Side Effects, Interactions, Uses, Dosage, Warnings

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Reviewed: June 23, 2020

Echinacea is an herb also known as Purple Cone Flower, Black Sampson, Black Susans, Fleur à Hérisson, Hedgehog, Igelkopfwurzel, Indian Head, Kansas Snakeroot, Red Sunflower, Rock-Up-Hat, Roter Sonnenhut, Rudbeckie Pourpre, Scurvy Root, Snakeroot, and many other names.

Echinacea has been used in alternative medicine as a possibly effective aid in treating the common cold, or vaginal yeast infections.

Echinacea has also been used to treat ear infections, or increasing exercise performance. However, research has shown that echinacea may not be effective in these conditions.

Other uses not proven with research have included treating anxiety, migraine headache, attention deficit hyperactivity disorder (ADHD), gingivitis, tonsillitis, genital herpes, human papilloma virus (HPV), low white blood cell counts, bladder infections, an eye condition called uveitis, and other conditions.

It is not certain whether echinacea is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Echinacea should not be used in place of medication prescribed for you by your doctor.

Echinacea is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Echinacea may also be used for purposes not listed in this product guide.

warnings

What is the most important information I should know about Echinacea?

You should not use this product if you are allergic to echinacea or if you have:

• an autoimmune disorder such as rheumatoid arthritis, lupus, or psoriasis.

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have any allergies, especially plant allergies (especially ragweed, mums, marigolds, or daisies).

Ask a doctor before using echinacea if you are pregnant or breastfeeding.

Do not give any herbal/health supplement to a child without medical advice. Echinacea should not be used in a child younger than 12 years old.

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Side Effects

What are the side effects of Echinacea?

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, echinacea is thought to be possibly safe when taken for a short period of time.

Common side effects may include:

• nausea, vomiting, stomach pain, diarrhea;
• fever, sore throat;
• muscle or joint pain;
• unusual or unpleasant taste in the mouth;
• dry mouth, numb feeling in your tongue;
• headache, dizziness, confusion; or
• sleep problems (insomnia).

Echinacea applied to the skin in a topical form can cause an itchy or red skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Pregnancy & Breastfeeding

Can I take Echinacea if I’m pregnant or breastfeeding?

Ask a doctor before using echinacea if you are pregnant or breastfeeding.

Interactions

What drugs and food should I avoid while taking Echinacea?

Avoid coffee, tea, cola, energy drinks, or other products that contain caffeine. Taking echinacea with caffeinated products can increase caffeine side effects such as headache, increased heart rate, and feeling jittery.

Dosage Guidelines & Tips

How to take Echinacea?

Use Echinacea exactly as directed on the label, or as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended.

What should I do if I missed a dose of Echinacea?

Skip the missed dose and take the next regularly scheduled dose. Do not take two doses at one time.

Overdose Signs

What happens if I overdose on Echinacea?

If you think you or someone else may have overdosed on: Echinacea,  call your doctor or the Poison Control center

(800) 222-1222

If someone collapses or isn’t breathing after taking Echinacea, call 911

911

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Medical Disclaimer

Drugs A-Z provides drug information from Everyday Health and our partners, as well as ratings from our members, all in one place. Cerner Multum™ provides the data within some of the Overview, Uses, Warnings, Side Effects, Pregnancy, Interactions, Dosage, Overdose, and Images sections. The information within all other sections is proprietary to Everyday Health. 

Benefits, Dosage, Side Effects, and More

Goldenseal (Hydrastis canadensis) is a perennial plant native to eastern North America (1).

Its roots and leaves have been used in traditional medicine to treat a variety of ailments, especially those involving infections or inflammation (1).

Today goldenseal ranks amongst the most popular herbal remedies worldwide. Teas, herbal extracts, or capsules sourced from this plant are used to treat colds, hay fever, digestive problems, sore gums, and skin problems (2, 3, 4).

Goldenseal is also added to various over-the-counter remedies, such as ear drops, feminine hygiene products, eyewash formulations, cold and flu remedies, allergy relief products, laxatives, and digestive aids (1, 4).

The herb is naturally rich in a class of alkaloid compounds, with berberine, hydrastine, and canadine being found in the highest concentrations.

These alkaloids are linked to antibacterial and anti-inflammatory properties and believed to be the main reason behind goldenseal’s purported health benefits (1).

Goldenseal is praised for its antibacterial and anti-inflammatory properties. It’s often taken to prevent or treat upper respiratory tract infections and the common cold (3, 5).

It’s also used to treat skin disorders, lack of appetite, heavy or painful periods, sinus infections, indigestion, and other inflammatory or digestive disorders (1).

However, research supporting its benefits is limited and generally weak. The benefits with the most scientific backing are outlined below.

Colds and other upper respiratory tract infections

Goldenseal is a popular natural treatment for upper respiratory tract infections, including the common cold (6).

Cell and animal studies suggest that berberine, one of the main active compounds in goldenseal, may help fight infections caused by bacteria and viruses. This includes the virus responsible for the common cold (7, 8, 9, 10, 11).

However, despite goldenseal’s inclusion in many cold remedies, it’s unclear whether the effects observed in animals apply to humans.

The amount of berberine used in these animal studies is generally larger than the amount found in goldenseal supplements. In addition, the absorption of berberine from goldenseal may be lower than that of concentrated berberine supplements (4, 6).

Therefore, more research is needed to determine which effect, if any, goldenseal has against upper respiratory tract infections in humans.

Combined with echinacea

Goldenseal is often combined with echinacea in over-the-counter herbal cold and flu remedies (4, 12).

Echinacea is a plant that’s also native to North America and traditionally used to treat infections, including the common cold (12).

Although some studies suggest that echinacea may lower the risk of respiratory infections, not all agree (13, 14).

Currently, there’s no evidence to suggest that combining goldenseal with echinacea offers any benefits beyond those associated with taking each on their own.

Detoxing or passing a drug test

Some believe that goldenseal can help your body detox from toxins and harmful substances. Yet, very little evidence exists to support this claim.

Your body is naturally designed to detoxify itself. It does so by converting toxic compounds into harmless substances in your liver or making sure they’re eliminated from your body through urine and sweat (15, 16).

Research suggests that goldenseal may reduce the activity of certain liver enzymes responsible for breaking down drugs. As such, this herbal supplement may slow the detox process rather than promote it (1, 17).

However, there’s also evidence that goldenseal may help your body get rid of certain drugs more quickly through the urine. Because of this, some believe goldenseal may help hide the use of illegal drugs to pass a drug test (1).

Keep in mind that newer drug testing methods are now able to detect the use of goldenseal in urine samples, reducing the likelihood of a false negative result on a drug test (17).

While goldenseal’s detoxifying potential may depend on the type of toxin or harmful substance at hand, more studies are needed to confirm this.

Urinary tract and yeast infections

Goldenseal is a common herbal remedy for urinary tract infections (UTIs) and yeast infections.

Cell studies suggest that berberine, one of the main active compounds in goldenseal, may protect your body against various bacteria and fungi (18, 19, 20, 21).

For instance, berberine may stop bacteria from sticking to the walls of your bladder, potentially preventing or helping treat a UTI (22).

Berberine is also believed to keep Candida albicans, a fungus that’s naturally present in the human body, from multiplying in excess (23).

When present in normal numbers, Candida poses no health issues. However, when present in excessive amounts, this fungus can cause vaginal yeast infections, oral thrush, skin rashes, and UTIs (24, 25).

In one study, people with recurrent UTIs given a mix of herbal extracts containing berberine were less likely to experience another UTI than those given no berberine (26).

Although the results from this study seem promising, no human studies have directly examined the effect of goldenseal on UTIs or yeast infections to date. Therefore, more studies are needed before strong conclusions can be made.

Chlamydia or herpes

Chlamydia and herpes are some of the most common sexually transmitted diseases in the world (27, 28).

When left untreated, chlamydia can cause various complications, including infertility. Moreover, babies born vaginally to mothers with chlamydia have a higher risk of pneumonia and vision problems (28).

Herpes is a viral infection that causes watery blisters on the skin or mucous membranes of the lips, mouth, or genitalia. It can be transmitted through oral or sexual contact (28).

A handful of older studies suggest that berberine, one of the main active compounds in goldenseal, may help treat herpes and chlamydia infections.

For instance, some of these studies suggest that vaginal chlamydia infections may be treated with berberine-containing douches, vaginal suppositories, or various types of oral goldenseal supplements (29).

They also propose that berberine-containing plants may help prevent the herpes virus from replicating. One particular study observed that goldenseal mixed with myrrh and thyme helped treat oral herpes (30, 31).

That said, few of these studies looked at the direct effects of goldenseal in humans, and no recent research can be found to support these older findings. Therefore, more research is needed.

Acne and psoriasis

Berberine-containing plants like goldenseal may benefit your skin.

Older test-tube studies suggest that berberine, one of the main active compounds in goldenseal, may help fight P. acnes, the bacterium responsible for acne (32).

In addition, animal research suggests that berberine’s anti-inflammatory effects may help treat inflammatory skin conditions like psoriasis (33).

However, research on this topic is limited and not specific to goldenseal. Therefore, more research is needed.

Oral health

Goldenseal may help protect against tooth infections.

One study suggests that an herbal mouth rinse containing various herbs and goldenseal reduced the growth of bacteria responsible for dental plaque and gingivitis, a mild form of gum disease (31).

Another study suggests that using goldenseal as a toothpaste or mouthwash may help soothe inflamed gums (34).

Still, research is limited, and more studies are needed to confirm these proposed oral health benefits of goldenseal.

Digestion

A few test-tube studies suggest that goldenseal extracts may fight H. pylori, a bacterium that can infect the lining of your stomach and has been linked to the appearance of stomach ulcers (35, 36).

Goldenseal extracts also appear effective against the C. jejuni bacterium, which is a main cause of gastroenteritis (37).

Gastroenteritis is an inflammation of the stomach and intestines that causes diarrhea and vomiting. According to the World Health Organization (WHO), infections with C. jejuni are the most common cause of gastroenteritis (38).

Berberine, one of the main active compounds in goldenseal, is thought to be largely responsible for this plant’s potential ability to protect against H. pylori and C. jejuni (39, 40).

Yet, no studies have observed these effects directly in humans. Therefore, more research is needed before strong conclusions can be made.

Labor

Animal studies suggest that the berberine in goldenseal may induce labor by stimulating the uterus to contract (41).

However, goldenseal and other berberine-containing plants may not be safe to use during pregnancy for several reasons.

First, berberine administration in rats caused lower weight in both mothers and babies. In addition, berberine is believed to cause or worsen jaundice in newborns, which — in a low number of cases — may cause brain damage (4, 41, 42).

As such, women are advised to avoid goldenseal during pregnancy.

Cholesterol and triglyceride levels

Studies in mice and hamsters suggest that the berberine in goldenseal may help lower LDL (bad) cholesterol and triglyceride levels (43, 44).

A recent review of 12 studies found similar results in humans. The authors concluded that berberine may help reduce LDL (bad) cholesterol and triglyceride levels by 20–55 mg/dL (45).

Although these results seem promising, there’s currently no scientific proof that goldenseal produces the same effects.

Therefore, more research is needed to determine whether goldenseal has any cholesterol- and triglyceride-lowering effects in humans.

Diabetes

Goldenseal may be beneficial for people with type 2 diabetes.

Studies suggest that berberine, one of the main compounds in goldenseal, may reduce sugar absorption from the gut, lower insulin resistance, and promote insulin secretion — all of which are factors that may help lower blood sugar levels (46).

Research further suggests that the blood-sugar-lowering effects of berberine may be as effective as those of metformin, a common antidiabetic medication (46).

Moreover, the combination of berberine with blood-sugar-lowering medication appears to be more effective than taking blood-sugar-lowering medications on their own (47).

However, although the benefits of berberine appear promising, it’s unclear whether the amount of berberine in goldenseal is sufficient to produce the same effects. Therefore, more goldenseal-specific studies are needed.

Goldenseal is considered safe when consumed for short periods at the typically recommended dosages.

Side effects are rare but may include nausea, vomiting, and reduced liver function (42, 48, 49).

That said, research on this herbal supplement’s safety is very limited. In addition, short-term use is poorly defined, and little is known about the safety of long-term use or high dosages (1, 42).

Moreover, due to its high cost, some products claiming to contain goldenseal may not contain any amount of this plant or very little of it.

For instance, some products replace goldenseal with Chinese goldthread, Oregon grape root, barberry, yellow root, or Chinese goldenseal — all of which contain berberine but no hydrastine or canadine (50).

Therefore, these herbs may have different side effects and drug interactions than those associated with goldenseal (42).

People wishing to try goldenseal should carefully read a supplement’s ingredient label to ensure that it truly contains goldenseal before purchasing the product.

Goldenseal supplements are available in a wide range of forms, including capsules, lotions, drops, sprays, eyewashes, and feminine hygiene products. They’re currently consumed in various dosages, and little research exists on which dosage is best (1).

Dried root supplements tend to be taken in a dosage ranging from 0.5–10 grams three times a day, whereas alcoholic tinctures and liquid extracts are typically taken in dosages of 0.3–10-mL dosages three times a day (1).

Goldenseal can also be consumed as a tea by steeping 2 teaspoons of the dried herb in 1 cup (240 mL) of hot water for about 15 minutes.

That said, no studies can currently confirm whether these dosages are the most beneficial ones.

At this time, it’s unclear what dosage of goldenseal would cause an overdose — and what the effects of this overdose may be.

Over-the-counter goldenseal preparations tend to be available in doses ranging from 100–470 mg, and most people seem to take goldenseal in doses of 0.5–10 grams or 0.3–10 mL three times a day (1).

These dosages appear to be generally safe, but little is known about the potential effects of larger doses (1).

When in doubt, contact your healthcare provider or local poison control helpline.

Studies suggest that goldenseal may slow the activity of liver enzymes that are responsible for eliminating certain medications, including antidepressants.

This may cause these medications to remain in your body for longer than expected, possibly allowing them to reach toxic levels (41, 42, 49, 51).

People currently taking medications should consult their healthcare provider before starting to take goldenseal.

Little scientific guidance can be found regarding the optimal handling and storage of goldenseal supplements.

Goldenseal supplements are available in a wide range of forms, including dried herbs, lotions, and liquid extracts, among others.

As such, storage, handling, and expiration dates are likely to vary.

For best results, follow the storage and handling recommendations outlined on your product’s packaging and make sure to discard products that have passed their expiration date.

There’s currently little to no research regarding the safety of goldenseal use in pregnant or breastfeeding women.

Animal studies suggest that berberine, one of the main active compounds in goldenseal, is linked to lower weight in both mothers and babies. Berberine may also cause the uterus to contract, possibly increasing the risk of preterm birth (41).

According to animal research, berberine may also cause or worsen jaundice in newborns, possibly causing brain damage (4, 41, 42).

It’s currently unknown whether berberine can pass from mother to baby through breastmilk (52).

Based on this limited evidence, women are discouraged from consuming goldenseal while pregnant or breastfeeding.

At one point, goldenseal ranked amongst the top 20 most popular herbal remedies worldwide and the 6th most commonly used herbal preparation by children under 18 years of age (2).

However, little is known about its effects in children, other than that it may cause or worsen jaundice in newborns. Therefore, experts generally do not advise giving goldenseal to infants and young children (42).

Animal studies suggest that berberine-containing supplements like goldenseal may result in lower birth weight and cause the uterus to contract, potentially increasing the risk of preterm birth (41).

Moreover, little is known about the safety of goldenseal while breastfeeding. As such, it’s recommended that women avoid taking this herbal supplement during pregnancy or while nursing (52).

Finally, goldenseal may interact with certain medications, including antidepressants. Therefore, people currently taking any type of medication should consult their healthcare provider before taking goldenseal (42, 49, 51).

Most of goldenseal’s purported health effects are attributed to its active compounds berberine, hydrastine, and canadine.

Therefore, other berberine-, hydrastine-, or canadine-containing herbs or purified supplements may exert effects similar to those of goldenseal.

Research on the health benefits of purified berberine supplements is generally stronger than research regarding the benefits of goldenseal (53).

Berberine may be more easily absorbed into the body when taken alone compared with when ingested along with other compounds, as would be the case when taking goldenseal (4).

However, berberine supplements contain little to no hydrastine and canadine. Therefore, they may be expected to have effects and side effects that are different than those of goldenseal.