What is the dermatologic preoperative evaluation and management of echinacea?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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In the past 2 years, echinacea was the most common herb used by the American public. It was reported that of all herbs used as a medicine, the rate of echinacea use was 48%. Three species of echinacea are used to treat viral, bacterial, and fungal infections of the upper respiratory tract. Preclinical studies of echinacea have revealed a number of immunostimulatory effects. Although no study specifically addresses the interactions between echinacea and immunosuppressive drugs, experts generally warn against the concomitant use of this herb and immunosuppressive drugs because of the probability of diminished effectiveness.

Patients who may require perioperative immunosuppression, such as those awaiting organ transplantation, should be counseled to avoid taking echinacea. In contrast to the immunostimulatory effects with short-term use, the long-term use of echinacea (>8 wk) is accompanied by the potential for immunosuppression and a theoretically increased risk of certain postsurgical complications, such as poor wound healing and opportunistic infections.

Echinacea has been associated with allergic reactions, including 1 reported case of anaphylaxis. Echinacea should be used with caution in patients with asthma or allergic rhinitis. Concerns of potential hepatotoxicity have been raised, although documented cases are lacking. Patients with preexisting liver dysfunction should be cautious when taking echinacea. Echinacea has been suggested to have the potential to stimulate tumor necrosis factor-alpha, interleukin 1, and interleukin 6. In light of this, some believe that it should not be used in AIDS patients due to the possibility of accelerating the course of the disease.

Furthermore, the pharmacokinetics of echinacea have not been fully studied. Patients should discontinue echinacea as far in advance of surgery as possible when compromises in hepatic function or blood flow are anticipated. These situations often occur secondary to concomitant anesthetic drug administration or as an effect of surgical manipulation.

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