Echinacea for Upper Respiratory Tract Infections
B Good Evidence At least one randomized trial supports this, with mostly consistent results.Cochrane-reviewed meta-analyses suggest echinacea may modestly reduce cold duration and severity when started at symptom onset. Daily prophylactic use may reduce cold risk. Individual trial effects are small but consistently positive across multiple preparations.
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B
The Bottom Line
Cochrane-reviewed meta-analyses suggest echinacea may modestly reduce cold duration and severity when started at symptom onset. Daily prophylactic use may reduce cold risk. Individual trial effects are small but consistently positive across multiple preparations.
Key Study Findings
Meta-Analysis
n=3169
Efficacy and safety of Echinacea purpurea in treating upper respiratory infections and complications of otitis …
Dose: None
vs: Placebo
Outcome: URTI treatment duration, incidence, antibiotic use
Effect: SMD=-0.19 (duration); RR=0.81 (incidence)
<0.01
Population: Children with URTI and otitis media (9 RCTs)
Review
Plant-Based Support of Respiratory Health during Viral Outbreaks.
Dose: None
vs: None
Outcome: None
Effect: None
None
Population: None
Meta-Analysis
Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and …
Dose: None
vs: Placebo
Outcome: Upper respiratory tract infection
Effect: None
None
Population: None
Meta-Analysis
n=3135
13.0 weeks
Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A …
Dose: None
vs: Placebo
Outcome: Upper respiratory tract infection
Effect: odds ratio = 0.75
p=0.07
Population: children
In Vitro
Prevention and Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural …
Dose: None
vs: Placebo
Outcome: Influenza and common cold prevention/treatment
Effect: None
None
Population: General population with respiratory infections
Randomized Controlled Trial
n=177
Double-blind
Antitussive effect of a fixed combination of Justicia adhatoda, Echinacea purpurea and Eleutherococcus senticosus extracts …
Dose: 30 ml/day
vs: placebo
Outcome: cough relief, which was assessed as the change …
Effect: None
None
Population: men
Key Statistics
20
Studies
4000
Participants
↑
Positive
B
Grade
Referenced Papers
Clinical nutrition ESPEN
2025
2 citations
Journal of agricultural …
2022
9 citations
Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children.
Meta-Analysis
European journal of …
2019
54 citations
Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis.
Meta-Analysis
Complementary therapies in …
2019
51 citations
Journal of evidence-based …
2017
134 citations
Phytomedicine : international …
2015
36 citations
Frontiers in pharmacology
2014
14 citations
American family physician
2012
Natural product communications
2011
7 citations
Annals of allergy, …
2008
28 citations
Alternative medicine review …
2007
163 citations
International journal of …
2007
41 citations
Canadian journal of …
2007
20 citations
American journal of …
2006
51 citations
Journal of alternative …
2005
44 citations
Southern medical journal
2005
35 citations
Journal of clinical …
2004
109 citations
Clinical evidence
2003
Clinical evidence
2003
Annals of internal …
2002
178 citations
Primary care
2002
56 citations
American family physician
2002
Archives of family …
1998
162 citations
Dosage & Usage
mg = milligrams · mcg = micrograms (1,000× smaller) · IU = International Units
Commonly Used Dosages
- general:
- 300-500 mg standardized extract 3x/day
- acuteuse:
- At first sign of symptoms for 7-10 days
Upper limit: No established UL; generally used for 10 days or less
Dosages Studied in Research
| Dosage | Duration | Effect | N |
|---|---|---|---|
| None | -- | Positive | 3169 |
| None | -- | Mixed | -- |
| None | -- | Positive | -- |
| None | 13.0 weeks | Mixed | 3135 |
| None | -- | Positive | -- |
| 30 ml/day | -- | Positive | 177 |
| None | -- | Neutral | -- |
| None | -- | Mixed | -- |
Best taken: At first sign of symptoms; multiple doses throughout the day
Safety & Side Effects
Reported Side Effects
- ⚠ Gastrointestinal upset (nausea, stomach pain)
- ⚠ Allergic reactions (especially in those allergic to daisies, ragweed)
- ⚠ Headache
- ⚠ Dizziness
Known Interactions
- ● Immunosuppressant medications (may counteract immunosuppression)
- ● CYP3A4 substrates (may alter metabolism of various drugs)
- ● Caffeine (may slow caffeine metabolism)
- ● Anabolic steroids and methotrexate (increased hepatotoxicity risk)
Tolerable upper intake: No established UL; generally used for 10 days or less
Always consult your healthcare provider before starting any supplement.
Frequently Asked Questions
Does Echinacea help with Upper Respiratory Tract Infections?
Based on 20 studies with 4,000 participants, there is moderate evidence from clinical studies that Echinacea may support Upper Respiratory Tract Infections management. Our evidence grade is B (Good Evidence).
How much Echinacea should I take for Upper Respiratory Tract Infections?
Studies have used various dosages. A commonly studied range is 300-500 mg standardized extract 3x/day. Always consult your healthcare provider before starting any supplement regimen.
Are there side effects of Echinacea?
Reported side effects may include Gastrointestinal upset (nausea, stomach pain), Allergic reactions (especially in those allergic to daisies, ragweed), Headache, Dizziness. Most side effects are mild and dose-dependent. Consult your doctor if you experience any adverse reactions.
How strong is the evidence for Echinacea and Upper Respiratory Tract Infections?
We rate the evidence as Grade B (Good Evidence). This rating is based on 20 peer-reviewed studies with 4,000 total participants. The overall direction of effect is positive.
Related Evidence
Other ingredients for Upper Respiratory Tract Infections
References
- [1] Thi-Phuong-Thao Pham et al.. Clin Nutr ESPEN. 2025. Efficacy and safety of Echinacea purpurea in treating upper respiratory infections and complications of otitis media in children: Systematic review … doi:10.1016/j.clnesp.2025.04.025 PubMed
- [2] Thirumurugan Rathinasabapathy et al.. J Agric Food Chem. 2022. Plant-Based Support of Respiratory Health during Viral Outbreaks. doi:10.1021/acs.jafc.1c06227 PubMed
- [3] Philippe Vorilhon et al.. Eur J Clin Pharmacol. 2019. Efficacy of vitamin C for the prevention and treatment of upper respiratory tract infection. A meta-analysis in children. doi:10.1007/s00228-018-2601-7 PubMed
- [4] Sholto David et al.. Complement Ther Med. 2019. Echinacea for the prevention and treatment of upper respiratory tract infections: A systematic review and meta-analysis. doi:10.1016/j.ctim.2019.03.011 PubMed
- [5] Haider Abdul-Lateef Mousa. J Evid Based Complementary Altern Med. 2017. Prevention and Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies. doi:10.1177/2156587216641831 PubMed
- [6] Anders Barth et al.. Phytomedicine. 2015. Antitussive effect of a fixed combination of Justicia adhatoda, Echinacea purpurea and Eleutherococcus senticosus extracts in patients with acute upper … doi:10.1016/j.phymed.2015.10.001 PubMed
- [7] Lone Holst et al.. Front Pharmacol. 2014. Echinacea and elderberry-should they be used against upper respiratory tract infections during pregnancy? doi:10.3389/fphar.2014.00031 PubMed
- [8] Julia Fashner et al.. Am Fam Physician. 2012. Treatment of the common cold in children and adults. PubMed
- [9] Jie Ma et al.. Nat Prod Commun. 2011. Simultaneous quantification of Echinacea species, Flos Lonicerae, Radix Scutellaria and Fructus Forsythiae combinations by rapid resolution liquid chromatography. PubMed
- [10] Joelle O'Neil et al.. Ann Allergy Asthma Immunol. 2008. Effects of echinacea on the frequency of upper respiratory tract symptoms: a randomized, double-blind, placebo-controlled trial. doi:10.1016/S1081-1206(10)60603-5 PubMed
- [11] Mario Roxas et al.. Altern Med Rev. 2007. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. PubMed
- [12] H Hall et al.. Int J Sports Med. 2007. Echinacea purpurea and mucosal immunity. doi:10.1055/s-2007-964895 PubMed
- [13] Paul Richard Saunders et al.. Can J Physiol Pharmacol. 2007. Echinacea purpurea L. in children: safety, tolerability, compliance, and clinical effectiveness in upper respiratory tract infections. doi:10.1139/Y07-103 PubMed
- [14] Roxane R Carr et al.. Am J Health Syst Pharm. 2006. Complementary and alternative medicine for upper-respiratory-tract infection in children. doi:10.2146/ajhp040613 PubMed
- [15] Wendy Weber et al.. J Altern Complement Med. 2005. Echinacea purpurea for prevention of upper respiratory tract infections in children. doi:10.1089/acm.2005.11.1021 PubMed
- [16] Jamal Islam et al.. South Med J. 2005. Use of Echinacea in upper respiratory tract infection. doi:10.1097/01.SMJ.0000154783.93532.78 PubMed
- [17] V Goel et al.. J Clin Pharm Ther. 2004. Efficacy of a standardized echinacea preparation (Echinilin) for the treatment of the common cold: a randomized, double-blind, placebo-controlled trial. doi:10.1111/j.1365-2710.2003.00542.x PubMed
- [18] Chris Del Mar et al.. Clin Evid. 2003. Upper respiratory tract infection. PubMed
- [19] Chris Del Mar et al.. Clin Evid. 2003. Upper respiratory tract infection. PubMed
- [20] Bruce P Barrett et al.. Ann Intern Med. 2002. Treatment of the common cold with unrefined echinacea. A randomized, double-blind, placebo-controlled trial. doi:10.7326/0003-4819-137-12-200212170-00006 PubMed
- [21] Raja Jaber. Prim Care. 2002. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. doi:10.1016/s0095-4543(01)00008-2 PubMed
- [22] Chris B Del Mar et al.. Am Fam Physician. 2002. Upper respiratory tract infection. PubMed
- [23] D Melchart et al.. Arch Fam Med. 1998. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. doi:10.1001/archfami.7.6.541 PubMed
FDA Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The products and information on this website are not intended to diagnose, treat, cure, or prevent any disease. The evidence grades presented are based on our analysis of published peer-reviewed research and do not constitute medical advice. Always consult your healthcare provider before starting any supplement regimen.