Quick answer

Ask your pharmacist or doctor before combining. NIH and NCCIH both say echinacea might interact with medicines that suppress the immune system, because it may stimulate immune activity. NCCIH calls the reasons theoretical. Neither source names a specific medicine, and both tell people on any medicine to talk to a health care provider first.^1,2,3

Key facts

NCCIH says there are theoretical reasons to suspect that echinacea might interact with immunosuppressants.³
NIH's health professional sheet says echinacea might reduce the effectiveness of immunosuppressants because of its potential immunostimulatory activity.¹
NIH also says echinacea might increase cytochrome P450 activity and so reduce levels of some medicines broken down by those enzymes.¹
MedlinePlus describes cyclosporine, azathioprine and mycophenolate as immunosuppressants, which work by decreasing or weakening the activity of the immune system.^4,5,6
The tacrolimus label tells patients to report natural or herbal remedies, nutritional supplements and vitamins to their healthcare providers when they start or stop them.⁷

Ask your pharmacist or doctor first

Echinacea might make medicines that suppress the immune system work less well, because it may stimulate immune activity. NIH and NCCIH both name this as a possible interaction on theoretical grounds.^1,2,3

Expected from how the two work, not shown in studies

What do NIH and NCCIH say about echinacea and immunosuppressants?

Both agencies use cautious wording: might, potential, theoretical. NIH makes the point in two fact sheets. The version for health professionals says echinacea might reduce the effectiveness of immunosuppressants because of its potential immunostimulatory activity, and the consumer version says echinacea might make some medicines work less well, including those that suppress the immune system.^1,2

NCCIH says there are theoretical reasons to suspect an interaction with immunosuppressants, and adds that the evidence on drugs broken down by the liver is conflicting. That is why the pair is marked expected here: the concern follows from how the two work.³

Which medicines count as immunosuppressants?

They are medicines that lower the activity of the immune system. MedlinePlus describes cyclosporine as one: it is used with other medicines to prevent rejection of a kidney, liver or heart transplant and, in its modified form, for rheumatoid arthritis and psoriasis. Azathioprine and mycophenolate are described the same way, as medicines that weaken or decrease the activity of the immune system so it does not attack a new organ or the joints.^4,5,6

NIH and NCCIH name the class and no individual medicine. Neither says whether a particular product is affected, or how much echinacea matters. Treat your own medicine as unanswered by this page and ask your pharmacist or the team that manages it.^1,3

Medicine labels ask for the same openness. The tacrolimus label tells patients to report natural or herbal remedies, nutritional supplements and vitamins whenever they start or stop one, and the patient information for mycophenolate says to tell your provider about vitamins and herbal supplements.^7,8

What else do NIH and NCCIH say to tell a pharmacist about echinacea?

Echinacea is closely related to sunflowers, daisies and ragweed, and NCCIH says some people have allergic reactions to it that may be severe.³
NIH says its most common effects are stomach upset, trouble sleeping and skin rashes, and that isolated reports of raised liver enzymes and liver injury exist.¹
NIH says the safety of echinacea in pregnancy is not known, and NCCIH says little is known about breastfeeding.^1,3
NIH raises the same immunosuppressant caution for andrographis, elderberry and ginseng, so a blend that mixes herbs needs every ingredient checked.¹

US echinacea products often mix species and plant parts, and NIH says the plant's active compounds are not well defined. The exact product matters, and your pharmacist can read it better from the bottle than from memory.¹

Questions for your pharmacist or care team

Does my medicine count as an immunosuppressant for this purpose?
What does my echinacea product contain: which species, which plant parts, and any other herbs?
Should I avoid echinacea while I take this medicine, and how long after stopping it?
Do my other immune or herbal products raise the same question?

Questions people ask

Can you take echinacea with immunosuppressants?

Ask your pharmacist or doctor first. NIH and NCCIH both say echinacea might make these medicines work less well, though NCCIH describes the reason as theoretical.^1,3

Does echinacea weaken immunosuppressant medicines?

NIH says echinacea might reduce their effectiveness because of its potential immunostimulatory activity. Neither NIH nor NCCIH names a specific medicine or an amount of echinacea.^1,2

Which medicines does echinacea interact with?

NIH says it might lower levels of some medicines broken down by cytochrome P450 enzymes and might reduce immunosuppressants. NCCIH calls the evidence on liver-processed drugs conflicting. Ask your pharmacist about your own list.^1,3

Is a transplant medicine an immunosuppressant?

Many are. MedlinePlus describes cyclosporine, azathioprine and mycophenolate as medicines that lower the immune system's activity to prevent rejection of a transplanted organ. Confirm your own medicine with your pharmacist.^4,5,6

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This page is information, not medical advice. Talk to your doctor or pharmacist about your own situation.