ECHINACEA

COMMON NAMES:

American Cone Flower, Black Sampson,Black Susans,Brauneria Angustifolia, Brauneria Pallida, Comb Flower, Coneflower, Echinaceawurzel, Equinácea, Hedgehog, Igelkopfwurzel, Indian Head, Kansas Snakeroot, Narrow-leaved Purple Cone Flower, Pale Coneflower, Purple Cone Flower, Purpursonnenhutkraut, Purpursonnenhutwurzel, Racine d'echininacea, Red Sunflower, Rock-Up-Hat, Roter Sonnenhut, Schmallblaettrige Kegelblumenwurzel, Schmallblaettriger Sonnenhut, Scurvy Root, Snakeroot, Sonnenhutwurzel.

SCIENTIFIC CLASSIFICATION:

KINGDOM: PlantaeORDER: AsteralesFAMILY: Asteraceae/CompositaeSUB FAMILY: AsteroideaeTRIBE: HeliantheaeGENUS: EchinaceaSPECIES: There were 9 distinct species.

Echinacea angustifolia – Narrow-leaf Coneflower Echinacea atrorubens – Topeka Purple Coneflower Echinacea laevigata – Smooth Coneflower, Smooth Purple

Coneflower Echinacea pallida – Pale Purple Coneflower Echinacea paradoxa – Yellow Coneflower, Bush's Purple

Coneflower Echinacea purpurea – Purple Coneflower, Eastern Purple

Coneflower Echinacea sanguinea – Sanguine purple Coneflower Echinacea simulata – Wavyleaf Purple Coneflower Echinacea tennesseensis – Tennessee Coneflower

Echinacea angustifolia, Echinacea pallida and Echinacea purpurea are the main medicinal Echinacea species.

GENERIC NAME ORIGIN:

Echinacea is derived from a Greek word “Echinos” meaning "hedgehog" or "sea urchin," referring to the sharp pointed bracts of the receptacles, giving the herb one of its many common names, "Hedgehog." 

GEOGRAPHICAL SOURCE:

Echinacea is a perennial herb native to the mid western region of North America growing from Virginia to Ohio, Michigan, south to Georgia and Louisiana. It is found growing on road banks, prairies, fields and in dry, open woods, from the prairie states northward to Pennsylvania and has been widely cultivated in Europe.

SOURCE MATERIALS:

Roots and/ Rhizomes.

MORPHOLOGY:

ROOTS: COLOUR: pale to yellowish brown.TEXTURE: tapering, cylindrical, slightly spiral, and fibrousODOR: aromatic smell.DIAMETER: 4 – 10mmLEAVES: COLOUR: dark green.TEXTURE: bristly.STEMS:LENGTH: 2 to 3 ft. HEIGHT: 60cm-90cm high. TEXTURE: slender but stout, rough and bristly.FLOWERS: HEIGHT: 4 to 5 in. DIAMETER: 10cm-13cmSEED:COLOUR: tan or two-toned tan and brownSIZE: varies depending on species and availability of water and nutrients.RHIZOMES:COLOUR: pale to yellowish brownTEXTURE: crowned with remains of the aerial stem, and sometimes showing surface annulations up to 15mm in diameter.

MICROSCOPY:

The rhizomes and roots in transverse section show a thin outer bark separated from a wide xylem by a distinct cambial line. The cork is composed of several rows of thin-walled cells containing yellowish brown pigment. The rhizome has a small circular pith, occasional small groups of thick-walled, lignified fibers in the pericycle, and a parenchymatous cortex. The phloem and xylem are composed of narrow strands of vascular tissue separated by wide, non-lignified medullary rays. Xylem vessels are lignified, 25to 75µm in diameter, usually with reticulate thickening but occasionally with spiral or annular thickening. Sclereids occur singly or in small groups, varying considerably in size and shape from rounded to rectangular to elongated and fiber-like, up to 300µm long and 20to 40µm wide, with intercellular spaces forming schizogenous oleoresin canals that are 80to 150µm in diameter and contain a dense black deposit. The canals are present outside of the central cylinder only (unlike Echinacea pallida, where they are present

both inside and outside of the central cylinder). Spherocrystalline masses of inulin occur throughout the parenchymatous tissues. Lignified fibers, 300to 800µm long, are present in scattered groups, and are usually surrounded by phytomelanin (unlike fibers in Echinacea pallida, where they usually occur singly in the periphery of the cortex and are 100to 300µm long, with phytomelanin often absent).

PROPERTIES:

LOSS ON DRYING: Dry it at 105 for 2hours:it loses USP28not more than 10.0%. FOREIGN ORGANIC MATTER: not more than 3.0%.

TOTAL ASH: not more than 7.0%.

ACID INSOLUBLE ASH: not more than 4.0%.

PESTICIDE RESIDUES: meets the requirements.

HEAVY METALS: 0.001%.

CULTIVATION:

Echinacea plants prefer full sun, well-drained, limey soil, and regular watering. All species will give some germination in 2 to 3 weeks if planted shallowly in well-drained potting soil in a warm (not too hot!) greenhouse and watered gently. A period of cold, moist conditioning (stratification) will improve germination rate on most species. Natural outdoor stratification is much more successful than artificial (refrigerated) stratification. Sow the seed directly in the garden or field in the fall or early spring. Barely cover the seed and tamp in. Keep weeded and thin to between 6 inches to 1 foot apart (for the tap rooted species), and 2 feet apart for Echinacea purpurea.

HARVESTING AND PROCESSING THE ROOT:

Although all parts of the plant have some medicinal value, it is the fresh root that is most practical and effective for home medicine making. Echinacea root is harvested during the dormant period, preferably in the autumn after 2 or 3 years of growth. The roots are dug up with a garden fork or shovel, shaken free of dirt, and washed with a pressure hose. Large crowns will need to be hacked apart with a hatchet or machete in order to allow access to dirt and stones lodged at the base of the crown. Echinacea roots are pretty stable after washing and may be cold-stored or shipped over a period of several days without molding. However, it

makes sense to make the fresh root tincture as soon as possible after washing, which will minimize oxidation.

CHEMICAL CONSTITUENTS:

Echinacea Consists of

alkamides betain echinolene echinacein echinacin caryophylene myristic acid copper esquiterpenes essential oil fatty acids flavonoids glycoproteins glycosides carbohydrates cynarin resins iron sucrose polyacetylenes polysaccharides - the important components stimulating the

immune system are the large polysaccharides, which contribute to the herb's immune empowering effects and increases T-cell production and other natural killer cell activity. These include:

caffeic acid glycoside Echinacoside  fat-soluble alkylamides inulin  protein tannins vitamins A, C, E volatile oils

ROOTS:

The chemicals contained in the root differ considerably from the upper part of the plant. The roots have high concentrations of volatile oils (odorous compounds) while the above-ground parts of the plant tend to

contain more polysaccharides (substances known to trigger the activity of the immune system). The beneficial effects of Echinacea appear to be due to the combination of these active substances.

NUTRIENT COMPOSTION:

Calcium Chromium

Manganese

Vitamin A

Vitamin B-3

Vitamin C

B complex Vitamins

Sodium

Potassium

UFA

ECHINACEA ANGUSTIFOLIA:

It contains not less than 0.5percent of total phenols,calculated on the dried basis as the sum of caftaric acid (C13H12O9),chicoric acid (C22H18O12),chlorogenic acid (C16H18O9),dicaffeoylquinic acids (C25H24O12),and echinacoside (C35H46O20).It contains not less than 0.075percent of dodecatetraenoic acid isobutylamides (C16H25NO) on the dried basis. USP28

ECHINACEA PALLIDA:

It contains not less than 0.5percent of total phenols,calculated on the dried basis as the sum of caftaric acid (C13H12O9),chicoric acid (C22H18O12),chlorogenic acid (C16H18O9),and echinacoside (C35H46O20).

AVAILABLE FORMS:

Three species of echinacea are commonly used for medicinal purposes: Echinacea angustifolia, Echinacea pallida, and Echinacea purpurea. Many echinacea preparations contain one, two, or even all three of these

species. Different products use different parts of the echinacea plant. This is why the effectiveness of echinacea may differ from one product to another.

Echinacea (including one, two, or all three species) is available in extracts, tinctures, tablets, capsules, and ointments. It is also available in combination with other immune boosting herbs, vitamins, and minerals.

A study performed by ConsumerLab.com (an independent company that tests the purity of health, wellness, and nutrition products) found that of 11 brands of echinacea purchased for testing, only 4 contained what was stated on their labels. About 10% had no echinacea at all; half were mislabelled as to the species of echinacea in the product; and more than half of the standardized preparations did not contain the labelled amount of active ingredients.

Buy products made by reputable, established companies that distribute their products through trustworthy and knowledgeable establishments. When possible, select products with guaranteed potency or standardized extracts

IDENTIFICATION TESTS FOR ECHINACEA ANGUSTIFOLIA:

1. PRESENCE OF ECHINACOSIDE AND DICAFFEOYLQUINIC ACIDS (CYNARIN[E]):

Thin-Layer Chromatographic Identification Test:

Test solution: Weigh and finely pulverize about 10g of Echinacea angustifolia , and transfer 1g of the powder to a suitable extraction thimble. Transfer the thimble to a continuous extraction apparatus, and extract with 50mL of chloroform for 1hour.Retain the chloroform extract for Identification test B . Continue the extraction with 50mLof methanol, and concentrate to a small volume at 40 in vacuum. With the aid of methanol, transfer the extract to a 10-mLvolumetric flask, and dilute with methanol to volume.

Standard solution 1: Dissolve an accurately weighed quantity of USP

Powdered Echinacea angustifolia Extract RS in methanol to obtain a

solution having a concentration of about 20USP28mg per ml.

Standard solution 2: Dissolve an accurately weighed quantity of 1,3-

dicaffeoylquinic acidUSP28in methanol to obtain a solution having a

concentration of about 1mg per ml.

Developing solvent system: Prepare a mixture of ethyl acetate, formic

acid, and water (17:2:1).

Spray reagent 1: Dissolve a suitable quantity of diphenylborinic acid,

ethanolamine ester in methanol to obtain a solution having a

concentration of about 10mg per ml.

Spray reagent 2: Dissolve a suitable quantity of polyethylene glycol

4000in alcohol to obtain a solution having a concentration of about 50mg

per ml.

Procedure: Proceed as directed in the chapter. Develop the

chromatograms in Developing solvent system until the solvent front has

moved not less than 12USP28cm, and dry the plate in a current of air. Spray

the plate with Spray reagent 1 followed by Spray reagent 2 , and examine

the plate under UV light at 365nm:the chromatogram obtained from the

Test solution shows a yellowish zone at an R F value of 0.14characteristic

of echinacoside (absent or only traces present in Echinacea purpurea ) that

corresponds in colour and R F value to that in the chromatogram of

Standard solution 1 , and another zone characteristic of 1,3-

dicaffeoylquinic acidUSP28(absent in Echinacea pallida and Echinacea

purpurea ) corresponding in colour and R F value USP28to that in the

chromatogram of Standard solution 2. Other coloured zones of varying

intensities may be observed in the chromatogram of the Test solution .

2. PRESENCE OF ISOBUTYLALKENYLAMIDES

Thin-Layer Chromatographic Identification Test:

Test solution: Evaporate the chloroform extract retained from preparation

of the Test solution in Identification test A to dryness at 40 in vacuum.To

the residue,add 1mLof alcohol,and pass through a nylon membrane filter

having a porosity of 0.45µm.

Standard solution 1: Transfer an accurately weighed quantity of USP

Powdered Echinacea angustifolia Extract RSto a centrifuge tube,and add

chloroform to obtain a solution having a known concentration of about

100USP28mg per mL.Shake by hand to disperse,sonicate for 5minutes,and

centrifuge.Use the supernatant.

Standard solution 2: Dissolve an accurately weighed quantity of b-

sitosterol in methanol to obtain a solution having a concentration of about

1mg per mL.

Developing solvent system: Prepare a mixture of hexane USP28and ethyl

acetate (2:1).

Spray reagent: Prepare a mixture of glacial acetic acid,sulfuric acid,and p -

anisaldehyde (10:5:0.5) in an ice bath. USP28

Procedure: Proceed as directed in the chapter.Develop the chromatograms

in Developing solvent system until the solvent front has moved not less

than 12USP28cm,and dry the plate in a current of air. ExamineUSP28the plate

under UVlight at 254nm:the chromatogram obtained from the Test

solution shows one main zone at an R Fvalue of about 0.25USP28due to

2 E , 4 E , 8 Z , 10 E -dodecatetraenoic acid isobutylamide and dodeca-

2 E, 4 E, 8 Z, 10 Z -tetraenoic acid isobutylamide (absent in E.pallida )that

corresponds in R Fvalue to that in the chromatogram of Standard solution

1USP28 ,Spray the plate with Spray reagent , and then heat the plate at 100

for 5minutes:the chromatogram obtained from the Test solution shows a

zone due to b-sitosterol that corresponds in R Fvalue to the principal spot

in the chromatogram of Standard solution 2 , below this spot,there is USP28a

USP28zone USP28due to dodeca-2 E, 4 E, 8 Z, 10 E -tetraenoic acid isobutylamide

and to dodeca-2 E, 4 E, 8 Z, 10 Z -tetraenoic acid isobutylamide that

corresponds in R Fvalue to that in the chromatogram of Standard solution

1, and below this spot,there are several yellowish zones due to a,b-

unsaturated isobutylamides (absent in Echinacea pallida and mostly violet

in Echinacea purpurea due to the presence of a,b,g,d-unsaturated

isobutylamides)that are not visible or are very weak when viewed under

UVlight at 254nm.

3. RETENTION TIME:

The retention time of the major peak in the chromatogram of the Test

solution corresponds to that of the echinacoside peak in the

chromatogram of Standard solution 1 , as obtained in the test for Content

of total phenols . The chromatogram of the Test solution shows a peak for

1,3-dicaffeoylquinic acid corresponding in retention time to that obtained

with Standard solution 1 USP28

4. CONTENT OF TOTAL PHENOLS :

Solvent: Prepare a mixture of alcohol and water (7:3).

Solution A: Prepare a filtered and degassed solution of phosphoric acid

(0.1in 100).

Solution B: Use filtered and degassed acetonitrile.

Mobile phase: Use variable mixtures of Solution A and Solution B as

directed for Chromatographic system . Make adjustments if necessary.

Standard solution 1: Dissolve an accurately weighed quantity of USP

Powdered Echinacea angustifolia Extract RS in Solvent , shaking and

heating in a water bath.DiluteUSP28with Solvent to obtain a solution having

a known concentration of about 1mg of per mL.Pass through a membrane

filter having a 0.45-µm or finer porosity.

Standard solution 2: Dissolve an accurately weighed quantity of

chlorogenic acid RS in Solvent,shaking for 1minute.Dilute

quantitatively,and stepwise if necessary,with Solvent to obtain a solution

having a known concentration of about 40µg per mL.Pass through a

membrane filter having a 0.45-µm or finer porosity.

Test solution: Transfer about 125mg of finely powdered Echinacea

angustifolia (capable of passing through a 40-mesh sieve),accurately

weighed,to a round bottom flask equipped with a condenser. USP28Add

25.0mLof Solvent,and heat under reflux,while shaking by mechanical

means,for 15minutes.Centrifuge,or pass through a membrane filter having

a 0.45-µm or finer porosity.

Chromatographic System: The liquid chromatograph is equipped with a

330-nm detector and a 4.6-mm ×25-cm column that contains 5-µm

packing L1.The column temperature is maintained at 35 .The flow rate is

about 1.5mL per minute.The chromatograph is programmed as follows.

Time (minutes)

Solution A

(%)

Solution B

(%) Elution

0–13 90®78 10®22 linear gradient

13–14 78®60 22®40 linear gradient

14–17 60 40 isocratic

17–17.5 60®90 40®10 linear gradient

17.5–22 90 10 equilibration

Chromatograph Standard solution 1,and record the peak responses as

directed for Procedure: The chromatogram obtained is similar to the

Reference Chromatogram for total phenols provided with the USP

Powdered Echinacea angustifolia Extract RSand the resolution,R,between

the 1,3-dicaffeoylquinic acid isomer and echinacoside is not less than 1.0.

USP28Chromatograph Standard solution 2,and record the peak responses as

directed for Procedure: The capacity factor,k¢,is not less than 3.0; USP28the

tailing factor is not more than 2.0;and the relative standard deviation for

replicate injections is not more than 2.5%.

Procedure: Separately inject equal volumes (about 5µL)of Standard

solution 1,Standard solution 2,and the Test solution into the

chromatograph,record the chromatograms,and measure the areas for the

relevant peaks.Identify the relevant analytes in the chromatogram

obtained from the Test solution by comparison with the chromatogram

obtained from Standard solution 1.Separately calculate the percentage of

caftaric acid (C13H12O9),chicoric acid (C22H18O12),chlorogenic acid

(C16H18O9),dicaffeoylquinic acids (C25H24O12),and echinacoside

(C35H46O20)in the portion of Echinacea angustifolia taken by the formula:

2500F(C/W)(ri/rS),

in whichFis the response factor and is equal to 0.695for chicoric

acid,0.729for dicaffeoylquinic acids, USP280.881for caftaric acid,1.000for

chlorogenic acid,and 2.220for echinacoside; Cis the concentration,in mg

per mL,of USP Chlorogenic Acid RS in Standard solution 2;Wis the

weight,in mg,of Echinacea angustifolia taken; and riand rS are the peak

responses for the relevant analyte obtained from the Test solution and the

collagen from reactive oxygen species-induced damage. Chichoric acid

and echinacoside are almost always found, their concentration depending

on the different species of Echinacea.

BIOAVAILABILITY:

“We examined the bioavailability of Echinacea phytochemicals on two

levels: in cell culture using a cell monolayer made from human colon

cancer cells, where the alkylamides were found to readily cross the

monolayer, suggesting that they will be able to cross the intestinal barrier

and be found in blood, hence gaining access to immune cells and

therefore able to modulate their actions. The caffeic acid derivatives

(cichoric acid and echinacoside) did not cross the cell monolayer. This

was an indication that they would not cross the intestinal barrier when

taken orally. These results were then confirmed in a clinical trial.

Alkylamides, but not caffeic acid derivatives, have been found in blood

samples after ingestion of Echinacea preparations.”

REFERENCE:

Matthias A, Blanchfield JT, Penman KG, et al. J Clin Pharm Ther. 2004; 29:7-13.

Matthias A, Addison RS, Penman KG, et al. Life Sciences. 2005; 77:2018-2029

Matthias, et al. Phytomedicine. 2007; in press.

USES BASED ON EVIDENCE:

Uses based on scientific evidence Grade * Prevention of upper respiratory tract infections (adults and children)

Preliminary studies suggest that echinacea is not helpful for preventing the common cold in adults. A recent meta-analysis suggested that standardized extracts of echinacea were effective in the prevention of symptoms of the common cold after clinical inoculation, compared with placebo. In children, a combination of echinacea, propolis, and vitamin C has been reported to reduce the number and duration of cold episodes. However, prevention research overall has not been well designed, and additional trials are needed before a clear conclusion can be drawn.

B

Treatment of upper respiratory tract infections (adults)

Although multiple low quality studies have previously suggested that taking echinacea by mouth by adults when cold symptoms begin may reduce the length and severity of symptoms, a clinical trial reported in July 2005 did not demonstrate any clinical benefit. Recent meta-analyses are conflicting; one suggested that standardized extracts of echinacea were effective in the prevention of symptoms of the common cold after clinical inoculation, compared with placebo, whereas

B

the other reported no such benefit. Further research is needed. Cancer

There is a lack of clear human evidence that echinacea affects any type of cancer.

C

Immune system stimulation

Echinacea has been studied alone and in combination preparations for immune system stimulation (including in patients receiving cancer chemotherapy). It remains unclear if there are clinically significant benefits. Additional studies are needed in this area before conclusions can be drawn regarding safety or effectiveness.

C

Low white blood cell counts after X-ray treatment (leukopenia)

Studies have reported mixed results, and it is not clear whether echinacea has benefits for this use.

C

Uveitis (eye inflammation)

Oral  Echinacea purpurea  may offer some benefits in people with low-grade uveitis. Further research is needed to confirm these findings.

C

Vaginal yeast infections

When echinacea is used at the same time as the prescription cream econazole nitrate (Spectazole®), vaginal yeast infections ( Candida ) may occur less frequently. However, further research is needed to confirm this.

C

Genital herpes

Initial human studies suggest that echinacea is not helpful in the treatment of genital herpes.

D

Treatment of upper respiratory tract infections (children)

Initial research suggests that echinacea may not be helpful in children for alleviation of cold symptoms, possibly because parents are not able to recognize the

D

onset of common cold symptoms soon enough to begin treatment, or because the dose of echinacea for use in children is not clear. There are fundamental differences in causes of upper respiratory tract infection symptoms in children versus adults (bacterial versus viral causes, different viruses, different sites of infection, etc). Until additional research is available, echinacea cannot be considered effective in children for this use. Furthermore, development of rash has been associated with echinacea use, and therefore the risks may outweigh the potential benefits in this population.

*Key to grades

A: Strong scientific evidence for this use;

B: Good scientific evidence for this use;

C: Unclear scientific evidence for this use;

D: Fair scientific evidence against this use;

F: Strong scientific evidence against this use.

ECHINACEA AND IMMUNE SYSTEM:

From Dr. Jurg Gertsch,

“We found that some of these alkylamide compounds have a very strong

effect on the regulation of tumour necrosis factor, which is a key

substance in the cellular immune system. Later we managed to find a

mechanism of action for alkylamides, namely that they bind to the type-2

(CB2) cannabinoid receptors, which are known to modulate different

aspects of immune function.”

ECHINACEA AND INFLAMMATION:

Mechanisms of anti-inflammatory activity comes mainly via:inhibited

oedema, antihyaluronidase activity,COX-I and COX-II enzymes

inhibition,cytokine antibody stimulation,inhibits rhinovirus induced

secretion of IL-6 (interleukin-6) and IL-8 (chemokine CXCL-8),PGE(2)

inhibition with a synergistic manner,Cyclooxygenase-2 (COX-2) enzyme

inhibition,Inflammatory response mediators(such like Nitric oxide (NO),

tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta)

inhibition.

Anti-inflammatory principles of Echinacea got identified major comes

from high-molecular weight polysaccharides(molecular weight between

30,000 and 100,000), echinacoside(caffeoyl derivative),alkamides,such

like dodeca-2Z,4E,10Z-trien-8-ynoic acid isobutylamide (1) from E.

angustifolia and dodeca-2Z,4E-diene-8,10-diynoic acid isobutylamide (2)

from E. purpurea and E. pallida.

BLEND OF ECHINACEA PURPUREA AND ANGUSTIFOLIA:

By Dr. Jurg Gertsch, PhD, Dr. Gertsch, Professor Reg Lehmann, PhD

“We have also been fortunate to have had the opportunity to have this

product clinically tested as well in two trials to date and another one

underway. The first trial was with the research group of Dr. Anna

Macintosh at the National College of Naturopathic Medicine in Oregon

and showed a reduction in the incidence of winter infections in a group of

highly stressed and therefore susceptible students over those on placebo.

We have also recently published a clinical study looking at the effect of

supplementation of this combination upon the human immune response.

Specifically, it was found that supplementation for two weeks caused an

increase in white cell counts, an increase in the expression of leucocyte

heat shock proteins, and an improvement of erythrocyte antioxidant

defenses”

Dose information expressed as “quantity dried equivalent” of

Echinacea purpurea root presented as dose per day.

SUB POPULATION

QUANTITY DRIED

EQUIVALENT(root) (g/day)

MINIMUM MAXIMUM

CHILDREN 2 – 4 y 0.15 0.8

CHILDREN

AND

ADOLESCENTS

5 – 9 y 0.23 1.1

ADOLESCENTS 10 – 14y 0.45 2.3

ADOLESCENTS

AND ADULTS

≥ 14 y 0.90 4.5

Children and adolescent doses were calculated as a proportion of the adult dose (JC 2008). The use of Echinacea purpurea root in children is supported by the following references: McIntyre 2005; Bove 2001; Schilcher 1997. Adult dose supported by the following references: Mills and Bone 2000; Bräunig et al. 1992 Includes pregnant and breastfeeding women.

Dose information for the pressed juice of Echinacea purpurea aerial

parts presented as dose per day.

SUB POPULATION

PRESSED JUICE(AERIAL

PARTS) (ml/day)

MINIMUM MAXIMUM

CHILDREN 2 -4 y 0.7 1.7

CHILDREN

AND

ADOLESCENTS

5 – 9y 1.0 2.5

ADOLESCENTS 10 – 14 y 2.0 5.0

ADOLESCENTS

AND ADULTS

≥ 14 y 3.9 10.0

Children and adolescent doses were calculated as a proportion of the adult dose (JC 2008). The use of Echinacea purpurea aerial parts in children is supported by the following references: McIntyre 2005; Bove 2001; Schilcher 1997. Adult dose supported by the following references: Schulten et al. 2001; Hoheisel et al. 1997 Includes pregnant and breastfeeding women.

Dose information expressed as “quantity dried equivalent” of

Echinacea purpurea aerial parts presented as dose per day

SUB POPULATION

PRESSED JUICE(AERIAL

PARTS) (ml/day)

MINIMUM MAXIMUM

CHILDREN 2 -4 y 0.4 1.0

CHILDREN

AND

ADOLESCENTS

5 – 9y 0.6 1.5

ADOLESCENTS 10 – 14 y 1.3 3.0

ADOLESCENTS

AND ADULTS

≥ 14 y 2.5 6.0

Children and adolescent doses were calculated as a proportion of the adult dose (JC 2008). The use of Echinacea purpurea aerial parts in children is supported by the following references: McIntyre 2005; Bove 2001; Schilcher 1997. Adult dose supported by the following reference: Mills and Bone 2000 Includes pregnant and breastfeeding women

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angustifolia_1.html17. http://www.herbalextractsplus.com/echinacea-purpurea.cfm 18. http://www.newdruginfo.com/pharmacopeia/usp28/v28230/

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