**3.4 Echinacea toxicity**

In a review article, echinacea was considered to have a high or medium evidence for efficacy and safety [32]. Debatable concern of hepatotoxicity with echinacea when used for more than 8 weeks has been raised [6]. On the other hand, echinacea *Safety Review of Herbs and Supplements in Heart Disease, Diabetes, and COVID-19 DOI: http://dx.doi.org/10.5772/intechopen.96811*

has shown hepatic and renal protection against toxins in rats with no effect by itself on liver and kidney parameters including AST, ALT, ALP, blood urea nitrogen and creatinine [33]. No toxicity was found in rats and mice after oral or intravenous injection of *Echinacea purpurea* at high doses. No evidence of mutagenicity in vitro and in mice or carcinogenicity in hamster embryo cells [34]. Echinacea is contraindicated in patients with autoimmune disease. Little evidence to evaluate the effect of echinacea in renal impairment [35].
