Nature's Cure Two Part Acne Treatment System, for Females, Tablets by Nature's Cure

POSSIBLY EFFECTIVE

• Poisoning. Oral activated charcoal taken after ingestion of certain drugs reduces systemic drug exposure. However, it is unclear if it affects clinical endpoints such as morbidity or mortality. Details: Taking activated charcoal orally appears to be effective when used as part of standard treatment for some, but not all, acute poisonings (12392,12393,93198,93606,93607,93613,94730). Single doses of activated charcoal, 25-100 grams in adults (10-50 grams in children, depending on age), are effective for preventing absorption of some drugs, including acetaminophen, aminophylline, amiodarone, aspirin, atenolol, carbamazepine, digoxin, fluoxetine, indomethacin, phenytoin, valproate, and verapamil, especially if taken within one hour of ingestion (93602,93610,93612,93613,94730,108852). A single dose reduces drug exposure by 38% to 52% when given within 1 hour, by 21% to 35% when given 2-4 hours after ingestion, and by about 14% when given 6 hours after ingestion. These late effects, occurring after oral absorption is complete, are due to enhanced elimination via interruption of enterohepatic circulation and binding of drug that has been actively or passively transported back into the gastrointestinal tract (105543). Multiple-dose activated charcoal, 50-100 grams initially followed by doses of 25 grams every 2 hours or 50 grams every 4 hours, or 10-25 grams per dose in children, is recommended for patients who ingest life-threatening amounts of carbamazepine, dapsone, phenobarbital, quinine, or theophylline. This is based on clinical, animal, and in vitro research showing increased elimination of these drugs (12392,105543). This increased elimination can also reduce levels of drugs that have been given intravenously, with the median half-life being decreased by an average of 45% and the median area under the concentration/time curve (AUC) by an average of 47% (105543). Additional research suggests that multiple-dose activated charcoal may be useful for increasing the elimination of amitriptyline, digoxin, imipramine, moxifloxacin, nadolol, phenytoin, piroxicam, and sotalol. Evidence supporting the use of multiple-dose activated charcoal in aspirin, doxepin, tobramycin, valproate, or vancomycin overdose is limited or conflicting (12392,105543). While activated charcoal may reduce absorption of some toxic agents, there is contradictory evidence about whether it improves clinical outcomes (12392,93200,93601,93613,94730). Administering activated charcoal 50 grams every 6 hours for carbamazepine poisoning decreases the duration of coma by 9 hours, the duration of mechanical ventilation by 12 hours, and the length of hospital stay by 9 hours. However, activated charcoal does not reduce the duration of hospitalization, intensive care admission, vomiting, or mortality when compared with control after oral overdose of benzodiazepines, acetaminophen, or selective serotonin reuptake inhibitors (93200). Other preliminary clinical research in patients with phenytoin toxicity shows that taking activated charcoal 50 grams orally every 4 hours reduces the time to return to therapeutic levels by about 22 hours when compared with control, but without reducing symptoms (93609). In patients with pesticide or yellow oleander seed toxicity, neither single-dose nor multi-dose regimens of activated charcoal reduce mortality, seizures, or the need for intubation when compared with control (93601).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Celiac disease. Although there is interest in using activated charcoal for acute gluten exposure in those with celiac disease, there is insufficient reliable information about the clinical effects of activated charcoal for this purpose.
• Chemotherapy-induced diarrhea. It is unclear if oral activated charcoal is beneficial in patients with chemotherapy-induced diarrhea. Details: Preliminary clinical research in children treated with irinotecan shows that taking activated charcoal 250 mg the night before the first infusion and every 8 hours thereafter until the end of the cycle reduces the risk of diarrhea by 60% when compared with no treatment. Activated charcoal also appears to reduce the risk of severe diarrhea by 92% and to decrease chemotherapy discontinuation by 87% in these patients (93608).
• Cholestasis. It is unclear if oral activated charcoal is beneficial in patients with pregnancy-induced cholestasis. Details: Preliminary clinical research in pregnant patients with cholestasis shows that taking activated charcoal 50 grams orally three times daily for 8 days decreases bile acid levels by about 50%, compared with an increase in those not taking activated charcoal. However, itching was not significantly improved with activated charcoal when compared with control (126).
• Constipation. Oral activated charcoal has only been evaluated in combination with other ingredients; its effects when used alone are unclear. Details: A clinical study in patients with chronic constipation shows that a specific combination product (Nucarb; Wilshire Laboratories Ltd) containing activated charcoal 180 mg, calcium sennosides 50 mg, peppermint oil 0.5 mg, fennel oil 0.5 mg, rhubarb extract 250 mg, and sulfur 50 mg, taken as two tablets at bedtime for one week, followed by 1 tablet at bedtime for 1 week, reduces passing gas, abdominal pain, and sensation of bloating by 81%, 73%, and 72% respectively, when compared with baseline. Sensation of straining, severity of constipation, and feeling of incomplete evacuation were reduced by 69%, 67%, and 54% respectively, when compared with baseline (108853). The validity of this finding is limited by the lack of a comparator group.
• Dyspepsia. Oral activated charcoal has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with functional dyspepsia shows that taking a specific combination product containing activated charcoal 280 mg, simethicone 90 mg, and magnesium oxide 180 mg (Carbosymag, Laboratoires Grimberg) three times daily for one month reduces symptoms of dyspepsia, such as postprandial fullness, epigastric pain, and abdominal bloating, when compared with placebo (93199). Other preliminary clinical research in patients with dyspepsia shows that taking another specific combination product containing activated charcoal 280 mg and simethicone 90 mg (Carbosylane, Laboratoires Grimberg) three times daily for 3 months does not improve overall symptoms of dyspepsia or nausea, but does improve abdominal fullness by 20%, bloating by 20%, and slow digestion by 30%, when compared with placebo (93604).
• Flatulence. It is unclear if oral activated charcoal is beneficial for reducing the occurrence of flatulence. Details: Some preliminary clinical research shows that taking activated charcoal (Requa Charcocaps) 582 mg after a gas-producing meal significantly decreases the number of flatus events when compared with placebo. On average, subjects taking activated charcoal reported less than 3 flatus events over 8 hours, compared with more than 14 flatus events in those taking placebo (12395). However, other preliminary clinical research shows that taking activated charcoal 520 mg at breakfast, lunch, dinner, and bedtime for 7 days does not significantly reduce excessive gas or total flatus events when compared with baseline (12396).
• Hangover. There is no reliable evidence that activated charcoal prevents or treats hangover. Details: Activated charcoal is included in some hangover remedies. However, ethanol adsorbs poorly to activated charcoal (12400).
• Hypercholesterolemia. It is unclear if oral activated charcoal is beneficial in patients with hypercholesterolemia. Details: Some preliminary clinical research in patients with hypercholesterolemia shows that taking activated charcoal 4-32 grams daily for 3 weeks decreases total cholesterol by up to 29% and low-density lipoprotein (LDL) cholesterol by up to 41% when compared with control. The effects of activated charcoal appear to be dose-dependent. Additional clinical research shows that taking activated charcoal 20 grams twice daily for 3 weeks is as effective as cholestyramine 8 grams twice daily for treating hypercholesterolemia (12398), but the combined use of activated charcoal and cholestyramine does not appear to confer additional benefit when compared with either agent alone (12397). However, other research suggests that activated charcoal is not effective for treating hypercholesterolemia (12399). Reasons for the discrepancies are unclear but may relate to the small size of the latter study, and the inclusion of some patients without hyperlipidemia.
• Hyperphosphatemia. Oral activated charcoal might reduce the incidence of hyperphosphatemia in patients with kidney disease. Details: Preliminary clinical research in a small number of patients with stage 3 or 4 chronic kidney disease (CKD) shows that taking activated charcoal 0.6-1.2 grams three times daily for 12 months reduces the risk of hyperphosphatemia by 64% when compared with placebo. Additionally, in CKD patients who develop hyperphosphatemia, use of activated charcoal at the same dose for up to 24 months seems to delay the development of vascular calcification when compared with calcium carbonate, but not when compared with lanthanum carbonate (103193). Other preliminary clinical research in patients on hemodialysis shows that taking activated charcoal for 24 weeks, at a starting dose of 600 mg three times daily, increasing by 300 mg three times daily every 4 weeks until the goal phosphate level is reached, reduces phosphate levels to the goal in over 90% of patients when compared with baseline (93611). The lack of a control group limits the validity of these findings.
• Tooth whitening. It is unclear if toothpaste containing activated charcoal is beneficial for tooth whitening. Details: A small clinical study in adults with dental stains due to factors such as coffee or tobacco use shows that using a toothpaste containing activated charcoal (Blanx Black, Coswell SpA) twice daily for 3 months reduces visible staining, dental plaque, and bleeding when compared to baseline, but not when compared with a micro-cleaning crystal toothpaste (Sensation White, Colgate) (111718).
• Wound healing. Research on the use of activated charcoal-containing dressings for wound healing is limited and conflicting. Details: One preliminary clinical study shows that treating chronic venous leg ulcers with activated charcoal-containing dressings (Actisorb, Systagenix) for 6 weeks reduces ulcer size by 17% when compared with control occlusive or semi-occlusive dressings containing antibacterial or antiseptic agents (94731). However, other preliminary clinical research shows that treating pressure ulcers or venous leg ulcers with activated charcoal-containing dressings (Actisorb and Actisorb Silver 220, Systagenix) for 4 weeks does not significantly improve wound healing when compared with a hydrocolloid dressing (93603). More evidence is needed to rate activated charcoal for these uses.

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POSSIBLY EFFECTIVE

• Common cold. Taking echinacea orally while still healthy may help prevent the common cold, but the benefit is probably modest. Echinacea does not seem to have a significant benefit for treating colds that have already developed. Details: Three meta-analyses show a 10% to 58% reduction in the risk of developing a cold when taking various forms of echinacea (17520,17522,95652). A large clinical study shows that adults who use a specific echinacea extract (Echinaforce, A. Vogel Bioforce AG) 0.9 mL three times daily (2400 mg echinacea daily) for 4 months, with an increase to 0.9 mL five times daily (4000 mg echinacea daily) at the first sign of a cold, have 59% fewer cold episodes and 26% fewer days with cold symptoms than those taking placebo (18225). Many smaller studies have shown a non-significant trend toward a prophylactic benefit, but they were likely underpowered to detect a statistically significant difference (3282,6386,17521,95652). Research in adults who are deliberately infected with cold viruses shows that taking echinacea products either does not reduce the incidence of colds, or has a limited effect which is not statistically significant. Products used include E. angustifolia root extract 300 mg three times daily for 7 days before and 5 days after experimental infection (13419), an alcoholic extract of E. purpurea above-ground parts (EchinaGuard, Madaus AG) 2.5 mL three times daily for 7 days before and 7 days after experimental infection (12354), or echinacea 300 mg three times daily for 14 days before and 5 days after experimental infection (8228). These studies are small and have methodological problems. Some small clinical studies have suggested that taking E. purpurea extracts as a tincture or tea to treat the common cold modestly reduces symptom severity and reduces cold duration by a couple of days (6384,10320,10802,12355,14419,20062,111530). Specific products used in these studies include Echinilin by Inovobiologic Inc., and Echinacin and EchinaGuard by Madaus AG (10320,10802,12355,20062). In contrast, higher quality clinical research shows that taking E. purpurea alone or with E. angustifolia does not reduce duration or severity of cold symptoms when compared with placebo (10800,11970,17519,20059). Echinacea has also been evaluated in children. Preliminary clinical research in healthy children 4-12 years old shows that taking a specific E. purpurea product (Echinaforce Junior, A. Vogel) 400 mg three times daily for 4 months reduces the occurrence of cold symptoms, respiratory complications (such as pneumonia and otitis media), and antibiotic prescriptions by 30%, 52%, and 62%, respectively, when compared with vitamin C 50 mg three times daily. Taking echinacea also reduces the average duration of symptoms during respiratory illness by an average of 1.4 days when compared with vitamin C (105719). However, other clinical research in children has found no benefit with a specific E. purpurea product (Echinacin, Madaus AG) (4989,95653).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Anxiety. It is unclear if oral echinacea reduces anxiety. Details: Preliminary clinical research shows that taking a specific E. angustifolia extract (ExtractumPharma ZRT) 40 mg once or twice daily for 7 days reduces anxiety scores on the State-Trait Anxiety Inventory scale when compared with placebo (20064,103233). This extract seems to be more effective in patients with high baseline anxiety scores (103233). A lower dose of 20 mg daily appears to be ineffective (20064). Conversely, a small clinical study in physically healthy adults with mild to moderate anxiety shows that taking the same E. angustifolia extract at doses of 20 or 40 mg twice daily for 6 weeks does not reduce anxiety when compared with placebo (106626).
• Athletic performance. It is unclear if oral echinacea improves athletic performance in healthy, recreationally active males. Details: Preliminary clinical research in healthy, recreationally active males shows that taking echinacea (Puritan's Pride) 2 grams four times daily for 28 days increases serum erythropoietin levels and maximal oxygen consumption (VO2max) during exercise tests (20066). However, two small clinical studies in endurance trained athletes and in non-athletes with high aerobic fitness show that taking E. purpurea 8 or 16 grams once daily for 35 days in combination with other ingredients (Biomedical Research Lab), or taking E. purpurea (Puritan's Pride) 8 grams daily for 42 days, has no effect on erythropoietin levels, VO2max, or aerobic capacity (95651,101593).
• Atopic dermatitis (eczema). Some evidence shows that an echinacea cream may be effective in mild disease, but it has not been compared to conventional treatments such as corticosteroids. Details: Preliminary clinical research in patients with mild atopic dermatitis shows that applying a cream containing echinacea (Linola Plus Cream, Dr. August Wolff GmbH & Co) 2-3 times daily for 12 weeks reduces symptoms such as erythema, edema, pruritus, and dryness when compared with a cream containing birch bark extract (Imlan Crème Pur, Birken AG). However, the echinacea product was no different to the comparator cream at the 4- and 8-week assessments, indicating that it might take up to 12 weeks to show benefit (97499).
• Attention deficit-hyperactivity disorder (ADHD). Although there has been interest in using oral echinacea for ADHD, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Burns. Although there has been interest in using topical echinacea for burns, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Chronic fatigue syndrome (CFS). Although there has been interest in using oral echinacea for CFS, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Coronavirus disease 2019 (COVID-19). It is unclear if oral echinacea is beneficial for preventing or treating COVID-19. Details: A moderate-size open-label clinical study tested the effects of echinacea to prevent or treat respiratory viruses. This study of otherwise healthy adults in Bulgaria shows that taking echinacea extract (Echinaforce, A. Vogel AG) 2400 mg daily for cycles of 2, 2, and 1 months, with a 1-week break between each cycle, does not reduce symptomatic respiratory tract infections, including SARS-CoV-2, or respiratory virus detection overall when compared with usual care. However, echinacea extract does reduce the risk of a positive test for coronaviruses or SARS-CoV-2 by 48% and 63%, respectively. In patients who develop a symptomatic respiratory tract infection, this study also shows that taking the same echinacea extract 4000 mg daily for up to 10 days speeds viral clearance compared with usual care when all virus types were analyzed; however, clearance of SARS-CoV-2 was not improved. Echinacea may also reduce the number of days with a fever, but not other symptoms (111174). The validity of this study is limited by lack of blinding. Further, most patients were unvaccinated against COVID-19; it is unclear whether these results can be extrapolated to vaccinated patients.
• Genital herpes. It is unclear if oral echinacea is beneficial for genital herpes in patients with herpes simplex virus (HSV) type 1 or 2. Details: Some clinical research shows that a specific E. purpurea extract (Echinaforce, A. Vogel Bioforce AG) 800 mg orally twice daily for 6 months does not seem to prevent or reduce the frequency or duration of recurrent genital herpes in patients with herpes simplex virus (HSV) type 1 or 2 (7087).
• Gingivitis. Echinacea, in a mouth rinse or periodontal patch, has only been studied in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that using a mouth rinse containing echinacea, gotu kola, and elderberry (HM-302, Izun Pharmaceuticals) 15 mL three times daily for 14 days might prevent worsening of gingivitis when compared with a placebo rinse, but it produces only minimal improvement in symptoms (20069). Applying a periodontal patch containing echinacea, gotu kola, and elderberry (PerioPatch, Izun Pharmaceuticals) either as a single dose, or three times daily for 1 day then once daily for 2 days seems to reduce some measures of inflammation and gingivitis at some time points, but effects lack consistency (20068,20070).
• Herpes labialis (cold sores). Although there has been interest in using topical echinacea for herpes labialis, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• HIV/AIDS. Although there has been interest in using oral echinacea for HIV/AIDS, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Human papillomavirus (HPV). Oral echinacea has only been studied in combination with other ingredients; its benefit when used alone is unclear. Details: Preliminary clinical research shows that taking a specific combination product containing echinacea, andrographis, grapefruit, papaya, pau d'arco, and cat's claw (Immune Act, Erba Vita SpA) three tablets daily for one month reduces the recurrence of anal condylomata in patients following surgical removal. After one month, the recurrence rate was about 4% in the echinacea group compared with 18% in the control group; after 6 months the recurrence rates were about 7% and 27%, respectively (20073). However, poor study methodology limits the validity of these findings.
• Influenza. Limited data suggest that oral echinacea may improve the response to influenza vaccine, and that a combination product containing echinacea may improve rates of recovery from influenza. Details: Preliminary clinical research shows that a taking a specific echinacea product (Monoselect Echinacea, PharmExtracta) 200 mg orally daily for 15 days, then 100 mg daily for 15 days, followed by 100 mg every other day for 60 days, might improve the response to influenza vaccine in people with chronic bronchitis or asthma (18226). Higher quality research is needed to confirm these results. Taking a specific combination product (Echinaforce Hot Drink, A. Vogel Bioforce AG), containing elderberry juice and extracts of E. purpurea above-ground parts and roots, 5 mL five times daily for 3 days, then three times daily for 7 days, improves rates of recovery and influenza-related respiratory complications similarly to oseltamivir 75 mg twice daily for 5 days (95650). However, due to the lack of a placebo group, it is unclear if both treatments were beneficial or if the outcomes represent the natural progression of influenza.
• Insect bite. It is unclear if topical homeopathy with a gel containing echinacea is beneficial for insect bite treatment. Oral echinacea has not been evaluated for this use. Details: Preliminary clinical research shows that using a homeopathic after-bite gel, containing echinacea, marsh Labrador tea, and stinging nettle, on affected areas does not reduce erythema or itching after a mosquito bite when compared with placebo (89235).
• Lichen planus. It is unclear if oral echinacea is beneficial for patients with this condition. Details: A small clinical study in adults with erosive oral lichen planus in Iran shows that taking a specific echinacea extract tablet (Immustim, Goldaru Corp.) 114 mg three times daily for 35 days decreases pain scores, number of lesions, and symptom severity when compared with placebo. However, all patients also used a mouthwash containing betamethasone, diphenhydramine, nystatin, and aluminum-magnesium suspension three times daily (111173).
• Malaria. Although there has been interest in using oral echinacea for malaria, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Migraine headache. Although there has been interest in using oral echinacea for migraine headache, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Otitis media. Oral echinacea does not seem to reduce the rate of recurrence of otitis media in young children, and may actually increase it. Details: Preliminary clinical research shows that taking a specific liquid extract of echinacea fresh roots and dried mature seeds, 0.5 mL three times daily for 3 days at the first sign of a common cold, followed by 0.25 mL three times daily for 7 days, does not prevent otitis media in children 1-5 years of age with a history of recurrent otitis media. In fact, the risk of an episode of otitis media during the 6 month follow-up seemed to increase by 59% in those taking echinacea when compared with placebo (20063).
• Psoriasis. Although there has been interest in using topical echinacea for psoriasis, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Respiratory tract infections. It is unclear if oral echinacea is beneficial for patients with respiratory tract infections. Details: A large clinical study in adults with respiratory tract infections shows that using echinacea spray or taking echinacea lozenges 16,800 mg daily during days 1-3 and 2240-3360 mg daily afterward for up to 10 days does not improve time to recovery, symptom relief, or number of sick days when compared with echinacea tablets or drops at a prophylactic dose of 2400 mg daily for 10 days. However, the higher dose from days 1-3 is associated with faster viral clearance than the prophylactic dose (111540). The validity of these effects is limited by insufficient blinding and a lack of a placebo group.
• Rheumatoid arthritis (RA). Although there has been interest in using oral echinacea for RA, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Tonsillitis. Oral echinacea has been used with azithromycin to reduce relapses of recurrent tonsillitis in children. A throat spray containing echinacea has also been evaluated for tonsillitis-associated sore throat. It is unclear if echinacea is beneficial for either purpose. Details: Preliminary clinical research in children with recurrent tonsillitis shows that adding echinacea suspension, 250 mg root powder per 5 mL, orally 3 times daily for 10 consecutive days per month for 6 months, to azithromycin 10 mg/kg/day for 6 consecutive days per month for 6 months reduces the number of tonsillitis attacks when compared with azithromycin alone (104127). However, the study was not blinded and the number of tonsillitis episodes in both groups was very low. Other preliminary clinical research shows that applying a throat spray containing sage and echinacea whole plant extract every 2 hours up to 10 times daily for up to 5 consecutive days is as effective as a chlorhexidine-lidocaine spray in patients with sore throat due to acute pharyngitis or tonsillitis (20077).
• Tonsillopharyngitis. Oral echinacea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized study in patients aged 12-75 years with acute tonsillopharyngitis shows that taking lozenges containing echinacea extract 800 mg and sage extract 5 times daily for 4 days reduces throat pain and tonsillopharyngitis symptoms when compared to baseline, both acutely within 90 minutes and after 4 days of treatment (111530). The validity of these effects is limited by a lack of a comparator group. It is unclear if these effects are due to echinacea, sage, or the combination.
• Upper respiratory tract infection (URTI). It is unclear if oral echinacea is beneficial for preventing or treating URTIs. Details: A moderate-size open-label clinical study tested the effects of echinacea to prevent or treat respiratory viruses. This study of otherwise healthy adults in Bulgaria shows that taking echinacea extract (Echinaforce, A. Vogel AG) 2400 mg daily for cycles of 2, 2, and 1 months, with a 1-week break between each cycle, does not reduce symptomatic respiratory tract infections, including SARS-CoV-2, or respiratory virus detection overall when compared with usual care. However, echinacea extract does reduce the risk of a positive test for coronaviruses or SARS-CoV-2 by 48% and 63%, respectively. In patients who develop a symptomatic respiratory tract infection, this study also shows that taking the same echinacea extract 4000 mg daily for up to 10 days speeds viral clearance compared with usual care when all virus types were analyzed; however, clearance of SARS-CoV-2 was not improved. Echinacea may also reduce the number of days with a fever, but not other symptoms (111174). The validity of this study is limited by lack of blinding. Further, most patients were unvaccinated against COVID-19; it is unclear whether these results can be extrapolated to vaccinated patients. Another large study in adults with URTIs shows that taking a combination product containing echinacea 1100-2200 mg, zinc, and vitamin C (EZC Pak) daily for 5 days reduces time to recovery by 1.4 days but does not reduce symptom severity when compared with placebo (111512). The validity of these effects is severely limited by multiple instances of selection bias. Additionally, it is unclear if these effects are due to echinacea, other ingredients, or the combination.
• Urinary tract infections (UTIs). Although there has been interest in using oral echinacea for UTIs, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Vaginal candidiasis. Although there has been interest in using oral echinacea for vaginal candidiasis, there is insufficient reliable information about the clinical effects of echinacea for this purpose.
• Warts. It is unclear if oral echinacea is beneficial for warts when used alone or in combination with other ingredients. Details: Preliminary clinical research shows that taking echinacea 600 mg orally once daily for up to 3 months does not clear common, plantar, or plain cutaneous warts any more effectively than placebo (20080). Other preliminary clinical research shows that taking an oral supplement containing echinacea with methionine, zinc, probiotics, antioxidants and immunostimulants for 6 months, in addition to using conventional topical therapy to treat cutaneous warts, seems to increase the rate of complete remission from 54% to 86% when compared with conventional therapy alone (20071). It is unclear if these effects are due to echinacea, other ingredients, or the combination.
• Water warts. It is unclear if oral echinacea is beneficial for water warts (molluscum contagiosum). Details: In children who have been successfully treated with curettage for molluscum contagiosum, taking a combination of E. angustifolia and E. purpurea orally daily for 2 months is associated with a relapse rate of about 39%, compared with a rate of 68% in a control group that received no oral treatment (104128). The validity of this finding is limited by the lack of a placebo control. E. angustifolia and E. purpurea were taken in doses of 200 mg each in children under 20 kg and 400 mg each in children over 20 kg. More evidence is needed to rate echinacea for these uses.

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POSSIBLY EFFECTIVE

• Hypercholesterolemia. Small clinical trials show that consuming English walnuts as part of a low-fat diet seems to lower cholesterol. Total cholesterol and lipoproteins are decreased when English walnuts are substituted for other fatty foods and constitute up to 20% of the calories in the diet. When English walnuts are added to a low fat diet, total cholesterol may be decreased by 4% to 12% and low-density lipoprotein (LDL) may be decreased by 8% to 16% (6431,8476,8477). Substituting English walnuts for other dietary fats as part of a diet containing 30% fat seems to improve high-density lipoprotein (HDL) cholesterol-to-total cholesterol ratios in patients with type 2 diabetes. However, there is no effect on levels of low-density lipoprotein (LDL) cholesterol when compared with a 30% fat diet without English walnuts (13300).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Coronary heart disease (CHD). Epidemiological research has found that people who increase dietary consumption of nuts in general might have a lower risk of CHD and death due to coronary events. However, there is no available evidence showing that eating English walnut, specifically, reduces the risk of CHD (8478,13299). In 2004, the US Food and Drug Administration (FDA) determined that it would allow a qualified health claim stating that consuming 1.5 ounces of walnuts per day, as part of a diet low in saturated fat and cholesterol, may reduce the risk of CHD. The FDA has concluded that this claim is based on supporting, rather than conclusive, evidence (102335).
• Diabetes. Data from preliminary clinical research on the effects of English walnuts in people with type 2 diabetes are conflicting. Some clinical research shows that taking English walnut leaf extract 100 mg twice daily for 3 months decreases fasting blood glucose by about 13% when compared with placebo (97750). In contrast, other clinical research shows that taking English walnut leaf extract 100 mg once daily for one week and then twice daily for 7 weeks has no effect on fasting blood glucose levels (97749). In a meta-analysis of 4 studies involving a total of 195 patients, taking English walnut leaf extracts orally, 200-750 mg daily for 8 to 12 weeks, reduces fasting blood glucose by a mean of about 18 mg/dL and increases fasting insulin levels by a mean of about 2 units/L, but does not alter post-prandial glucose levels (113406). The majority of studies do not show a significant effect on glycated hemoglobin (HbA1c), but the meta-analysis shows a reduction when English walnut leaf extracts are taken for more than 8 weeks (97749,97750,113406). Substituting English walnuts for other dietary fats as part of a diet containing 30% fat seems to improve high-density lipoprotein (HDL) cholesterol-to-total cholesterol ratios in patients with type 2 diabetes. However, there is no effect on levels of low-density lipoprotein (LDL) cholesterol when compared with a 30% fat diet without English walnuts (13300). More evidence is needed to rate English walnut for these uses.

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There is insufficient reliable information available about the effectiveness of frostwort.

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INSUFFICIENT RELIABLE EVIDENCE to RATE

• Back pain. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with acute low back pain shows that using a topical homeopathic gel (Spiroflor SRL) containing marsh Labrador tea, comfrey, and poison ivy, for one week, might have similar efficacy to capsaicin cream for reducing pain scores on a visual analog scale (40358).
• Insect bite. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that using a homeopathic after-bite gel, containing marsh Labrador tea, echinacea, and stinging nettle, topically on mosquito bites does not reduce erythema or itching when compared with placebo (89235).
• Osteoarthritis. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with knee osteoarthritis shows that topical use of a homeopathic gel containing marsh Labrador tea, comfrey, and poison ivy, 1 gram three times daily for 4 weeks, is as effective as topical piroxicam gel 5% for reducing pain scores on a visual analog scale (89245).
• Postoperative swelling. Topical marsh Labrador tea has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small observational study in adults undergoing oculofacial surgery shows that applying hydrogel pads (OcuMend, Cearna Inc) containing homeopathic doses of marsh Labrador tea and arnica for 6 days postoperatively might improve swelling and healing when compared to historical data (96770). The validity of these results is reduced by the absence of a control group, and the lack of information on how efficacy was measured. More evidence is needed to rate marsh Labrador tea for these uses.

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LIKELY SAFE ...when used orally, short-term (12392,12393,93200,93609,93610,93611,93613). ...when activated charcoal-containing wound dressings are used topically (93603,94731).

POSSIBLY SAFE ...when used orally, long-term. Activated charcoal has been used with apparent safety in doses up to 1.2 grams three times daily for up to 3 years (103193).

PREGNANCY AND LACTATION: POSSIBLY SAFE
when used orally short-term. Activated charcoal 50 grams three times daily for 8 days has been used with apparent safety in pregnancy (126).

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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.

(Read more about ECHINACEA)

LIKELY SAFE ...when the fruit (nut), leaf, or hull is consumed in amounts normally found in foods (4912,6431,8476,8477).

POSSIBLY SAFE ...when the leaf extract is used orally at doses of up to 200 mg for up to 3 months (97749,97750).

POSSIBLY UNSAFE ...when the bark is used orally or topically, due to its juglone content (12). When applied topically, juglone-containing bark can cause skin irritation. When used orally on a daily basis, juglone-containing bark is associated with increased risk of tongue cancer and lip leukoplakia (2,12). There is insufficient reliable information available about the safety of the fruit, leaf, or hull when used orally in medicinal amounts or when applied topically.

PREGNANCY AND LACTATION: LIKELY SAFE
when the fruit (nut), leaf, or hull is consumed in amounts normally found in foods (4912).

PREGNANCY AND LACTATION: POSSIBLY UNSAFE
when the bark is used orally or topically (12); avoid using. There is insufficient reliable information available about the safety of the fruit, leaf, or hull when used orally in medicinal amounts during pregnancy and lactation; avoid using.

(Read more about ENGLISH WALNUT)

There is insufficient reliable information available about the safety of frostwort.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about FROSTWORT)

LIKELY UNSAFE ...when large amounts are used orally to induce abortion (2). The essential oil of marsh Labrador tea can cause severe gastrointestinal tract irritation, kidney and urinary tract damage, and paralysis (2). There is insufficient reliable information available about the safety of marsh Labrador tea for its other uses.

PREGNANCY: LIKELY UNSAFE
when used orally; avoid using (2,19). Marsh Labrador tea is considered to be a potential uterine stimulant and abortifacient (19,97164).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MARSH LABRADOR TEA)

ALCOHOL (Ethanol) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D The binding action of activated charcoal may be reduced by alcohol.  Details Alcohol may lower the adsorptive capacity of activated charcoal (12400).

CONTRACEPTIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Activated charcoal may reduce the clinical effects of oral contraceptives.  Details Activated charcoal, taken in a dose of 5 grams four times daily for 3 days, may bind to, and reduce the absorption of, oral contraceptives, thereby limiting their effectiveness and increasing the risk of contraceptive failure. However, some clinical research shows that the risk for this interaction is minimal when activated charcoal is taken either 3 hours after or at least 12 hours before oral contraceptives (103192).

ORAL DRUGS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = B Activated charcoal reduces systemic exposure to many drugs, including those that undergo enterohepatic recirculation, regardless of the route of administration.  Details Activated charcoal adsorbs various drugs and may reduce their absorption and/or half-life. Examples of affected drugs include acetaminophen, aminophylline, amiodarone, atenolol, carbamazepine, dapsone, digoxin, disopyramide, fluoxetine, indomethacin, moxifloxacin, nadolol, phenytoin, phenobarbital, piroxicam, quinine, sotalol, theophylline, tricyclic antidepressants, valproate, and verapamil (12392,12400,93198,93602,93610,93612,93613,94730,105543). Avoid co-administration, except after drug overdose.

SYRUP OF IPECAC Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = C Syrup of ipecac is inactivated by activated charcoal.  Details Activated charcoal adsorbs and inactivates syrup of ipecac (12394). Avoid co-administration.

(Read more about ACTIVATED CHARCOAL)

CAFFEINE Interaction Rating = Moderate Be cautious with this combination. Severity = Mild •  Occurrence = Probable •  Level of Evidence = B 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.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B 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.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B 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).

DARUNAVIR (Prezista) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Unlikely •  Level of Evidence = B 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).

DOCETAXEL (Taxotere) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Unlikely •  Level of Evidence = B 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).

ETOPOSIDE (VePesid) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D 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).

ETRAVIRINE (Intelence) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Unlikely •  Level of Evidence = B Theoretically, echinacea may interfere with the metabolism of etravirine; however, a small clinical study found no effect.  Details Etravirine is metabolized by cytochrome P450 3A4 (CYP3A4). Echinacea has variable effects on CYP3A4, but taking E. purpurea root extract (Arkocapsulas Echinacea, Arkopharma) 500 mg three times daily for 14 days did not alter the pharmacokinetics of etravirine in HIV-infected patients (88165,93578).

IMMUNOSUPPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Echinacea has immunostimulant activity which may interfere with immunosuppressant therapy.  Details Theoretically, echinacea may interfere with immunosuppressant therapy because of its immunostimulant activity (3279,6388,6389,12639).

LOPINAVIR/RITONAVIR (Kaletra) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Unlikely •  Level of Evidence = B 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).

MIDAZOLAM (Versed) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = B 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.

WARFARIN (Coumadin) Interaction Rating = Minor Be watchful with this combination. Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = B 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).

(Read more about ECHINACEA)

(Read more about ENGLISH WALNUT)

(Read more about FROSTWORT)

(Read more about MARSH LABRADOR TEA)

General ...Orally, activated charcoal is generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, black stools, bloating, constipation, and flatulence.
Serious Adverse Effects (Rare):
Orally: Gastrointestinal obstruction and pulmonary aspiration.

Gastrointestinal ...The most common adverse reactions reported with activated charcoal are gastrointestinal in nature. Constipation appears to be the most frequent complaint, but is typically transient. Black stools, abdominal pain, bloating, and flatulence have also been reported (12392,12398,93611,103193). Rarely, activated charcoal may lead to gastrointestinal obstruction (12392).

Pulmonary/Respiratory ...Rarely, pulmonary aspiration has been reported in patients taking activated charcoal orally. This may happen if activated charcoal is regurgitated or if a misplaced nasogastric tube delivers activated charcoal to the lungs rather than the stomach (12392).

(Read more about ACTIVATED CHARCOAL)

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).

(Read more about ECHINACEA)

General ...Orally, the fruit (nut) of English walnut is well tolerated (8476,8477); however, it can cause softening of stools and mild bloating (6431). Oral allergy syndrome may occur in people who are allergic to English walnuts. This is characterized by itching of the oral cavity immediately after consumption. Rarely this syndrome may cause swelling of the lips and tongue (angioedema) (8479). English walnut leaf extract has been reported to cause gastrointestinal adverse events, especially mild diarrhea (97750). Daily use of English walnut bark is associated with increased risk of tongue cancer and lip leukoplakia due to its juglone content (2,12).
Topically, English walnut hull preparations can lead to yellow or brown discoloration of skin and mucous membranes due to its juglone content. It can also cause contact dermatitis (12,12980).

Dermatologic ...Topically, English walnut hull preparations, which contain juglone, can cause a temporary yellow or brown discoloration of skin and mucous membranes. It can also cause contact dermatitis (12,12980).

Gastrointestinal ...Orally, the fruit (nut) of English walnut might cause softening of stools and mild bloating (6431). Oral allergy syndrome may occur in people who are allergic to English walnuts. This is characterized by itching of the oral cavity immediately after consumption. Rarely this syndrome may cause swelling of the lips and tongue (angioedema) (8479). Walnut leaf extract has been reported to cause gastrointestinal adverse events, especially mild diarrhea, in 39% of adults in one study (97750). Daily use of walnut bark is associated with increased risk of tongue cancer and lip leukoplakia due to its juglone content (2,12).

Immunologic ...Tree nuts, which include English walnuts, can cause allergic reactions in sensitive individuals. Due to the prevalence of this allergy in the general population, tree nuts are classified as a major food allergen in the United States (105410).
Oral allergy syndrome may occur in people who are allergic to English walnuts. This is characterized by itching of the oral cavity immediately after consumption. Rarely this syndrome may cause swelling of the lips and tongue (angioedema) (8479).

(Read more about ENGLISH WALNUT)

General ...None reported; however, a thorough evaluation of safety outcomes has not been conducted.

(Read more about FROSTWORT)

General ...Orally, large amounts of marsh Labrador tea can cause poisoning due to its ledol constituent (2). The essential oil of marsh Labrador tea can cause severe irritation of the gastrointestinal tract, vomiting, diarrhea, irritation and damage to the kidneys and urinary tract, heavy perspiration, myalgias, and arthralgias. It can also cause central nervous system excitation with narcotic intoxication, seizures, paralysis, and even death (2,97164). The content of ledol in marsh Labrador tea is unpredictable, and seems to range from 3.9% to 30.5% depending on the geographical source (97164).

Gastrointestinal ...Orally, ledol, a constituent of the essential oil of marsh Labrador tea, can cause gastrointestinal irritation resulting in vomiting, gastroenteritis, and diarrhea (97164).

Genitourinary ...Orally, the essential oil of marsh Labrador tea can cause irritation and damage to the kidneys and urinary tract (2).

Musculoskeletal ...Orally, the essential oil of marsh Labrador tea can cause myalgias and arthralgias (2).

Neurologic/CNS ...Orally, ledol, a constituent of marsh Labrador tea essential oil, can cause central nervous system excitation in a dose-dependent manner. Small amounts of ledol can lead to mild stimulating effects similar to caffeine, while larger doses can lead to spasms, seizures, paralysis, and even death (97164).

(Read more about MARSH LABRADOR TEA)