Breastfeeding and echinacea

Herbal medicines & breastfeeding | The Royal Women's Hospital

Some complementary and alternative medicines have very good information about their safety and effectiveness while breastfeeding, others have very little because not enough research has been done on them. 

Herbal medicines are produced from plants and are based on traditional knowledge. They fall under the umbrella of complementary and alternative medicines (CAM).  CAM also include such therapies as acupuncture, dietary supplements, massage, aromatherapy, homeopathy and relaxation therapy.   

Herbal and traditional medicines are generally bought from shops such as pharmacies, supermarkets and health food stores. They may have been prescribed by a naturopath, a Chinese doctor or another kind of health provider. While most complementary medicines are used for the relief of symptoms of minor and self-limiting conditions, many are used for maintaining health and wellbeing.

Like conventional medicines, certain herbal and traditional medicines, can transfer into your breast milk. Some herbal and traditional medicines may be harmful to your baby, while others can affect your breast milk production. Unless you or your practitioner are very sure about a product's effect on breastfeeding, it is important that you do not take that product.

Breast milk is the best nutrient for your baby and has many health benefits for both you and your baby. You should be very careful about what herbal and traditional medicines you use while breastfeeding, especially when your baby is a newborn, or if your baby was born prematurely.

Things to consider

There are concerns around the unregulated use of herbal and traditional medicines in breastfeeding.

• All herbal and traditional medicines have the potential to pass into breast milk and affect your baby.

• With most herbal and traditional medicines, there is not enough documented information to determine their safety in breastfeeding.

• Some herbal and traditional medicines have not been scientifically proven to be effective.

• Some herbal and traditional medicine products have not been regulated to ensure they are of good quality.

Common herbal and traditional medicines

Aloe vera

Aloe vera gel is used to help heal cracked nipples. Remove aloe gel from the nipple areas before feeding your baby because the bitter taste of the aloe vera gel can affect feeding.

Aloe vera latex is a yellow-coloured liquid that comes from the inner skin of the aloe leaf. It is taken orally in both the dried and liquid form. Avoid taking aloe vera latex as it has a strong laxative effect.

Cranberry

Cranberry may be used to prevent urinary tract infections in breastfeeding mothers. There is no information on the safety and efficacy of the medicine in breastfeeding, but is considered safe to use at the recommended doses.

Echinacea

Echinacea has been commonly used to treat or prevent upper respiratory tract infections. There is no information about the safety and efficacy of echinacea in breastfeeding. If you take echinacea while breastfeeding, watch for possible side effects in your baby, such as diarrhoea or constipation, poor feeding and skin rashes.

Fenugreek

Traditionally, fenugreek is used to increase milk supply. The transfer of fenugreek into breast milk is unknown and unusual side effects such as allergy, colic, abdominal discomfort and diarrhoea have been reported in babies. Also, there is the potential for fenugreek to interact with other medicines.

Garlic

Garlic appears to be safe in amounts usually used in food preparation. Garlic may change the smell of breast milk and affect your baby’s feeding. There is no information on the safety of garlic supplements in breastfeeding.

Ginger

Ginger appears to be safe in amounts usually used in food preparation. Avoid using large amounts as there is not enough information available about the safety of ginger while breastfeeding.

Milk thistle

Avoid using milk thistle because there is no information on the safety of this traditional medicine when used by breastfeeding mothers.

Raspberry leaf

When used as a tea, raspberry leaf is safe to use while breastfeeding. Raspberry leaf supplements should be avoided because there is limited safety information.

St John’s Wort

There is very little information available about the safety and efficacy of St John’s Wort in breastfeeding women. It is recommended that an alternative medicine be considered. See your doctor or pharmacist for advice before starting St John’s Wort.

References

1. McGuire T, Walters J, Dean A, et al. Review of the Quality of Complementary Medicines Information Resources: Summary Report. In: Service NP, ed. Sydney; 2009.

2. The regulation of complementary medicines in Australia – an overview. 2012. (Accessed 29/06/12, 2012, at http://www.tga.gov.au/industry/cm-basics-regulation-overview.htm)

3. Loke Y, ed. Pregnancy and Breastfeeding Medicines Guide. 1st ed. Melbourne: The Royal Women’s Hospital, Pharmacy Department; 2010.

4. Hale TW. Medications and mothers’ milk. 14th ed ed. Texas: Hale Publishing; 2010.

5. Lactmed. In: Lactmed; 2012.

6. Australian Pharmaceutical Formulary and Handbook. 22 ed. Canberra: Pharmaceutical Society of Australia; 2012.

7. Braun L, Cohen M. Herbs and Natural Supplements. 3 ed; 2010.

8. Francois CA, Connor SL, Bolewicz LC, Connor WE. Supplementing lactating women with flaxseed oil does not increase docosahexaenoic acid in their milk. Am J Clin Nutr 2003;77:226–33.

9. Swiss Ultiboost Spirulina. 2012. (Accessed June 2012, at http://www.swisse.com/products/superfoods/ultiboost-spirulina)

The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

Echinacea - Drugs and Lactation Database (LactMed)

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Last Revision: October 18, 2021.

Estimated reading time: 2 minutes

CASRN: 84696-11-7; 90028-20-9; 97281-15-7

Drug Levels and Effects

Summary of Use during Lactation

Echinacea species (Echinacea angustifolia, Echinacea purpurea, Echinacea pallida) contain high molecular weight polysaccharides (e. g., heteroxylan, arabinogalactan) and lower molecular weight compounds (e.g., alkylamides, caffeoyl conjugates such as cichoric acid and echinacosides), but no single chemical is known to be responsible for Echinacea's biological activity. Some products have been standardized based on echinacoside, and others on cichoric acid. Echinacea has no specific uses during breastfeeding, but is commonly used orally to treat or prevent upper respiratory infections. Excretion of some of the purportedly active alkamides was found in breastmilk in one mother. No data exist on the safety and efficacy of Echinacea in nursing mothers or infants. In general, Echinacea is well tolerated with gastrointestinal upset, diarrhea and constipation, skin rash and rarely allergic reactions reported. It may also alter the metabolism of some dugs metabolized by the P450 enzyme system. Some sources indicate that Echinacea is safe in recommended doses,[1] while others recommend avoiding it during breastfeeding because of the lack of published safety data. Echinacea has also been used topically to treat skin infections. A topical combination with Calendula (Calendit-E) was more effective than breastmilk in treating sore and cracked nipples in one study.[2-4]

Dietary supplements do not require extensive pre-marketing approval from the U.S. Food and Drug Administration. Manufacturers are responsible to ensure the safety, but do not need to prove the safety and effectiveness of dietary supplements before they are marketed. Dietary supplements may contain multiple ingredients, and differences are often found between labeled and actual ingredients or their amounts. A manufacturer may contract with an independent organization to verify the quality of a product or its ingredients, but that does not certify the safety or effectiveness of a product. Because of the above issues, clinical testing results on one product may not be applicable to other products. More detailed information about dietary supplements is available elsewhere on the LactMed Web site.

Drug Levels

Maternal Levels. One woman was given 4 Echinacea Premium tablets (each containing the equivalent of 675 mg of Echinacea purpurea root and 600 mg of Echinacea angustifolia root made from the dried ethanolic extracts). The total dose of N-isobutyldodeca-2E,4E,8Z,10E/Z-tetraenamide alkamides was 13.1 mg. The alkamides were present in breastmilk between 1 and 4 hours after ingestion in concentrations similar to those reported in the blood with the same dose of the product.[5] Further details were not present in the abstract.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1.

Perri D, Dugoua JJ, Mills E, et al. Safety and efficacy of echinacea (Echinacea augustafolia, E. purpurea and E. pallida) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e262–7. [PubMed: 17085774]

2.

Niazi A, Rahimi VB, Soheili-Far S, et al. A systematic review on prevention and treatment of nipple pain and fissure: Are they curable? J Pharmacopuncture. 2018;21:139–50. [PMC free article: PMC6168189] [PubMed: 30283701]

3.

As'adi N, Kariman N. Herbal prevention and treatment of nipple trauma and/or pain in Iranian studies: A systematic review. J Herbmed Pharmacol. 2018;7:168–75. [CrossRef]

4.

Pezeshki B, Pouredalati M, Zolala S, et al. Comparison of the effect of aloe vera extract, breast milk, calendit-E, curcumin, lanolin, olive oil, and purslane on healing of breast fissure in lactating mothers: A systematic review. Int J Pediatr-Mashhad. 2020;8:10853–63. [CrossRef]

5.

Matthias A, Merika H, Addison RS, et al. Bioavailability of echinacea alkamides in human breast milk. Planta Med 2008;74:921. Abstract. doi:10.1055/s-002-12952. [CrossRef]

Substance Identification

Substance Name

Echinacea

Scientific Name

Echinacea angustifolia; Echinacea purpurea; Echinacea pallida

CAS Registry Number

84696-11-7; 90028-20-9; 97281-15-7

Drug Class

Breast Feeding

Lactation

Complementary Therapies

Phytotherapy

Plants, Medicinal

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

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Bookshelf ID: NBK501810PMID: 30000869

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Echinacea and breastfeeding. Can Echinacea be taken while breastfeeding?

Can Echinacea be taken while breastfeeding? What are the alternatives to Echinacea?

July 1, 2015 (Low risk)

A herb that is widely used even during pregnancy and breastfeeding. Due to the lack of toxicity with an appropriate dose and moderate consumption, it should be compatible with breastfeeding. nine0003

Roots and aerial tops are used. It contains polysaccharides, essential oil, flavonoids, pyrrolizidine alkaloids and others.

Unproven effects: immune stimulant, wound healing, anti-inflammatory.

Indications are: colds, bronchitis, skin lesions. Edges and air vertices are used.

It contains polysaccharides, essential oil, flavonoids, pyrrolizidine alkaloids ...

Unproven effects: immune stimulant, wound healing, anti-inflammatory. nine0003

Indications according to Commission E of the German Ministry of Health: colds, bronchitis, skin lesions.

Unlike the European Scientific Collaboration for Phytotherapy (ESPC), the European Medicines Agency does not recommend use under 12 years of age (allergy risk). Avoid use for more than 8 weeks (risk of leukopenia)

Alternatives

We do not have alternatives to echinacea .

Very low risk

Breastfeeding compatible. Low risk for the baby.

Low risk

Moderately safe. Read the comment carefully.

High risk

Dangerous. Use a less risky alternative. Read the comment.

Very high risk

Very dangerous. High risk of stopping breastfeeding.

Synonyms

• Black Sampson
• Brauneria angustifolia
• Coneflower
• Amer MR, Cipriano GC, Venci JV, Gandhi MA. Safety of Popular Herbal Supplements in Lactating Women. J Hum Lact. 2015 Abstract
• Kennedy DA, Lupattelli A, Koren G, Nordeng H. Herbal medicine use in pregnancy: results of a multinational study. BMC Complement Altern Med. 2013 Abstract Full text (link to source) Full text (link to our server)
• The Royal Women’s Hospital Victoria Australia. nine0070 Herbal and Traditional Medicines in Breasfeeding. Fact sheet. 2013 Full text (link to source) Full text (link to our server)
• Sachs HC; committee on drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Abstract Full text (link to source) Full text (link to our server)
• Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Abstract Full text (source link) Full text (link to our server)
• Cuzzolin L, Francini-Pesenti F, Verlato G, Joppi M, Baldelli P, Benoni G. Use of herbal products among 392 Italian pregnant women: focus on pregnancy outcome. Pharmacoepidemiol Drug Saf. 2010 Abstract
• Shah SA, Sander S, White CM, Rinaldi M, Coleman CI. nine0070 Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis. 2007 Abstract
• Perri D, Dugoua JJ, Mills E, Koren G. Safety and efficacy of echinacea (Echinacea angustafolia, e. purpurea and e. pallida) during pregnancy and lactation. Can J Clin Pharmacol. 2006 Abstract
• Zaffani S, Cuzzolin L, Benoni G. Herbal products: behaviors and beliefs among Italian women. nine0071 Pharmacoepidemiol Drug Saf. 2006 Abstract
• Huntley AL, Thompson Coon J, Ernst E. The safety of herbal medicinal products derived from Echinacea species: a systematic review. Drug Safe. 2005 Abstract
• Nordeng H, Havnen GC. Use of herbal drugs in pregnancy: a survey among 400 Norwegian women. Pharmacoepidemiol Drug Saf. 2004 Abstract
• Tesch BJ. Herbs commonly used by women: an evidence-based review. Am J Obstet Gynecol. 2003 Abstract
• Einarson A, Lawrimore T, Brand P, Gallo M, Rotatone C, Koren G. Attitudes and practices of physicians and naturopaths towards herbal products, including use during pregnancy and lactation. Can J Clin Pharmacol. 2000 Abstract
• Gallo M, Sarkar M, Au W, Pietrzak K, Comas B, Smith M, Jaeger TV, Einarson A, Koren G. Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study. Arch Intern Med. 2000 Abstract
• WHO. World Health Organization. Geneva. WHO monographs on selected medicinal plants. Volume I. WHO monographs 1999 Full text (link to source) Full text (link to our server)

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