonstrates efficacy in the prevention and treatment of colds in athletes. Ross SM. Holist Nurs Pract. 2010 Mar-Apr;24(2):107-9.

Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial. Schapowal A, Berger D, Klein P, Suter A. Eur J Med Res. 2009 Sep 1;14(9):406-12.

[Application of antihomotoxic preparations in complex treatment of early inflammatory complications, occurring after gastrointestinal operations]. Todurov IM, Dibrova IuA, Kucheruk VV, Kalashnikov OO. Klin Khir. 2009 Feb;(2):5-8. Ukrainian.

Content of proinflammatory cytokine in patients with clinical remission of chronic herpes infection during immunocorrection. Obukhova OO, Shvayuk AP, Gorbenko OM, Trunov AN, Trunova LA. Bull Exp Biol Med. 2008 Dec;146(6):803-5.

Identification and exploration of herb-drug combinations used by cancer patients. Engdal S, Klepp O, Nilsen OG. Integr Cancer Ther. 2009 Mar;8(1):29-36. Epub 2009 Jan 27.

Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial. Wahl RA, Aldous MB, Worden KA, Grant KL. BMC Complement Altern Med. 2008 Oct 2;8:56.

Prophylactic effects of Echinacea purpurea polysaccharide against lethal ocular herpes simplex virus type I. Ghaemi A, Soleimanjahi H, Gill P, Arefian E, Soudi S, Hassan ZM. Saudi Med J. 2008 Aug;29(8):1204-6.

Evaluation of widely consumed botanicals as immunological adjuvants. Ragupathi G, Yeung KS, Leung PC, Lee M, Lau CB, Vickers A, Hood C, Deng G, Cheung NK, Cassileth B, Livingston P. Vaccine. 2008 Sep 2;26(37):4860-5. Epub 2008 Jul 18.

Oral malodor reduction by a palatal mucoadhesive tablet containing herbal formulation. Sterer N, Nuas S, Mizrahi B, Goldenberg C, Weiss EI, Domb A, Davidi MP. J Dent. 2008 Jul;36(7):535-9. Epub 2008 May 12.

Effects of echinacea on the frequency of upper respiratory tract symptoms: a randomized, double-blind, placebo-controlled trial. O'Neil J, Hughes S, Lourie A, Zweifler J. Ann Allergy Asthma Immunol. 2008 Apr;100(4):384-8.

The effect of 4 wk of oral echinacea supplementation on serum erythropoietin and indices of erythropoietic status. Whitehead MT, Martin TD, Scheett TP, Webster MJ. Int J Sport Nutr Exerc Metab. 2007 Aug;17(4):378-90.

The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD25 expression in humans: a pilot study. Zwickey H, Brush J, Iacullo CM, Connelly E, Gregory WL, Soumyanath A, Buresh R. Phytother Res. 2007 Nov;21(11):1109-12.

Effects of echinacea on electrocardiographic and blood pressure measurements. Shah SA, Schlesselman L, Cios D, Lipeika J, Patel AA, Kluger J, White CM. Am J Health Syst Pharm. 2007 Aug 1;64(15):1615-8.

Oral Echinacea purpurea extract in low-grade, steroid-dependent, autoimmune idiopathic uveitis: a pilot study. Neri PG, Stagni E, Filippello M, Camillieri G, Giovannini A, Leggio GM, Drago F. J Ocul Pharmacol Ther. 2006 Dec;22(6):431-6.

The use of herbal therapies in pediatric oncology patients: treating symptoms of cancer and side effects of standard therapies. Quimby EL. J Pediatr Oncol Nurs. 2007 Jan-Feb;24(1):35-40.

Open, multicenter study to evaluate the tolerability and efficacy of Echinaforce Forte tablets in athletes. Schoop R, Büechi S, Suter A. Adv Ther. 2006 Sep-Oct;23(5):823-33.

Effect of various natural medicinals on salivary protein putrefaction and malodor production. Sterer N, Rubinstein Y. Quintessence Int. 2006 Sep;37(8):653-8.

The effect of Echinacea purpurea, Astragalus membranaceus and Glycyrrhiza glabra on CD69 expression and immune cell activation in humans. Brush J, Mendenhall E, Guggenheim A, Chan T, Connelly E, Soumyanath A, Buresh R, Barrett R, Zwickey H. Phytother Res. 2006 Aug;20(8):687-95.

[Echinacea angustifolia is ineffective in an experimental study]. Kreutzkamp B. Med Monatsschr Pharm. 2006 Jan;29(1):39-40. German.

Echinacea extracts modulate the pattern of chemokine and cytokine secretion in rhinovirus-infected and uninfected epithelial cells. Sharma M, Arnason JT, Burt A, Hudson JB. Phytother Res. 2006 Feb;20(2):147-52.

Echinacea purpurea for prevention of upper respiratory tract infections in children. Weber W, Taylor JA, Stoep AV, Weiss NS, Standish LJ, Calabrese C. J Altern Complement Med. 2005 Dec;11(6):1021-6.

A randomized, double-blind, placebo-controlled, clinical dose-response trial of an extract of Baptisia, Echinacea and Thuja for the treatment of patients with common cold. Naser B, Lund B, Henneicke-von Zepelin HH, Köhler G, Lehmacher W, Scaglione F. Phytomedicine. 2005 Nov;12(10):715-22.

Effect of oral administration of freshly pressed juice of Echinacea purpurea on the number of various subpopulations of B- and T-lymphocytes in healthy volunteers: results of a double-blind, placebo-controlled cross-over study. Schwarz E, Parlesak A, Henneicke-von Zepelin HH, Bode JC, Bode C. Phytomedicine. 2005 Sep;12(9):625-31.

A proprietary extract from the echinacea plant (Echinacea purpurea) enhances systemic immune response during a common cold. Goel V, Lovlin R, Chang C, Slama JV, Barton R, Gahler R, Bauer R, Goonewardene L, Basu TK. Phytother Res. 2005 Aug;19(8):689-94.

Randomized trial of a fixed combination (KanJang) of herbal extracts containing Adhatoda vasica, Echinacea purpurea and Eleutherococcus senticosus in patients with upper respiratory tract infections. Narimanian M, Badalyan M, Panosyan V, Gabrielyan E, Panossian A, Wikman G, Wagner H. Phytomedicine. 2005 Aug;12(8):539-47.

Echinacea intake induces an immune response through altered expression of leucocyte hsp70, increased white cell counts and improved erythrocyte antioxidant defences. Agnew LL, Guffogg SP, Matthias A, Lehmann RP, Bone KM, Watson K. J Clin Pharm Ther. 2005 Aug;30(4):363-9.

[Effectiveness of echinacin in therapy of chronic recurrent respiratory disease]. Heinen-Kammerer T, Holtmannspötter C, Schnabel S, Motzkat K, Kiencke P, Rychlik R. Gesundheitswesen. 2005 Apr;67(4):296-301.

Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. Barrett B. J Pediatr. 2004 Jul;145(1):135-6.

Echinacea purpurea therapy for the treatment of the common cold: a randomized, double-blind, placebo-controlled clinical trial. Yale SH, Liu K. Arch Intern Med. 2004 Jun 14;164(11):1237-41.

Effectiveness of an herbal preparation containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Cohen HA, Varsano I, Kahan E, Sarrell EM, Uziel Y. Arch Pediatr Adolesc Med. 2004 Mar;158(3):217-21.

Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Phytother Res. 2004 Jan;18(1):47-53.

Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. Goel V, Lovlin R, Barton R, Lyon MR, Bauer R, Lee TD, Basu TK. J Clin Pharm Ther. 2004 Feb;29(1):75-83.

Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C. JAMA. 2003 Dec 3;290(21):2824-30.

Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. Barrett BP, Brown RL, Locken K, Maberry R, Bobula JA, D'Alessio D. Ann Intern Med. 2002 Dec 17;137(12):939-46.

Oral administration of freshly expressed juice of Echinacea purpurea herbs fail to stimulate the nonspecific immune response in healthy young men: results of a double-blind, placebo-controlled crossover study. Schwarz E, Metzler J, Diedrich JP, Freudenstein J, Bode C, Bode JC. J Immunother. 2002 Sep-Oct;25(5):413-20.

Immunological activity of larch arabinogalactan and Echinacea: a preliminary, randomized, double-blind, placebo-controlled trial. Kim LS, Waters RF, Burkholder PM. Altern Med Rev. 2002 Apr;7(2):138-49.

Polysaccharides isolated from Echinacea purpurea herba cell cultures to counteract undesired effects of chemotherapy--a pilot study. Melchart D, Clemm C, Weber B, Draczynski T, Worku F, Linde K, Weidenhammer W, Wagner H, Saller R. Phytother Res. 2002 Mar;16(2):138-42.

Efficacy of Echinacea purpurea in patients with a common cold. A placebo-controlled, randomised, double-blind clinical trial. Schulten B, Bulitta M, Ballering-Brühl B, Köster U, Schäfer M. Arzneimittelforschung. 2001;51(7):563-8.

Does the extract of the plant Echinacea purpurea influence the clinical course of recurrent genital herpes? Vonau B, Chard S, Mandalia S, Wilkinson D, Barton SE. Int J STD AIDS. 2001 Mar;12(3):154-8.

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 study. Lindenmuth GF, Lindenmuth EB. J Altern Complement Med. 2000 Aug;6(4):327-34.

Efficacy and safety of a fixed combination phytomedicine in the treatment of the common cold (acute viral respiratory tract infection): results of a randomised, double blind, placebo controlled, multicentre study. Henneicke-von Zepelin H, Hentschel C, Schnitker J, Kohnen R, Köhler G, Wüstenberg P. Curr Med Res Opin. 1999;15(3):214-27.

A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Grimm W, Müller HH. Am J Med. 1999 Feb;106(2):138-43.

Echinaforce and other Echinacea fresh plant preparations in the treatment of the common cold. A randomized, placebo controlled, double-blind clinical trial. Brinkeborn RM, Shah DV, Degenring FH. Phytomedicine. 1999 Mar;6(1):1-6.

The efficacy of Prrrikweg gel in the treatment of insect bites: a double-blind, placebo-controlled clinical trial. Hill N, Stam C, van Haselen RA. Pharm World Sci. 1996 Jan;18(1):35-41.

Nonspecific immunostimulation with low doses of cyclophosphamide (LDCY), thymostimulin, and Echinacea purpurea extracts (echinacin) in patients with far advanced colorectal cancers: preliminary results. Lersch C, Zeuner M, Bauer A, Siemens M, Hart R, Drescher M, Fink U, Dancygier H, Classen M. Cancer Invest. 1992;10(5):343-8.

Stimulation of the immune response in outpatients with hepatocellular carcinomas by low doses of cyclophosphamide (LDCY), echinacea purpurea extracts (Echinacin) and thymostimulin. Lersch C, Zeuner M, Bauer A, Siebenrock K, Hart R, Wagner F, Fink U, Dancygier H, Classen M. Arch Geschwulstforsch. 1990;60(5):379-83.

[Clinical and laboratory assessment of the therapeutic activity of the drug Echinacin-extern in mixed periodontopathies]. Gasiorowska I, Patalas B, Powiertowski J. Czas Stomatol. 1982 Dec;35(12):901-6.

[Non-specific increase of the body's own immunity by Echinacin administration]. Schimmel KC, Werner GT. Ther Ggw. 1981 Nov;120(11):1065-76. German.

[Echinacin externa use in the treatment of periodontopathies]. Gasiorowska I, Patalas B, Wiktorowska B. Czas Stomatol. 1981 Jul;34(7):677-9.

[Echinacin in primary chronic polyarthritis therapy]. Reuss D. ZFA (Stuttgart). 1981 Apr 20;57(11):865.

[Evaluation of the effect of Calendula officinalis and Echinacea angustifolia extracts of Trichomonas vaginalis in vitro]. Samochowiec E, Urbańska L, Mańka W, Stolarska E. Wiad Parazytol. 1979;25(1):77-81.

 

Predklinička ispitivanja i farmakokinetika

Echinacea purpurea aerial extract alters course of influenza infection in mice. Fusco D, Liu X, Savage C, Taur Y, Xiao W, Kennelly E, Yuan J, Cassileth B, Salvatore M, Papanicolaou GA. Vaccine. 2010 May 21;28(23):3956-62. Epub 2010 Apr 9.

Bactericidal and anti-inflammatory properties of a standardized Echinacea extract (Echinaforce): dual actions against respiratory bacteria. Sharma SM, Anderson M, Schoop SR, Hudson JB. Phytomedicine. 2010 Jul;17(8-9):563-8. Epub 2009 Dec 29.

Cytotoxic activity and G1 cell cycle arrest of a Dienynone from Echinacea pallida. Chicca A, Adinolfi B, Pellati F, Orlandini G, Benvenuti S, Nieri P. Planta Med. 2010 Mar;76(5):444-6. Epub 2009 Oct 20.

Anti-herpetic properties of hydroalcoholic extracts and pressed juice from Echinacea pallida. Schneider S, Reichling J, Stintzing FC, Messerschmidt S, Meyer U, Schnitzler P. Planta Med. 2010 Feb;76(3):265-72. Epub 2009 Sep 29.

Immunostimulation to reduce recurrence after surgery for anal condyloma acuminata: a prospective randomized controlled trial. Mistrangelo M, Cornaglia S, Pizzio M, Rimonda R, Gavello G, Dal Conte I, Mussa A. Colorectal Dis. 2010 Aug;12(8):799-803. Epub 2009 Jun 22.

Protective effects of echinacoside, one of the phenylethanoid glycosides, on H(2)O(2)-induced cytotoxicity in PC12 cells. Kuang R, Sun Y, Yuan W, Lei L, Zheng X. Planta Med. 2009 Nov;75(14):1499-504. Epub 2009 Jun 22.

Pharmacokinetics and tissue distribution of dodeca-2E,4E,8E,10E/Z-tetraenoic acid isobutylamides after oral administration in rats. Woelkart K, Frye RF, Derendorf H, Bauer R, Butterweck V. Planta Med. 2009 Oct;75(12):1306-13. Epub 2009 Apr 27.

Echinacea purpurea polysaccharide reduces the latency rate in herpes simplex virus type-1 infections. Ghaemi A, Soleimanjahi H, Gill P, Arefian E, Soudi S, Hassan Z. Intervirology. 2009;52(1):29-34. Epub 2009 Apr 17.

Synergistic immunomopharmacological effects of N-alkylamides in Echinacea purpurea herbal extracts. Chicca A, Raduner S, Pellati F, Strompen T, Altmann KH, Schoop R, Gertsch J. Int Immunopharmacol. 2009 Jul;9(7-8):850-8. Epub 2009 Mar 19.

The effect of Echinacea purpurea (L.) Moench extract on experimental prostate hyperplasia. Skaudickas D, Kondrotas AJ, Kevelaitis E, Venskutonis PR. Phytother Res. 2009 Oct;23(10):1474-8.

Echinacea-induced macrophage activation. Sullivan AM, Laba JG, Moore JA, Lee TD. Immunopharmacol Immunotoxicol. 2008;30(3):553-74.

Pharmacokinetics and immunomodulatory effects of phytotherapeutic lozenges (bonbons) with Echinacea purpurea extract. Guiotto P, Woelkart K, Grabnar I, Voinovich D, Perissutti B, Invernizzi S, Granzotto M, Bauer R. Phytomedicine. 2008 Aug;15(8):547-54. Epub 2008 Jun 25.

Pharmacokinetics of the main alkamides after administration of three different Echinacea purpurea preparations in humans. Woelkart K, Dittrich P, Beubler E, Pinl F, Schoop R, Suter A, Bauer R. Planta Med. 2008 May;74(6):651-6. Epub 2008 Jan 31.

Cytotoxic activity of polyacetylenes and polyenes isolated from roots of Echinacea pallida. Chicca A, Pellati F, Adinolfi B, Matthias A, Massarelli I, Benvenuti S, Martinotti E, Bianucci AM, Bone K, Lehmann R, Nieri P. Br J Pharmacol. 2008 Mar;153(5):879-85. Epub 2008 Jan 14.

Bioavailability of Echinacea constituents: Caco-2 monolayers and pharmacokinetics of the alkylamides and caffeic acid conjugates. Matthias A, Penman KG, Matovic NJ, Bone KM, De Voss JJ, Lehmann RP. Molecules. 2005 Oct 30;10(10):1242-51.

Phytotherapeutic effects of Echinacea purpurea in gamma-irradiated mice. Abouelella AM, Shahein YE, Tawfik SS, Zahran AM. J Vet Sci. 2007 Dec;8(4):341-51.

Enhancement of innate and adaptive immune functions by multiple Echinacea species. Zhai Z, Liu Y, Wu L, Senchina DS, Wurtele ES, Murphy PA, Kohut ML, Cunnick JE. J Med Food. 2007 Sep;10(3):423-34.

[Effect of Echinacea purpurea tincture and its polysaccharide complex on the efficacy of cytostatic therapy of transferred tumors]. Razina TG, Lopatina KA, Zueva AM, Gur'ev AM, Krylova SG, Amosova EN. Eksp Klin Farmakol. 2007 May-Jun;70(3):33-5.

Alkamides from Echinacea inhibit cyclooxygenase-2 activity in human neuroglioma cells. Hinz B, Woelkart K, Bauer R. Biochem Biophys Res Commun. 2007 Aug 24;360(2):441-6. Epub 2007 Jun 19.

Assessment of the effect of Echinacea purpurea (L.) Moench on apoptotic and mitotic activity of liver cells during intoxication by cadmium. Smalinskiene A, Lesauskaite V, Ryselis S, Abdrakhmanov O, Kregzdyte R, Sadauskiene I, Ivanov L, Savickiene N, Zitkevicius V, Savickas A. Ann N Y Acad Sci. 2007 Jan;1095:574-84.

The fate of trans-caftaric acid administered into the rat stomach. Vanzo A, Cecotti R, Vrhovsek U, Torres AM, Mattivi F, Passamonti S. J Agric Food Chem. 2007 Feb 21;55(4):1604-11.

Comparison of Echinacea alkylamide pharmacokinetics between liquid and tablet preparations. Matthias A, Addison RS, Agnew LL, Bone KM, Watson K, Lehmann RP. Phytomedicine. 2007 Sep;14(9):587-90. Epub 2007 Feb 7.

Liver enzyme-mediated oxidation of Echinacea purpurea alkylamides: production of novel metabolites and changes in immunomodulatory activity. Cech NB, Tutor K, Doty BA, Spelman K, Sasagawa M, Raner GM, Wenner CA. Planta Med. 2006 Dec;72(15):1372-7. Epub 2006 Oct 20.

Bioavailability and pharmacokinetics of Echinacea purpurea preparations and their interaction with the immune system. Woelkart K, Marth E, Suter A, Schoop R, Raggam RB, Koidl C, Kleinhappl B, Bauer R. Int J Clin Pharmacol Ther. 2006 Sep;44(9):401-8.

The hepatoprotective action of ten herbal extracts in CCl4 intoxicated liver. Rusu MA, Tamas M, Puica C, Roman I, Sabadas M. Phytother Res. 2005 Sep;19(9):744-9.

Dietary Echinacea purpurea during murine pregnancy: effect on maternal hemopoiesis and fetal growth. Chow G, Johns T, Miller SC. Biol Neonate. 2006;89(2):133-8. Epub 2005 Oct 5.

Effect on prolactin secretion of Echinacea purpurea, hypericum perforatum and Eleutherococcus senticosus. Di Carlo G, Pacilio M, Capasso R, Di Carlo R. Phytomedicine. 2005 Sep;12(9):644-7.

The endocannabinoid system as a target for alkamides from Echinacea angustifolia roots. Woelkart K, Xu W, Pei Y, Makriyannis A, Picone RP, Bauer R. Planta Med. 2005 Aug;71(8):701-5.

An evaluation of Echinacea angustifolia in experimental rhinovirus infections. Turner RB, Bauer R, Woelkart K, Hulsey TC, Gangemi JD. N Engl J Med. 2005 Jul 28;353(4):341-8.

In vitro and in vivo immune stimulating effects of a new standardized Echinacea angustifolia root extract (Polinacea). Morazzoni P, Cristoni A, Di Pierro F, Avanzini C, Ravarino D, Stornello S, Zucca M, Musso T. Fitoterapia. 2005 Jul;76(5):401-11.

Echinacea alkamide disposition and pharmacokinetics in humans after tablet ingestion. Matthias A, Addison RS, Penman KG, Dickinson RG, Bone KM, Lehmann RP. Life Sci. 2005 Sep 2;77(16):2018-29.

Bioavailability and pharmacokinetics of alkamides from the roots of Echinacea angustifolia in humans. Woelkart K, Koidl C, Grisold A, Gangemi JD, Turner RB, Marth E, Bauer R. J Clin Pharmacol. 2005 Jun;45(6):683-9.

The effect of Echinacea purpurea extract on sexual glands of male rats. Skaudickas D, Kondrotas A, Baltrusaitis K. Medicina (Kaunas). 2004;40(12):1211-8.

Echinacea purpurea for prevention of experimental rhinovirus colds. Sperber SJ, Shah LP, Gilbert RD, Ritchey TW, Monto AS. Clin Infect Dis. 2004 May 15;38(10):1367-71. Epub 2004 Apr 26.

Regulation of human immune gene expression as influenced by a commercial blended Echinacea product: preliminary studies. Randolph RK, Gellenbeck K, Stonebrook K, Brovelli E, Qian Y, Bankaitis-Davis D, Cheronis J. Exp Biol Med (Maywood). 2003 Oct;228(9):1051-6.

The effect of herbal remedy on the development of Trichinella spiralis infection in mice. Bany J, Zdanowska D, Zdanowski R, Skopińska-Rózewska E. Pol J Vet Sci. 2003;6(3 Suppl):6-8.

Echinacea purpurea stimulates cellular immunity and anti-bacterial defence independently of the strain of mice. Bany J, Siwicki AK, Zdanowska D, Sokolnicka I, Skopińska-Rózewska E, Kowalczyk M. Pol J Vet Sci. 2003;6(3 Suppl):3-5.

Effect of Echinacea (Echinacea Purpurea L. Moench) preparations on experimental prostate gland. Skaudickas D, Kondrotas AJ, Baltrusaitis K, Vaitiekaitis G. Medicina (Kaunas). 2003;39(8):761-6.

Dietary supplementation with Echinacea and development of immunity to challenge infection with coccidia. Allen PC. Parasitol Res. 2003 Sep;91(1):74-8. Epub 2003 Jul 29.

The effect of aerial parts of Echinacea on the circulating white cell levels and selected immune functions of the aging male Sprague-Dawley rat. Cundell DR, Matrone MA, Ratajczak P, Pierce JD Jr. Int Immunopharmacol. 2003 Jul;3(7):1041-8.

The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Barak V, Birkenfeld S, Halperin T, Kalickman I. Isr Med Assoc J. 2002 Nov;4(11 Suppl):919-22.

Effect of oral application of an immunomodulating plant extract on Influenza virus type A infection in mice. Bodinet C, Mentel R, Wegner U, Lindequist U, Teuscher E, Freudenstein J. Planta Med. 2002 Oct;68(10):896-900.

Bioactivity of alkamides isolated from Echinacea purpurea (L.) Moench. Clifford LJ, Nair MG, Rana J, Dewitt DL. Phytomedicine. 2002 Apr;9(3):249-53.

Inhibitory effect of herbal remedies on 12-O-tetradecanoylphorbol-13-acetate-promoted Epstein-Barr virus early antigen activation. Kapadia GJ, Azuine MA, Tokuda H, Hang E, Mukainaka T, Nishino H, Sridhar R. Pharmacol Res. 2002 Mar;45(3):213-20.

Deleterious effects of Echinacea purpurea and melatonin on myeloid cells in mouse spleen and bone marrow. Currier NL, Sicotte M, Miller SC. J Leukoc Biol. 2001 Aug;70(2):274-6.

Effects of oral administration of Echinacea purpurea (American herb) on incidence of spontaneous leukemia caused by recombinant leukemia viruses in AKR/J mice. Hayashi I, Ohotsuki M, Suzuki I, Watanabe T. Nihon Rinsho Meneki Gakkai Kaishi. 2001 Feb;24(1):10-20.

Immunopharmacological activity of Echinacea preparations following simulated digestion on murine macrophages and human peripheral blood mononuclear cells. Rininger JA, Kickner S, Chigurupati P, McLean A, Franck Z. J Leukoc Biol. 2000 Oct;68(4):503-10.

Ineffectiveness of echinacea for prevention of experimental rhinovirus colds. Turner RB, Riker DK, Gangemi JD. Antimicrob Agents Chemother. 2000 Jun;44(6):1708-9.

Inhibition of human sperm motility by specific herbs used in alternative medicine. Ondrizek RR, Chan PJ, Patton WC, King A. J Assist Reprod Genet. 1999 Feb;16(2):87-91.

Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. Arch Fam Med. 1998 Nov-Dec;7(6):541-5.

In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. See DM, Broumand N, Sahl L, Tilles JG. Immunopharmacology. 1997 Jan;35(3):229-35.

Cytokine production in leukocyte cultures during therapy with Echinacea extract. Elsässer-Beile U, Willenbacher W, Bartsch HH, Gallati H, Schulte Mönting J, von Kleist S. J Clin Lab Anal. 1996;10(6):441-5.

[The effect of Echinacea purpurea Moench on phagocytosis in granulocytes measured by chemiluminescence]. Gaisbauer M, Schleich T, Stickl HA, Wilczek I. Arzneimittelforschung. 1990 May;40(5):594-8.

Immunomodulation with Viscum album and Echinacea purpurea extracts. Coeugniet EG, Elek E. Onkologie. 1987 Jun;10(3 Suppl):27-33.

[Effect of Echinacin on phagocytosis and natural killer cells]. Möse JR. Med Welt. 1983 Dec 30;34(51-52):1463-7.

 

Interakcije i toksičnost

Interactions between herbal medicines and prescribed drugs: an updated systematic review. Izzo AA, Ernst E. Drugs. 2009;69(13):1777-98. doi: 10.2165/11317010-000000000-00000. Review.

A critical evaluation of drug interactions with Echinacea spp. Freeman C, Spelman K. Mol Nutr Food Res. 2008 Jul;52(7):789-98. Review.

The safety of herbal medicinal products derived from Echinacea species: a systematic review. Huntley AL, Thompson Coon J, Ernst E. Drug Saf. 2005;28(5):387-400. Review.

Drug-herb interaction among commonly used conventional medicines: a compendium for health care professionals. Brazier NC, Levine MA. Am J Ther. 2003 May-Jun;10(3):163-9. Review.

An evaluation of selected herbal reference texts and comparison to published reports of adverse herbal events. Haller CA, Anderson IB, Kim SY, Blanc PD. Adverse Drug React Toxicol Rev. 2002;21(3):143-50. Review.

Interactions between herbal medicines and prescribed drugs: a systematic review. Izzo AA, Ernst E. Drugs. 2001;61(15):2163-75. Review.

Hypereosinophilia associated with echinacea use. Maskatia ZK, Baker K. South Med J. 2010 Nov;103(11):1173-4.

Use of herbal products among 392 Italian pregnant women: focus on pregnancy outcome. Cuzzolin L, Francini-Pesenti F, Verlato G, Joppi M, Baldelli P, Benoni G. Pharmacoepidemiol Drug Saf. 2010 Nov;19(11):1151-8.

Pharmacokinetic and pharmacodynamic interactions of echinacea and policosanol with warfarin in healthy subjects. Abdul MI, Jiang X, Williams KM, Day RO, Roufogalis BD, Liauw WS, Xu H, Matthias A, Lehmann RP, McLachlan AJ. Br J Clin Pharmacol. 2010 May;69(5):508-15.

Drug-botanical interactions: a review of the laboratory, animal, and human data for 8 common botanicals. Shord SS, Shah K, Lukose A. Integr Cancer Ther. 2009 Sep;8(3):208-27. Review.

Interactions between herbal medicines and prescribed drugs: an updated systematic review. Izzo AA, Ernst E. Drugs. 2009;69(13):1777-98. doi: 10.2165/11317010-000000000-00000. Review.

Spontaneously reported adverse reactions in association with complementary and alternative medicine substances in Sweden. Jacobsson I, Jönsson AK, Gerdén B, Hägg S. Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1039-47.

Remedies containing Asteraceae extracts: a prospective observational study of prescribing patterns and adverse drug reactions in German primary care. Jeschke E, Ostermann T, Lüke C, Tabali M, Kröz M, Bockelbrink A, Witt CM, Willich SN, Matthes H. Drug Saf. 2009;32(8):691-706. doi: 10.2165/00002018-200932080-00007.

Herbal supplement use and blood lead levels of United States adults. Buettner C, Mukamal KJ, Gardiner P, Davis RB, Phillips RS, Mittleman MA. J Gen Intern Med. 2009 Nov;24(11):1175-82. Epub 2009 Jul 3.

Echinacea metabolism and drug interactions: the case for standardization of a complementary medicine. Toselli F, Matthias A, Gillam EM. Life Sci. 2009 Jul 17;85(3-4):97-106. Epub 2009 May 8. Review.

In vitro CYP3A4 metabolism: inhibition by Echinacea purpurea and choice of substrate for the evaluation of herbal inhibition. Hansen TS, Nilsen OG. Basic Clin Pharmacol Toxicol. 2008 Nov;103(5):445-9.

Herb-drug interactions: theory versus practice. Cott JM. Mol Nutr Food Res. 2008 Jul;52(7):745-6.

A critical evaluation of drug interactions with Echinacea spp. Freeman C, Spelman K. Mol Nutr Food Res. 2008 Jul;52(7):789-98.

Herbal extracts used for upper respiratory tract infections: are there clinically relevant interactions with the cytochrome P450 enzyme system? Heinrich M, Modarai M, Kortenkamp A. Planta Med. 2008 May;74(6):657-60. Review.

Influence of Echinacea purpurea intake during pregnancy on fetal growth and tissue angiogenic activity. Barcz E, Sommer E, Nartowska J, Balan B, Chorostowska-Wynimko J, Skopińska-Rózewska E. Folia Histochem Cytobiol. 2007;45 Suppl 1:S35-9.

Echinacea-induced severe acute hepatitis with features of cholestatic autoimmune hepatitis. Kocaman O, Hulagu S, Senturk O. Eur J Intern Med. 2008 Mar;19(2):148. Epub 2007 Aug 9.

Gauging the clinical significance of P-glycoprotein-mediated herb-drug interactions: comparative effects of St. John's wort, Echinacea, clarithromycin, and rifampin on digoxin pharmacokinetics. Gurley BJ, Swain A, Williams DK, Barone G, Battu SK. Mol Nutr Food Res. 2008 Jul;52(7):772-9.

Clinical assessment of CYP2D6-mediated herb-drug interactions in humans: effects of milk thistle, black cohosh, goldenseal, kava kava, St. John's wort, and Echinacea. Gurley BJ, Swain A, Hubbard MA, Williams DK, Barone G, Hartsfield F, Tong Y, Carrier DJ, Cheboyina S, Battu SK. Mol Nutr Food Res. 2008 Jul;52(7):755-63.

Effects of herbal products and their constituents on human cytochrome P450(2E1) activity. Raner GM, Cornelious S, Moulick K, Wang Y, Mortenson A, Cech NB. Food Chem Toxicol. 2007 Dec;45(12):2359-65. Epub 2007 Jun 15.

Herb-drug interactions in oncology: focus on mechanisms of induction. Meijerman I, Beijnen JH, Schellens JH. Oncologist. 2006 Jul-Aug;11(7):742-52.

Possible drug-metabolism interactions of medicinal herbs with antiretroviral agents. van den Bout-van den Beukel CJ, Koopmans PP, van der Ven AJ, De Smet PA, Burger DM. Drug Metab Rev. 2006;38(3):477-514.

Severe thrombotic thrombocytopenic purpura (TTP) induced or exacerbated by the immunostimulatory herb Echinacea. Liatsos G, Elefsiniotis I, Todorova R, Moulakakis A. Am J Hematol. 2006 Mar;81(3):224. No abstract available. Erratum in: Am J Hematol. 2006 Sep;81(9):722. George, Liatsos [corrected to Liatsos, George]; Ioannis, Elefsiniotis [corrected to Elefsiniotis, Ioannis]; Radostina, Todorova [corrected to Todorova, Radostina]; Antonios, Moulakakis [corrected to Moulakakis, Antonios].

[Natural remedies and hormone preparations--potential risk for breast cancer patients. A study surveys the use of agents which possibly counteract with the treatment]. Malekzadeh F, Rose C, Ingvar C, Jernström H. Lakartidningen. 2005 Oct 31-Nov 6;102(44):3226-8, 3230-1.

In vivo assessment of botanical supplementation on human cytochrome P450 phenotypes: Citrus aurantium, Echinacea purpurea, milk thistle, and saw palmetto. Gurley BJ, Gardner SF, Hubbard MA, Williams DK, Gentry WB, Carrier J, Khan IA, Edwards DJ, Shah A. Clin Pharmacol Ther. 2004 Nov;76(5):428-40. Erratum in: Clin Pharmacol Ther. 2005 May;77(5):456.

Ocular side effects from herbal medicines and nutritional supplements. Fraunfelder FW. Am J Ophthalmol. 2004 Oct;138(4):639-47.

Activation of autoimmunity following use of immunostimulatory herbal supplements. Lee AN, Werth VP. Arch Dermatol. 2004 Jun;140(6):723-7.

Herbal remedies in the United States: potential adverse interactions with anticancer agents. Sparreboom A, Cox MC, Acharya MR, Figg WD. J Clin Oncol. 2004 Jun 15;22(12):2489-503.

The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo. Gorski JC, Huang SM, Pinto A, Hamman MA, Hilligoss JK, Zaheer NA, Desai M, Miller M, Hall SD. Clin Pharmacol Ther. 2004 Jan;75(1):89-100.

Drug-herb interaction among commonly used conventional medicines: a compendium for health care professionals. Brazier NC, Levine MA. Am J Ther. 2003 May-Jun;10(3):163-9.

Critical hypokalemic renal tubular acidosis due to Sjögren's syndrome: association with the purported immune stimulant echinacea. Logan JL, Ahmed J. Clin Rheumatol. 2003 May;22(2):158-9.

Contact sensitization from Compositae-containing herbal remedies and cosmetics. Paulsen E. Contact Dermatitis. 2002 Oct;47(4):189-98.

Herbal medication: potential for adverse interactions with analgesic drugs. Abebe W. J Clin Pharm Ther. 2002 Dec;27(6):391-401.

Possible leukopenia associated with long-term use of echinacea. Kemp DE, Franco KN. J Am Board Fam Pract. 2002 Sep-Oct;15(5):417-9.

Adverse reactions associated with echinacea: the Australian experience. Mullins RJ, Heddle R. Ann Allergy Asthma Immunol. 2002 Jan;88(1):42-51.

Interactions between herbal medicines and prescribed drugs: a systematic review. Izzo AA, Ernst E. Drugs. 2001;61(15):2163-75.

Recurrent erythema nodosum associated with Echinacea herbal therapy. Soon SL, Crawford RI. J Am Acad Dermatol. 2001 Feb;44(2):298-9.

Echinacea-associated anaphylaxis. Myers SP, Wohlmuth H. Med J Aust. 1998 Jun 1;168(11):583-4.

Phenytoin suppositories and echinacea. Kaatz B. S D J Med. 1997 Sep;50(9):335.