Echinacea
HerbalAlso called · 8 names▾▴
purple coneflower, coneflower, American coneflower, Echinacea purpurea, Echinacea angustifolia, Echinacea pallida, echinacea preparations, echinacia
Herbal supplement (cold and respiratory symptoms)
Herbs and supplements are not FDA-approved before sale. About these sources
- Tea
- Capsule/tablet
- Liquid extract
- Topical
Research strength: 3 / 5
MotherToBaby reports that small human studies have not reported an increased chance of birth defects above the usual background level. Gallo et al. (2000) reported 13 miscarriages and 6 major malformations among 206 exposed pregnancies, compared with 7 and 7 among 206 controls, with no significant group differences. Heitmann et al. (2016) studied 68,522 women and their children, including 363 women who reported echinacea use, and found no increased risk of malformations or adverse pregnancy outcomes. NCCIH says studies of certain extracts suggest possible use for up to 7 days in the first trimester with provider consultation, while EMA says pregnancy use is not recommended unless a doctor advises it because data are insufficient. MotherToBaby generally does not recommend herbal products during pregnancy unless a provider directs their use; Chow et al. found fewer viable fetuses in mice given Echinacea, which does not show the same effect in people. Ask your provider about your situation.
Last reviewed: 2026-10-16
Research strength: 3 / 5
MotherToBaby reports that small studies have not reported an increased chance of birth defects and that a Norwegian cohort found no increased risk of malformations or adverse pregnancy outcomes overall. Heitmann et al. (2016) included 68,522 women and their children, with 363 reported echinacea users, but its abstract does not report second-trimester outcomes separately. Gallo et al. (2000) found no significant overall difference in outcomes, but its abstract does not give trimester-specific results. EMA says pregnancy use is not recommended unless a doctor advises it because data are insufficient; MotherToBaby generally does not recommend herbal products unless a provider directs their use. NCCIH's limited pregnancy statement addresses possible use for up to 7 days in the first trimester, not the second trimester. Ask your provider about your situation.
Last reviewed: 2026-10-16
Research strength: 3 / 5
MotherToBaby reports that small studies have not reported an increased chance of birth defects and that a Norwegian cohort found no increased risk of malformations or adverse pregnancy outcomes overall. Heitmann et al. (2016) included 68,522 women and their children, with 363 reported echinacea users, but its abstract does not report third-trimester outcomes separately. Gallo et al. (2000) found no significant overall difference in outcomes, but its abstract does not give trimester-specific results. EMA says pregnancy use is not recommended unless a doctor advises it because data are insufficient; MotherToBaby generally does not recommend herbal products unless a provider directs their use. NCCIH's limited pregnancy statement addresses possible use for up to 7 days in the first trimester, not the third trimester. Ask your provider about your situation.
Last reviewed: 2026-10-16
Echinacea — Breastfeeding
Research strength: 2 / 5
LactMed reports alkamides in breast milk after one mother took echinacea tablets, but it found no published infant levels or infant outcome information. MotherToBaby also says the effect of these components on a nursing child is unknown. Sources differ: LactMed notes that some permit recommended doses while others advise against echinacea because published data are lacking; EMA says lactation use is not recommended unless a doctor advises it because data are insufficient. LactMed lists digestive upset, diarrhea, constipation, skin rash and rare allergic reactions as reported effects generally, not as documented infant outcomes. Ask your provider about your situation.
Last reviewed: 2026-10-16
Pregnancy
Gallo et al. (2000) prospectively followed 206 women with echinacea exposure and 206 controls; 112 exposed women used it in the first trimester. The exposed group had 13 spontaneous abortions and 6 major malformations, compared with 7 spontaneous abortions and 7 major malformations in controls. The study reported no statistically significant group differences across the outcomes analyzed. Heitmann et al. (2016) used the Norwegian Mother and Child Cohort Study, which included 68,522 women and children; 363 women (0.5%) reported echinacea use. The abstract reports no increased risk of malformations or adverse pregnancy outcomes, but does not provide outcome estimates by trimester. MotherToBaby describes no increase in preterm delivery, low birth weight, or small-for-gestational-age infants in its summary of this cohort; Heitmann's abstract does not list separate estimates for those endpoints. Chow et al. (2006) found fewer viable fetuses in pregnant mice fed E. purpurea. Barcz et al. (2007) also studied pregnant mice: fetal VEGF and bFGF concentrations were lower across treated groups, angiogenic activity differed by preparation, and two preparations had slightly smaller litters with differences near statistical significance. These animal findings do not establish human effects.
Breastfeeding
LactMed's October 15, 2024 revision reports that alkamides were detected in breast milk after one mother took echinacea tablets. It reports that no relevant published infant levels, infant effects, or effects on lactation were found as of that revision. MotherToBaby also describes limited milk-transfer information and says effects on a nursing child are unknown. LactMed cites a 2008 conference abstract and notes that further details were not present in that abstract. The available information does not establish effects in nursing infants.
Echinacea products may use E. purpurea, E. angustifolia, or E. pallida and may contain roots, stems, leaves, or flowers. MotherToBaby lists teas, extracts, capsules, tablets, tinctures, and topical preparations, and says ingredients and strength vary by species, plant part, and preparation. LactMed describes polysaccharides, alkamides, and caffeic acid conjugates such as cichoric acid and echinacosides; it says no single compound is known to account for the plant's biological activity. MotherToBaby notes tinctures may contain alcohol and that some preparations have been found to contain lead.
What was tested
The human pregnancy evidence reviewed here is observational: Gallo et al. (2000) used a prospective controlled cohort, while Heitmann et al. (2016) analyzed a Norwegian pregnancy cohort and linked questionnaire data with birth-registry outcomes. The two abstracts report overall results, not estimates by each trimester. Chow et al. (2006) and Barcz et al. (2007) studied pregnant mice and cannot determine human pregnancy outcomes. LactMed reports one milk-detection case and states that no relevant published infant levels or infant-outcome information were found. The EMA monograph applies to specified E. purpurea herb preparations, not every commercial supplement or species.
How pregnancy use is described when human findings are limited
- Source A says
- NCCIH says studies of certain solid or liquid extracts suggest possible use for up to 7 days in the first trimester with provider consultation. Perri et al. (2006) found low-level expert-opinion support for recommended-dose oral use during pregnancy, while noting that the main cohort evidence covered first-trimester exposure. (NCCIH: Echinacea, Perri et al. 2006 review)
- Source B says
- EMA says pregnancy use is not recommended unless a doctor advises it because data are insufficient. MotherToBaby generally does not recommend herbal products in pregnancy unless a provider directs their use and care. (EMA: Echinaceae purpureae herba monograph, MotherToBaby: Echinacea pregnancy and breastfeeding fact sheet)
- Why they differ
- The NCCIH statement is limited to certain oral extracts and a short first-trimester period. The EMA monograph covers specified E. purpurea herb medicines and emphasizes that reproductive information is limited. MotherToBaby gives broader guidance for herbal products, whose species, plant parts, and preparation can vary.
- Other sources
- Gallo et al. (2000) and Heitmann et al. (2016) found no statistically significant increase in the studied human pregnancy outcomes, but neither abstract gives results for each trimester or every product type. (Gallo et al. 2000, Heitmann et al. 2016)
- What the evidence shows overall
- The human studies have not identified an increase in the outcomes they measured, but they do not cover every product or provide trimester-specific estimates. EMA's restriction is based on insufficient information, not a reported human harm. The available human evidence remains limited, and the animal findings remain animal evidence.
Whether oral echinacea use during breastfeeding is supported
- Source A says
- Perri et al. (2006) reported low-level expert-opinion support for recommended-dose oral use during lactation, while advising caution until more high-quality human studies are available. LactMed notes that some sources permit recommended doses. (Perri et al. 2006 review, LactMed: Echinacea)
- Source B says
- EMA says lactation use is not recommended unless a doctor advises it because data are insufficient. LactMed reports no data on effects in nursing mothers or infants, and MotherToBaby says effects on a nursing child are unknown. (EMA: Echinaceae purpureae herba monograph, LactMed: Echinacea, MotherToBaby: Echinacea pregnancy and breastfeeding fact sheet)
- Why they differ
- The more permissive view relies on low-level expert opinion and standard-dose use, while the cautious views emphasize limited milk-transfer information and the lack of infant outcome data. The available information also does not cover every species or preparation.
- What the evidence shows overall
- One milk-detection report does not show what dose an infant receives or what effects follow. LactMed reports no published infant outcome information. EMA's recommendation is based on missing data, not on a reported infant effect.
- MotherToBaby states that herbal products are generally not recommended during pregnancy unless used under the direction and care of a healthcare provider to treat a medical condition. (MotherToBaby: Echinacea pregnancy and breastfeeding fact sheet)
- NCCIH says studies of certain solid or liquid E. purpurea and E. angustifolia extracts suggest possible use for up to 7 days in the first trimester and advises consultation with a healthcare provider. (NCCIH: Echinacea)
- EMA's monograph says use during pregnancy and lactation is not recommended unless advised by a doctor because data are insufficient; it also says products should not be applied to the breast of breastfeeding women. (EMA: Echinaceae purpureae herba monograph)
- MotherToBaby notes that echinacea tinctures can contain alcohol and that alcohol should be avoided during pregnancy and breastfeeding. (MotherToBaby: Echinacea pregnancy and breastfeeding fact sheet)
General research, not specific to pregnancy.
Outside pregnancy and breastfeeding, NCCIH describes limited evidence for echinacea's effect on colds and lists digestive symptoms, possible severe allergic reactions, and potential medicine interactions. EMA's July 2026 HMPC minutes describe draft work on a request for PRAC advice about Echinacea and drug-induced liver injury; the minutes say the request needed revision for possible September adoption and do not state an adopted recommendation. MotherToBaby notes that product ingredients can vary and that some preparations have contained lead.
- EMA's adopted July 2026 HMPC minutes report that a draft request for PRAC advice on Echinacea and an assessment report about drug-induced liver injury was discussed. The rapporteur was asked to revise the request for possible adoption at the September 2026 meeting; the minutes do not state that a recommendation was adopted. (EMA HMPC adopted minutes: 6-8 July 2026)
- NCCIH says the most common side effects are digestive tract symptoms such as abdominal pain, nausea, or stomach pain, and that allergic reactions may be severe. (NCCIH: Echinacea)
- NCCIH reports conflicting evidence about interactions with some medicines metabolized by the liver and theoretical interaction concerns with immunosuppressants or caffeine. (NCCIH: Echinacea)
- MotherToBaby says ingredients and doses on labels may differ from product contents and notes that some echinacea preparations have been found to contain lead. (MotherToBaby: Echinacea pregnancy and breastfeeding fact sheet)
- MotherToBaby: Echinacea pregnancy and breastfeeding fact sheetTeratology serviceSecondaryPage dated 2025-03-01Independent check
- LactMed: EchinaceaUS governmentSecondaryPage dated 2024-10-15
- NCCIH: EchinaceaUS governmentSecondaryIndependent check
- EMA: Echinaceae purpureae herba monographEU agencySecondaryPage dated 2014-11-24Independent checkEuropean guidance
- Gallo et al. 2000US governmentPrimaryIndependent check
- Heitmann et al. 2016US governmentPrimaryIndependent check
- Chow et al. 2006US governmentPrimaryIndependent check
- Barcz et al. 2007US governmentPrimaryIndependent check
- EMA HMPC adopted minutes: 6-8 July 2026EU agencySecondaryPage dated 2026-10-07European guidance
- Perri et al. 2006 reviewUS governmentPrimaryIndependent check
Last reviewed 2026-10-16
Independent check 2026-10-16
Not yet clinician-reviewed
Ask your provider about your situation.