Trifolium Pratense 2 X, 4 X • Isotonic Plasma 2 X, 4 X • Echinacea purpurea 4 X • Morbillinium 4 X, 12 X, 30 X • Asclepias Tuberosa 4 X, 12 X • Ferrum Iodatum 4 X • Thuja occidentalis 4 X, 12 X, 30 X • Lac Vaccinium 6 X • Euphrasia officinalis 6 X • Calcarea Arsenica 6 X, 12 X • Vaccinotoxinum 6 X, 12 X, 30 X • Camphora 12 X • Ichthyolum 12 X • Variolinum 12 X, 30 X, 60 X • Coxsackievirus 12 X, 30 X, 60 X • Influenzium 12 X, 30 X, 60 X • Vincetoxicum 12 X, 30 X, 60 X • Encephalitis 12 X, 30 X, 60 X • Bacille Calmette-Guerin 12 X, 30 X, 60 X • Cytomegalovirus 12 X, 30 X, 60 X. Other Ingredients: Base: 20% Alcohol, 80% Reverse Osmosis Water.
Brand name products often contain multiple ingredients. To read detailed information about each ingredient, click on the link for the individual ingredient shown above.
This is a homeopathic preparation. Homeopathy is a system of medicine established in the 19th century by a German physician named Samuel Hahnemann. Its basic principles are that "like treats like" and "potentiation through dilution." For example, in homeopathy, diarrhea would be treated with an extreme dilution of a substance that normally causes diarrhea when taken in high doses.
Practitioners of homeopathy believe that more dilute preparations are more potent. Many homeopathic preparations are so diluted that they contain little or no active ingredient. Therefore, most homeopathic products are not expected to have any pharmacological effects, drug interactions, or other harmful effects. Any beneficial effects are controversial and cannot be explained by current scientific methods.
Dilutions of 1 to 10 are designated by an "X." So a 1X dilution = 1:10, 3X=1:1000; 6X=1:1,000,000. Dilutions of 1 to 100 are designated by a "C." So a 1C dilution = 1:100; 3C = 1:1,000,000. Dilutions of 24X or 12C or more contain zero molecules of the original active ingredient.
Homeopathic products are permitted for sale in the US due to legislation passed in 1938 sponsored by a homeopathic physician who was also a Senator. The law still requires that the FDA allow the sale of products listed in the Homeopathic Pharmacopeia of the United States. However, homeopathic preparations are not held to the same safety and effectiveness standards as conventional medicines. For more information, see the Homeopathy monograph.
Below is general information about the effectiveness of the known ingredients contained in the product Immuno Anti Viral. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
INSUFFICIENT RELIABLE EVIDENCE to RATE
There is insufficient reliable information available about the effectiveness of pleurisy root.
INSUFFICIENT RELIABLE EVIDENCE to RATE
Below is general information about the safety of the known ingredients contained in the product Immuno Anti Viral. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
POSSIBLY SAFE ...when used topically in low concentrations, short-term. Concentrations ranging from 0.1% to 11% seem to be safe for short-term application to intact skin (272,10327,89893). ...when used by inhalation, appropriately. Even relatively dilute concentrations of camphor can irritate the nose and sinuses. However, it is difficult to determine a safe concentration of inhaled camphor. The Occupational Safety and Health Administration (OSHA) has set a permissible workplace air exposure to synthetic camphor of no more than 2 parts per million (ppm) (272,105033). It is unclear how this correlates to the exposure obtained from a camphor balm or steam bath.
LIKELY UNSAFE ...when used topically on broken or injured skin. Application of camphor to broken skin can result in systemic absorption and toxicity (272). ...when inhaled in large concentrations, which can result in systemic toxicity (13445,39666). However, it is difficult to determine a safe concentration of inhaled camphor. The National Institute for Occupational Safety and Health (NIOSH) has determined an Immediately Dangerous to Life or Health Concentration (IDLH) of synthetic camphor in workplace air to be 200 ppm (105033). It is unclear how this correlates to the exposure obtained from a camphor balm or steam bath.
UNSAFE ...when used orally. Although a particular oral product containing camphor and hawthorn (Korodin Herz-Kreislauf-Tropfen) has been used safely by adults in some clinical studies (103620), ingestion of camphor can cause significant toxicity, including death (13442). Oral preparations of camphor are no longer available in the US (13442).
CHILDREN: POSSIBLY UNSAFE
when used topically (4814).
Young children might be more susceptible to the adverse effects associated with even minor systemic absorption of camphor. The American Academy of Pediatrics recommends that camphor not be used in treating children (4814).
CHILDREN: UNSAFE
when used orally.
Ingestion of camphor can cause significant toxicity including death (4814). The American Academy of Pediatrics recommends that available non-prescription topical camphor products should not exceed 11% strength to limit toxicity if accidentally ingested by children (4814).
PREGNANCY AND LACTATION: UNSAFE
when used orally.
Ingestion of camphor can cause serious toxicity including death (13442). There is insufficient reliable information available about the safety of using camphor topically during pregnancy and lactation.
LIKELY SAFE ...when used orally and appropriately, short-term. Various liquid extracts of Echinacea purpurea have been used safely for up to 10 days, including EchinaGuard (Madaus AG) 20 drops every 2 hours for 1 day, then three times daily (10320), or Echinilin (Inovobiologic Inc.) 40 mL in divided doses for 1 day, then 15 mL in divided doses daily thereafter (12355,20062). Other liquid extracts have been used safely for relatively longer periods, including Echinaforce (A. Vogel Bioforce AG) 2.4 grams daily for 4 months or 1.6 grams daily for 6 months (7087,18225), and Echinacin (Madaus AG) 5 mL twice daily for 10 days, or 4 mL twice daily for 8 weeks (3282,10802). Specific solid dosage forms of echinacea that have been used safely for up to 10 days include Echinacea purpurea above-ground parts (EchinaFresh, Enzymatic Therapy) 300 mg daily (11970), and mixtures of Echinacea purpurea and Echinacea angustifolia herb in divided doses of 6 grams to 10.5 grams for 1 day then 3 grams to 5.1 grams daily (10800,17519,20059). A specific Echinacea angustifolia extract (ExtractumPharma ZRT) has also been used with apparent safety at a dose of 40 mg once or twice daily for up to 7 days (20064,103233). An Echinacea purpurea product (Natures Resource) has been used safely at a dose of 1.8 grams daily for 8 weeks (17521), and echinacea (Puritan's Pride) has been used safely at 8 grams daily for 28 days (20066).
POSSIBLY SAFE ...when used topically, short-term. A specific cream (Linola Plus Cream, Dr. August Wolff GmbH & Co.) containing echinacea extract (WO 3260) has been applied to the skin safely 2-3 times daily for up to 12 weeks (97499). There is insufficient reliable evidence about the safety of echinacea when used parenterally.
CHILDREN: POSSIBLY SAFE
when used orally, short-term.
Some clinical research shows that an extract of the above-ground parts of Echinacea purpurea (EC31J2, Echinacin Saft, Madaus AG) in a dose of 3.75 mL twice daily (for ages 2 years to 5 years) or 7.5 mL twice daily (for ages 6 years to 11 years) is safe when used for up to 10 days (4989). However, about 7% of children experienced a rash after taking echinacea, which might have been caused by an allergic reaction (4989). There is concern that allergic reactions could be severe in some children. The Medicines and Healthcare Products Regulatory Agency in the United Kingdom recommends against the use of oral echinacea products in children under 12 years of age due to this risk of allergic reaction (18207). In contrast, another clinical study in children 4-12 years old shows that a specific Echinacea purpurea product (Echinaforce Junior, A. Vogel) does not cause allergic or urticarial reactions more frequently than vitamin C (105719).
PREGNANCY: POSSIBLY SAFE
when used orally, short-term.
There is preliminary evidence that mothers can safely use echinacea in the form of E. purpurea or E. angustifolia solid dosage forms, 250-1000 mg daily, or tinctures, up to 30 drops daily, for 5 days to 7 days during the first trimester without adversely affecting the fetus (7056,13418,15123). There is insufficient reliable information available about the safety of echinacea when used for longer than 7 days.
LACTATION:
Insufficient reliable information available; avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Eyebright is listed by the Council of Europe as a natural source of food flavoring (4).
POSSIBLY UNSAFE ...when applied into the eyes. Avoid using due to hygienic concerns; eyebright ophthalmic products may be subject to contamination (8,11). There is insufficient reliable information available about the safety of eyebright when used orally in medicinal amounts.
PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.
POSSIBLY UNSAFE ...when used orally. Pleurisy root contains digitalis-like cardenolide glycosides (4). When taken in large doses, it can cause digitalis-like poisoning symptoms (18). Canadian regulations do not allow pleurisy root as an ingredient in oral products (12).
PREGNANCY: UNSAFE
when used orally (12).
Pleurisy root might have uterine stimulant and estrogenic activity (19).
LACTATION: POSSIBLY UNSAFE
when used orally (12); avoid using.
LIKELY SAFE ...when used orally in amounts commonly found in foods. Thuja that is thujone-free has Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).
POSSIBLY UNSAFE ...when used orally in medicinal amounts. Large doses of thuja have been reported to cause seizures, severe vomiting, organ toxicity, and death in some cases (6002,40888). There is insufficient reliable information available about the safety of thuja when used topically.
PREGNANCY: LIKELY UNSAFE
when used orally due to abortifacient activity (12); avoid using.
LACTATION: LIKELY UNSAFE
when used orally due to toxicity (11); avoid using.
Below is general information about the interactions of the known ingredients contained in the product Immuno Anti Viral. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
Theoretically, concomitant use of camphor with other hepatotoxic drugs might increase the risk of liver damage.
Details
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Echinacea can increase plasma levels of caffeine by inhibiting its metabolism.
Details
Echinacea seems to increase plasma concentrations of caffeine by around 30% (12155). This is likely due to inhibition of cytochrome P450 1A2 (CYP1A2) by echinacea.
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Echinacea might inhibit the metabolism of CYP1A2 and increase plasma levels of some drugs.
Details
Echinacea appears to inhibit CYP1A2 enzymes in humans. Additionally, echinacea seems to increase plasma concentrations of caffeine, a CYP1A2 substrate, by around 30% (12155). Theoretically, echinacea might increase levels of other drugs metabolized by CYP1A2.
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Echinacea may induce hepatic CYP3A4 and inhibit intestinal CYP3A4. This may increase or decrease levels of drugs metabolized by CYP3A4.
Details
Several clinical trials have shown that taking echinacea for up to one month does not significantly affect the metabolism of various CYP3A4 substrates, including midazolam, docetaxel, etravirine, lopinavir-ritonavir, and darunavir-ritonavir (13712,48618,88164,88165). However, other clinical research shows that echinacea may increase the clearance of midazolam, suggesting that echinacea might induce CYP3A4 (48618). The discrepancy is thought to be due to differing effects of echinacea on intestinal versus hepatic CYP3A4 enzymes. Echinacea appears to induce hepatic CYP3A4 but inhibit intestinal CYP3A4 (12155). In some cases, these effects might cancel each other out, but in others, drug levels may be increased or decreased depending on the level of effect at hepatic and intestinal sites. The effect of echinacea on CYP3A4 activity may differ depending on the CYP3A4 substrate (6450,11026,88162,88167).
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Theoretically, echinacea may interfere with the metabolism of darunavir; however, a small clinical study found no effect.
Details
Darunavir is metabolized by cytochrome P450 3A4 (CYP3A4) and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Echinacea has variable effects on CYP3A4, but administration of an E. purpurea root extract (Arkocapsulas Echinacea, Arkopharma) 500 mg four times daily for 14 days did not affect darunavir/ritonavir pharmacokinetics in 15 HIV-infected patients (88163,93578).
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Theoretically, echinacea may interfere with the metabolism of docetaxel; however, a small clinical study found no effect.
Details
Docetaxel is metabolized by cytochrome P450 3A4 (CYP3A4). Echinacea has variable effects on CYP3A4, but taking E. purpurea whole plant extract (Echinaforce, A. Vogel Biopharma AG) 20 drops three times daily for 2 weeks did not alter the pharmacokinetics of docetaxel in one clinical study (88164).
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Echinacea may increase levels of etoposide.
Details
In one report, concomitant use of etoposide and echinacea was associated with more severe thrombocytopenia than the use of etoposide alone, suggesting inhibition of etoposide metabolism (20082). Etoposide is a cytochrome P450 3A4 (CYP3A4) substrate. Echinacea has variable effects on CYP3A4, but some studies have reported inhibition of the enzyme (6450,11026,12155,88162,88167).
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Theoretically, echinacea may interfere with the metabolism of etravirine; however, a small clinical study found no effect.
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Echinacea has immunostimulant activity which may interfere with immunosuppressant therapy.
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Theoretically, echinacea may interfere with the metabolism of lopinavir; however, a small clinical study found no effect.
Details
Lopinavir is metabolized by cytochrome P450 3A4 (CYP3A4) and is administered with the CYP3A4 inhibitor ritonavir to increase its plasma concentrations. Echinacea has variable effects on CYP3A4, but taking E. purpurea (Echinamide, Natural Factors Nutritional Products, Inc.) 500 mg three times daily for 14 days did not alter the pharmacokinetics of lopinavir/ritonavir in healthy volunteers (48618,93578).
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Theoretically, echinacea may increase the metabolism of intravenous midazolam.
Details
Echinacea induces hepatic CYP3A4 and might decrease plasma levels of midazolam by about 20%, reducing the effectiveness of intravenous midazolam (12155). Echinacea also appears to inhibit intestinal CYP3A4, which could theoretically increase the bioavailability of oral midazolam. This may cancel out the decrease in availability caused by induction of hepatic CYP3A4, such that overall plasma levels after oral administration of midazolam are not affected by echinacea.
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Echinacea seems to increase the clearance of warfarin, although the effect may not be clinically significant.
Details
Preliminary clinical research in healthy male volunteers suggests that taking echinacea increases the clearance of the active S-isomer of warfarin after a single dose of warfarin, but there was not a clinically significant effect on the INR (20083).
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Preliminary research in animal models of diabetes suggests that eyebright lowers blood glucose levels (49393). Theoretically, concomitant use of eyebright might require dosing adjustment of anti-diabetes drugs; monitor closely. Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
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Pleurisy root contains digitalis-like cardenolide glycosides. Taking pleurisy root in combination with digoxin could increase the risk of adverse effects and toxicity (19).
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Theoretically, concomitant use of potassium-depleting diuretics and pleurisy root can increase the risk of cardiac glycoside toxicity due to potassium depletion (19). Some diuretics that can deplete potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, Hydrodiuril, Microzide), and others.
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Theoretically, excessive amounts of pleurisy root might interfere with hormone drug therapy (4).
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Thuja products can contain thujone, which might lower the seizure threshold (1304). Theoretically, this could decrease the effectiveness of anticonvulsants drugs.
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Thuja might stimulate immune function (1305). Theoretically, taking thuja might decrease the effects of immunosuppressive therapy. Immunosuppressant drugs include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), and other corticosteroids (glucocorticoids).
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Thuja products can contains significant amounts of thujone, a neurotoxin (1304). Theoretically, patients taking drugs that lower the seizure threshold might be at greater risk of seizure if they also take thuja. Advise patients taking these drugs to avoid thuja products. Some drugs that lower the seizure threshold include anesthetics (propofol, others), antiarrhythmics (mexiletine), antibiotics (amphotericin, penicillin, cephalosporins, imipenem), antidepressants (bupropion, others), antihistamines (cyproheptadine, others), immunosuppressants (cyclosporine), narcotics (fentanyl, others), stimulants (methylphenidate), theophylline, and others.
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Below is general information about the adverse effects of the known ingredients contained in the product Immuno Anti Viral. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.
General
...Orally, camphor is unsafe and can cause significant toxicity.
Topically and by inhalation, camphor seems to be generally well-tolerated.
Most Common Adverse Effects:
Oral: Gastrointestinal and ocular symptoms of toxicity can occur within 5-90 minutes of ingestion. Neurological symptoms can occur with ingestion of quantities greater than 50 mg/kg.
Topically: Dermatitis and skin irritation.
Inhalation: Nose and sinus irritation.
Serious Adverse Effects (Rare):
All routes: Systemically absorbed camphor can lead to seizures, respiratory depression, coma, and death.
Cardiovascular ...Case reports of intoxication due to accidental or intentional consumption have included peripheral circulatory shock and sinus tachycardia (39649,97261). A 54-year-old female with a history of cardiomyopathy and atrial fibrillation developed several episodes of ventricular tachycardia and fibrillation requiring use of a defibrillator after ingestion of Vicks VapoRub, containing 4.8% camphor. She had been taking 7.5 grams of the product weekly, and took an additional 150 grams the week prior to admission. After discontinuing all camphor-containing products and receiving supportive measures, the patient's symptoms and laboratory abnormalities returned to normal (97260).
Dermatologic
...Orally, camphor can cause significant toxicity.
In more severe toxicity, general pallor and cyanosis of the lips occur (13442,13444). Topically, camphor is not as likely to cause adverse effects. But some amount of camphor can be absorbed through intact skin. Topical use of camphor has been associated with contact eczema (13445).
Warn patients not to heat products such as Vicks VapoRub in the microwave. Serious burns have occurred when the product is superheated in the microwave (13446).
Gastrointestinal ...Orally, camphor can cause significant toxicity. Symptoms of camphor toxicity occur rapidly within 5-90 minutes of ingestion. Burning of the mouth and throat, and nausea and vomiting are the first symptoms (13442,13444,39589,39626,39646,39658).
Hepatic ...Orally, camphor can cause transient elevations of liver enzymes in both adults and children. There is also a report of increased liver enzymes in an infant who received a camphor-containing topical cold remedy. The enzymes affected included aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and lactate dehydrogenase (LDH). The liver enzymes normalized after stopping the topical cold formula (4608).There is also a report of increased liver enzymes in a 35-year-old adult following "coining" with a balm containing camphor, which involves applying the balm and then rubbing the area with a coin until ecchymosis. The liver enzymes normalized after stopping treatment (39576). Elevated liver enzymes were also reported in a 54-year-old female after oral ingestion of Vicks VapoRub, containing 4.8% camphor. She had been taking 7.5 grams of the product weekly, and took an additional 150 grams the week prior to admission. After discontinuing all camphor-containing products and receiving supportive measures, the patient's symptoms and laboratory abnormalities returned to normal (97260).
Neurologic/CNS
...Orally, camphor can cause significant toxicity.
Neurological symptoms occur with ingestion of greater than 50 mg/kg. These symptoms include irritability, exaggerated tendon reflexes, tonic muscular contraction, myoclonic jerks, seizures, confusion, coma, and apnea. Seizures are sometimes the first manifestation of serious toxicity (13442,13444,39560,39589,39629,39646,39649,39658,39660). In children under 6 years of age, doses as low as 700-800 mg, and possibly as low as 500 mg, have caused serious seizures, resulting in respiratory failure and death (13442,13444,39589). Asymptomatic patients who have ingested camphor should be observed for at least 3 hours in a hospital. A 12-hour observation period may be prudent as seizures have occurred 9 hours after ingestion in apparently recovering patients. In patients who survive, symptoms usually resolve within 24 hours, although there are reports of persistent abnormalities for days to weeks. Long-term sequelae have not been reported after resolution of symptoms (13442,13443). In one case, a 10-year-old boy who intentionally ingested cold remedy transdermal patches containing a total of camphor 300 mg experienced mental status changes and tremulousness (39626).
Topically, camphor is not as likely to cause adverse effects, but small amounts can be absorbed through intact skin. A considerable amount of camphor can also be absorbed when inhaled. Excessive use of camphor, either topically or by inhalation, can result in the development of systemic toxicity (13445,39666). Topically and by inhalation, camphor has been associated with the occurrence of seizures. In one prospective observational study, there were 20 reports of new onset seizures and 29 reports of recurrent seizures in adults and children after use of camphor, either alone or in combination with eucalyptus oil. Most cases of seizure with topical use occurred 0.5-24 hours after topical application to the chest, neck, or face. Most cases of seizure with inhalation occurred about 2-30 minutes after steam inhalation of camphor (105028).
Ocular/Otic
...Orally, camphor can cause significant toxicity.
Ocular symptoms such as mydriasis and darkening of vision may occur (13442,13444). There is a case report of blurry vision following accidental ingestion of camphor (39667).
There is a case report of self-inflicted conjunctival inflammation after using camphor in the eyes (39624). Warn patients not to heat products such as Vicks VapoRub in the microwave. Eye injury has occurred when the product is superheated in the microwave (13446).
Pulmonary/Respiratory
...When inhaled in large enough concentrations, camphor can irritate the nose and sinuses.
However, it is difficult to determine a safe concentration of inhaled camphor (105033).
A 54-year-old females with a history of asthma developed shortness of breath, hypoxemia, and respiratory acidosis after oral ingestion of Vicks VapoRub, containing 4.8% camphor. She had been taking 7.5 grams of the product weekly, and took an additional 150 grams the week prior to admission. After discontinuing all camphor-containing products and receiving supportive measures, the patient's symptoms and laboratory abnormalities returned to normal (97260).
Other ...A smell of camphor from the breath and body have been reported following oral intake of camphor (39560,39589,97261).
General
...Orally, echinacea is well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, constipation, diarrhea, heartburn, nausea and vomiting, rashes, and stomach upset.
Serious Adverse Effects (Rare):
Orally: Severe allergic reactions and hepatitis have been reported.
Dermatologic ...Itching, urticaria, tingling, and allergic rashes have been reported with various echinacea preparations (8225,12355,17519,20059,20077,101592,111530,111540). In a study of children aged 2-11 years, rash occurred in about 7% of children treated with an extract of the above-ground parts of E. purpurea (EC31J2, Echinacin Saft, Madaus AG), compared with about 3% of those treated with placebo (4989,95652). There is concern that allergic reactions could be severe in some children. The Medicines and Healthcare Products Regulatory Agency in the United Kingdom (UK) recommends against the use of oral echinacea products in children under 12 years of age due to this risk of allergic reaction (18207). However, another study in children 4-12 years old shows that a specific E. purpurea product (Echinaforce Junior, A. Vogel) did not cause allergic or urticarial reactions more frequently than vitamin C (105719).
Gastrointestinal ...Gastrointestinal adverse effects include nausea and vomiting, abdominal pain, stomach upset, heartburn, diarrhea, and constipation (10802,11970,12355,13419,17519,20059,48680,105719,106626). An unpleasant taste, dry mouth, and burning, tingling or numbness of the tongue also occur (11970,12355,17519,20059,20070,20077).
Hematologic ...A 51-year-old female presented with leukopenia after taking echinacea 450 mg three times daily for 2 months, along with ginkgo biloba, multivitamins, and calcium. Her leukocyte count recovered upon stopping these supplements, but dropped again when she restarted echinacea alone about a year later. The problem resolved when echinacea was stopped permanently (48533). A 32-year-old male presented with severe thrombotic thrombocytopenic purpura (TTP) about 2 weeks after using an extract of E. pallida to treat a cold. He required admission to an intensive care unit and extensive plasmapheresis. The authors speculate that immunostimulant effects of echinacea induced or exacerbated the TTP (48572).
Hepatic
...Although uncommon, cases of echinacea-induced hepatitis have been reported.
One case report describes acute cholestatic autoimmune hepatitis in a 45-year-old male who had been taking an echinacea root extract 1500 mg daily for about 2 weeks. He presented with significantly elevated liver function tests (LFTs), elevated immunoglobulin G (IgG) levels, and a positive test for anti-smooth muscle antibodies, indicating an autoimmune process. Elevated LFTs and IgG levels returned to normal within one month of stopping echinacea (17518). Another case report describes acute cholestatic hepatitis in a 44-year-old male who had taken echinacea root tablets 600 mg daily for 5 days to treat flu-like symptoms. He presented with elevated LFTs, prothrombin time, and international normalized ratio (INR). His condition gradually improved after stopping echinacea, and his LFTs normalized within 3 months (91528).
Seven cases of hepatitis associated with echinacea use were reported to the Australian Adverse Drug Reactions Advisory Committee between 1979 and 2000, but specific details are lacking (8225).
One case report describes acute liver failure in a 2 year-old child who had been given about 100 mg of echinacea daily for 2 weeks. The patient presented with jaundice, diarrhea, lethargy, anorexia, and significantly elevated LFTs. A liver biopsy showed hepatocyte swelling, spotty necrosis, and inflammatory infiltrate with eosinophils. A full recovery was made over a 2-week period (88166).
Immunologic
...Allergic reactions, including urticaria, runny nose, dyspnea, bronchospasm, acute asthma, angioedema, and anaphylaxis, have been reported with various echinacea preparations (638,1358,8225).
Atopic individuals and those sensitive to other members of the Asteraceae family (ragweed, chrysanthemums, marigolds, daisies) seem to be at higher risk for these reactions (1358,8225).
A case report describes a 36-year-old female who presented with muscle weakness, electrolyte abnormalities, renal tubular acidosis, fatigue, and dry mouth and eyes after taking echinacea, kava, and St. John's Wort for 2 weeks., She also had a positive antinuclear antibody (ANA) test, with elevated anti-dsDNA antibodies SSA and SSB. Sjogren syndrome was diagnosed; the authors hypothesize that it may have been triggered by the immunostimulant effects of echinacea (10319). A 55-year-old male with a history of pemphigus vulgaris in remission for about a year experienced a flare of the disease after taking an echinacea supplement for one week. After stopping echinacea, medical treatment resulted in partial control of the disease (12171). Another case report describes a 58-year-old male who presented with marked eosinophilia and elevated immunoglobulin E (IgE) levels while taking an echinacea supplement. He required prednisone therapy until he stopped taking echinacea 3 years later, at which time his eosinophils and IgE normalized (48623). A 41-year-old male experienced four episodes of erythema nodosum, each occurring after he had taken echinacea for early symptoms of influenza. After stopping echinacea, he had no further exacerbations of erythema nodosum, suggesting that it had been triggered by the immunostimulant effects of echinacea (7057).
Musculoskeletal ...Reports of arthralgia and myalgia have been associated with echinacea (13418).
Neurologic/CNS ...Headache has been reported in people taking various echinacea preparations orally (3282,11970,17519,20059,20064). Dizziness has also been reported (3282,8225,11970). In one study using an alcoholic extract of the above-ground parts of E. purpurea (EC31J0, Echinacin, Madaus AG), somnolence and a tendency to aggressiveness were reported (3282).
General ...There is a limited amount of information on the adverse effects of eyebright. Orally, eyebright has been reported to cause mental confusion, headache, nausea, constipation, cough, dyspnea, insomnia, and polyuria (4). Topically, eyebright applied to the eye has been reported to cause increased eye pressure, itching, redness, vision changes, and photophobia (4). Ophthalmic eyebright products should be used with caution due to the potential for contamination (8,11).
Gastrointestinal ...Orally, eyebright has been reported to cause nausea and constipation (4).
Genitourinary ...Orally, eyebright has been reported to cause polyuria (4).
Neurologic/CNS ...Orally, eyebright has been reported to cause confusion and headache (4).
Ocular/Otic ...Topically, eyebright has been reported to cause increased ocular pressure, lacrimation, pruritus, redness, swelling of eyelid margins, vision changes, and photophobia when applied to the eyes (4). Ophthalmic eyebright products should be used with caution due to the potential for contamination (8,11).
Pulmonary/Respiratory ...Orally, eyebright has been reported to cause cough, dyspnea, and nasal congestion (4).
General
...Orally, pleurisy root can cause gastrointestinal irritation, nausea, and vomiting (19).
When consumed in large quantities, pleurisy root may cause digitalis-like poisoning symptoms (18). Acute digitalis poisoning symptoms include gastrointestinal upset, contracted pupils, blurred vision, strong slow pulse, nausea, vomiting, dizziness, excessive urination, fatigue, muscle weakness and tremors, stupor, confusion, convulsions, atrial arrhythmias, bradycardia, AV block, cardiovascular shock, and death (6,159,501).
Topically, pleurisy root may cause dermatitis (19).
Cardiovascular ...Orally, consuming large quantities of pleurisy root may cause digitalis-like poisoning symptoms (18). Acute digitalis poisoning symptoms include strong slow pulse, atrial arrhythmias, bradycardia, AV block, cardiovascular shock, and death (6,159,501).
Dermatologic ...Topically, pleurisy root may cause dermatitis (19).
Gastrointestinal ...Orally, pleurisy root can cause gastrointestinal irritation, nausea, and vomiting (19). When consumed in large quantities, pleurisy root may cause digitalis-like poisoning symptoms (18). Acute digitalis poisoning symptoms include nausea, vomiting, and gastrointestinal upset (6,159,501).
Neurologic/CNS ...Orally, consuming large quantities of pleurisy root may cause digitalis-like poisoning symptoms (18). Acute digitalis poisoning symptoms include dizziness, stupor, confusion, convulsions, and fatigue (6,159,501).
Ocular/Otic ...Orally, consuming large quantities of pleurisy root may cause digitalis-like poisoning symptoms (18). Acute digitalis poisoning symptoms include contracted pupils and blurred vision (6,159,501).
Renal ...Orally, consuming large quantities of pleurisy root may cause digitalis-like poisoning symptoms (18). Acute digitalis poisoning symptoms include excessive urination (6,159,501).
General ...Orally, large doses of thuja have been reported to cause toxicity involving headache, nervous agitation, seizures, gastric irritation, vomiting, abdominal pain, and diarrhea. Thuja toxicity has also been reported to cause liver damage, renal toxicity, and death in some cases (6002,40888).
Dermatologic ...In one case report, a 5-year-old female presented with a papillary eccrine adenoma. In an effort to avoid excisional biopsy, alternative therapy was sought and an ointment containing thuja was advised to be applied to the lesion. Application of thuja for 6 months resulted in peripheral extension and central necrosis of the lesion, eventually necessitating complete excision of the lesion (106048).
Gastrointestinal ...Orally, large doses of thuja have been reported to cause toxicity involving gastric irritation, vomiting, abdominal pain, and diarrhea (6002,40888).
Hepatic ...Orally, large doses of thuja have been reported to cause toxicity involving liver damage and death (6002,40888). In one case report, a healthy 40-year-old female taking thuja and black cohosh for 1 month presented with 3 days of severe abdominal pain and AST and ALT levels exceeding 5 times the upper limit of normal. Symptoms improved within 5 days of supplement discontinuation and levels normalized within 2 weeks (106047). It is unclear if this reaction was due to thuja, black cohosh, or other factors.
Neurologic/CNS ...Orally, large doses of thuja have been reported to cause toxicity involving nervous agitation, seizures, and death (6002,40888).
Renal ...Orally, large doses of thuja have been reported to cause toxicity involving renal toxicity and death (6002,40888).