Echinacea pallida

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Note: The archived version of this monograph has been temporarily removed. For an electronic copy of this archived version, please contact the Natural Health Products Directorate (NHPD) at NHPD_DPSN@hc-sc.gc.ca.

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Date: June 26, 2008

Proper name(s): Echinacea pallida (Nutt.) Nutt. (Asteraceae) (USDA 2000)

Common name(s): Echinacea (McGuffin et al. 1997), Echinacea pallida, pale-flower echinacea, pale purple coneflower (McGuffin et al. 2000)

Source material(s): Root (Blumenthal 2003)

Route(s) of administration: Oral

Dosage form(s): Those suited to the allowable route(s) of administration.

This monograph is not intended to include food-like dosage forms such as bars, chewing gums or beverages.

Use(s) or Purpose(s): Statement(s) to the effect of:

• Traditionally used in Herbal Medicine to help relieve cold symptoms (Blumenthal et al. 2000; Moerman 1998).
• Supportive therapy in the treatment of upper respiratory tract infections (e.g. common colds) (Dorn et al. 1997).
• Helps to relieve the symptoms and shorten the duration of upper respiratory tract infections (e.g. common cold) (Dorn et al. 1997).

Dose(s):

Table 1: Dose information expressed as "quantity dried equivalent" of Echinacea pallida root presented as dose per day

Subpopulation		Quantity dried equivalent (root) (g/day)
		Minimum	Maximum
Children1	2-4 y	0.15	0.5
Children and adolescents1	5-9 y	0.23	0.8
Adolescents1	10-14 y	0.45	1.5
Adolescents and adults1,2,3	≥ 14 y	0.90	3.0

¹ Children and adolescent doses were calculated as a proportion of the adult dose (JC 2008). The use of Echinacea pallida in children is supported by the following references: Bove 2001; Schilcher 1997.
² Adult dose supported by the following references: Blumenthal 2003; Blumenthal et al. 2000; Blumenthal et al. 1998; Dorn et al. 1997.
³ Includes pregnant and breastfeeding women

See Appendix 1 for examples of appropriate dosage preparations, frequencies of use and directions for use, according to cited references. The purpose of Appendix 1 is to provide guidance to industry.

Duration of use: Consult a health care practitioner for use beyond 8 weeks (ESCOP 2003; Blumenthal et al. 1998).

Risk information: Statement(s) to the effect of:

Caution(s) and warning(s):

• Consult a health care practitioner if symptoms persist or worsen.
• Consult a health care practitioner prior to use if you have a progressive systemic disease such as tuberculosis, leukosis, collagenosis, multiple sclerosis, AIDS, or HIV infection (Brinker 2008; Brinker 2001; McGuffin et al. 1997).
• Consult a health care practitioner prior to use if you have an auto-immune disorder (Brinker 2008; McGuffin et al. 1997).
• Consult a health care practitioner prior to use if you are taking immunosuppressants (Brinker 2008; Mills et al. 2006).

Contraindication(s): No statement required.

Known adverse reaction(s): No statement required.

Non-medicinal ingredients: Must be chosen from the current NHPD List of Acceptable Non-medicinal Ingredients and must meet the limitations outlined in the list.

Specifications:

• The finished product must comply with the minimum specifications outlined in the current NHPD Compendium of Monographs.
• The medicinal ingredient may comply with the specifications outlined in the pharmacopoeial monographs listed in Table 2 below.

Table 2: Echinacea pallida monographs published in the British, European and US Pharmacopoeias

Pharmacopoeia	Monograph
British Pharmacopoeia	Echinacea Pallida Root
European Pharmacopoeia	Pale Coneflower Root: Echinacea pallidae radix
US Pharmacopoeia	Echinacea pallida Powdered Echinacea pallida Powdered Echinacea pallida Extract

References cited:

Blumenthal M, editor. 2003. The ABC Clinical Guide to Herbs. Austin (TX): American Botanical Council.

Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, Rister RS, editors. 1998. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin (TX): American Botanical Council.

Blumenthal M, Goldberg A, Brinckmann J. 2000. Herbal Medicine: Expanded Commission E Monographs. Newton (MA): Integrative Medicine Communications.

Bove M. 2001. An Encyclopedia of Natural Healing for Children and Infants, 2^nd edition. New York (NY): McGraw-Hill.

Bradley PR, editor. 2006. British Herbal Compendium: A Handbook of Scientific Information on Widely Used Plant Drugs, Volume 2. Bournemouth (UK): British Herbal Medicine Association.

Brinker F. 2008. Online Updates and Additions to Herb Contraindications and Drug Interactions, 3^rd edition. Sandy (OR): Eclectic Medical Publications. Available from: http://www.eclecticherb.com/emp/updatesHCDI.html [Accessed 26 June 2008].

Brinker F, editor. 2001. Herb Contraindications & Drug Interactions, 3^rd edition. Sandy (OR): Eclectic Medical Publications.

Dorn M, Knick E, Lewith G. 1997. Placebo-controlled, double-blind study of Echinacea pallidae radix in upper respiratory tract infections. Complementary Therapies in Medicine 5(1): 40-42.

ESCOP 2003: ESCOP Monographs: The Scientific Foundation for Herbal Medicinal Products, 2^nd edition. Exeter (UK): European Scientific Cooperative on Phytotherapy and Thieme.

JC 2008: Justice Canada. Food and Drug Regulations. (C.01.021) [online]. Ottawa (ON): Justice Canada. Available from: http://laws.justice.gc.ca/en/F-27/C.R.C.-c.870/text.html [Accessed 26 June 2008].

McGuffin M, Hobbs C, Upton R, Goldberg A, editors. 1997. American Herbal Products Association's Botanical Safety Handbook. Boca Raton (FL): CRC Press.

McGuffin M, Kartesz JJ, Leung AY, Tucker AO, editors. 2000. Herbs of Commence, 2^nd edition. Silver Spring (MD): American Herbal Products Association.

Mills E, Dugoua J, Perri D, Koren G. 2006. Herbal Medicines in Pregnancy and Lactation: An Evidence-Based Approach. London (UK): Taylor and Francis Medical.

Moerman DE. 1998. Native American Ethnobotany. Portland (OR): Timber Press.

Schilcher H. 1997. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart (DE): medpharm Scientific Publishers.

USDA 2000: United States Department of Agriculture, Agricultural Research Service, National Genetic Resources Program. Germplasm Resources Information Network (GRIN) [online database]. Echinacea pallida. Beltsville (MD): National Germplasm Resources Laboratory. Available from: http://www.ars-grin.gov/cgi-bin/npgs/html/tax_search.pl [Accessed 26 June 2008].

References reviewed:

Barnes J, Anderson LA, Gibbons S, Phillipson JD. 2005. Echinacea species (Echinacea angustifolia (DC.) Hell., Echinacea pallida (Nutt.) Nutt., Echinacea purpurea (L.) Moench: a review of their chemistry, pharmacology and clinical properties. Journal of Pharmacy and Pharmacology 57(8):929-954.

Barnes J, Anderson LA, Phillipson JD. 2007. Herbal Medicines, 3^rd edition. London (UK): The Pharmaceutical Press.

BHP 1983: British Herbal Pharmacopoeia. Bournemouth (UK): British Herbal Medicine Association.

Bielory L. 2004. Complementary and alternative interventions in asthma, allergy, and immunology. Annals of Allergy, Asthma & Immunology 93(1):S45-S54.

Boon H, Smith M, editors. 2004. The Complete Natural Medicine Guide to the 50 Most Common Medicinal Herbs, 2^nd edition. Toronto (ON): Robert Rose Inc.

Bradley PR, editor. 1992. British Herbal Compendium: A Handbook of Scientific Information on Widely Used Plant Drugs, Volume 1. Bournemouth (UK): British Herbal Medicine Association.

Chicca A, Pellati F, Adinolfi B, Matthias A, Massarelli I, Benvenuti S, Martinotti E, Bianucci AM, Bone K, Lehmann R, Nieri P. 2008. Cytotoxicity activity of polyacetylenes and polyenes isolated from roots of Echinacea pallida. British Journal of Pharmacology 153(5):879-885.

EMEA 2000: The European Agency for the Evaluation of Medicinal Products. Committee for Veterinary Medicinal Products: Echinacea (use in veterinary homeopathy) Summary Report [online]. London (UK): EMEA; 2000. Available from: http://www.emea.europa.eu/pdfs/vet/mrls/068799en.pdf [Accessed 26 June 2008].

Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G. 2000. Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Archives of Internal Medicine 160(20):3141-3143.

Huntley A, Coon JT, Ernst E. 2005. The safety of herbal medicinal products derived from echinacea species. Drug Safety 28(5):387-400.

Islam J, Carter R. 2005. Use of Echinacea in upper respiratory tract infection. Southern Medical Journal 98(3): 311-318.

Melchart D, Linde K, Worku F, Sarkady L, Holzmann M, Jurcic K, Wagner H. 1995. Results of five randomized studies on the immunomodulatory activity of preparations of Echinacea. Journal of Alternative and Complementary Medicine 1(2): 145-160.

Miller LG. 1998. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Archives of Internal Medicine 158(20):2200-2211.

Mills S. 1985. The Dictionary of Modern Herbalism. Wellingborough (UK): Thorsons Publishers Ltd.

Mills S, Bone K. 2005. The Essential Guide to Herbal Safety. St. Louis (MO): Elsevier Churchill Livingstone.

Mills S, Bone K. 2000. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Toronto (ON): Churchill Livingstone.

Newall CA, Anderson LA, Phillipson JD. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London (UK): The Pharmaceutical Press.

Perri D, Dugoua JJ, Mills E, Koren G. 2006. Safety and efficacy of echinacea (Echinacea angustifolia, E. purpurea and E. pallida) during pregnancy and lactation. The Canadian Journal of Clinical Pharmacology 13(3):e262-e267.

Speroni E, Govoni P, Guizzardi S, Renzulli C, Guerra MC. 2002. Anti-inflammatory and cicatrizing activity of Echinacea pallida Nutt. root extract. Journal of Ethnopharmacology 79(2): 265-272.

WHO 1999: World Health Organization. WHO Monographs on Selected Medicinal Plants: Radix Echinaceae [online]. Geneva (CH): World Health Organization; 2007. Available from: http://whqlibdoc.who.int/publications/1999/9241545178.pdf [Accessed 26 June 2008].

Wichtl M, editor. 2004. Herbal Drugs and Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis, 3^rd edition. Stuttgart (D): Medpharm GmbH Scientific Publishers.

Wiersema JH, León B, editors. 1999. World Economic Plants: A Standard Reference. Boca Raton (FL): CRC Press LLC.

Appendix 1: Examples of appropriate dosage preparations, frequencies of use and directions for use (for adults only)

Dried root:

• 0.9-1 g, 3 times per day (Blumenthal 2003)

Decoction:

• 1 g dried root, 3 times per day (Blumenthal et al. 2000)
  
  Directions for use: Place dried root in 150 ml of cold water, bring to a boil and simmer for 10 minutes (Blumenthal et al. 2000). Drink between meals (Blumenthal 2003).

Tincture:

• 0.9 g dried equivalent, per day
  (1:5, 50% ethanol) (Blumenthal et al. 1998)
• 0.9 g dried equivalent, per day (Dorn et al. 1997)