Drug Interaction Report

Echinacea and Cyclosporine Ophthalmic: Interaction Details

A pharmacist-reviewed analysis of the Echinacea and Cyclosporine Ophthalmic interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Cyclosporine Ophthalmic

Cequa Cequa® Restasis® Vevye
+

Echinacea

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
LinkedIn
Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 23 documented Echinacea interactions, 18 are rated moderate — including this one.
Onset
delayed
Evidence
theoretical
Severity
Moderate

What happens

Decreased effectiveness of cycloSPORINE

Interaction Deep Dive

Theoretically, Echinacea may antagonize the immunosuppressive effect of cycloSPORINE. Human studies have shown an increase in granulocytes, monocytes, and lymphocytes in response to treatment with Echinacea1, increased phagocytic activity 23, and increased natural killer cell function 4. Animals treated with Echinacea have shown increased immune response to antigens 5, and increased macrophage activation 6. Since this data indicates immunostimulation, Echinacea should be avoided with immunosuppressants such as cycloSPORINE 7.

Why it happens (mechanism)

Immune system stimulation by Echinacea

Common questions

Can I take Echinacea and Cyclosporine Ophthalmic together?

Decreased effectiveness of cycloSPORINE Always confirm with your pharmacist or prescriber before making any change.

How serious is the Echinacea and Cyclosporine Ophthalmic interaction?

It is rated moderate. Can be significant — usually manageable with monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

From our Q&A

Real reader questions about these medications, each personally answered by our pharmacist:

Questions for your pharmacist

  • Does my dose of Echinacea or Cyclosporine Ophthalmic need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there anything you'd monitor while I'm on both?

References (7)

  1. Parnham MJ: Benefit-risk assessment of the squeezed sap of the purple coneflower (Echinacea purpurea) for long-term oral immunostimulation. Phytomedicine 1996; 3:95-102. PubMed
  2. Jurcic K, Melchart D, Holzmann M, et al: Zwei Probandenstudien zur Stimulierung der Granulozyten-phagozytose durch echinaceaextrakthaltige Praparate. Z. Phytother 1989; 10:67-70.
  3. Mose JR: Zur Wirkung von Echinacin (R) auf Phagozytoseaktivitat und Natural Killer Cells. Med Welt 1983; 34:1463-67.
  4. See DM, Broumand N, Sahl L, et al: n vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacol 1997; 35:229-35.
  5. Rehman J, Dillow JM, Carter SM, et al: Increased production of antigen-specific immunoglobulins G and M following in vivo treatment with the medicinal plants Echinacea angustifolia and Hydrastis canadensis. Immunol Lett 1999; 68:391-5. PubMed
  6. Stimpel M, Proksch A, Wagner H, et al: Macrophage activation and induction of macrophage cytotoxicity by purified polysaccharide fractions from the plant Echinacea purpurea. Infection Immun 1984; 46:845-49. DOI
  7. Newall CA, Anderson LA, & Phillipson JDNewall CA, Anderson LA, & Phillipson JD: Herbal Medicines: A Guide for Health-care Professionals, Pharmaceutical Press, London, 1996.
Was this write-up helpful?
Cyclosporine Ophthalmic

Keep reading about Cyclosporine Ophthalmic

All Cyclosporine Ophthalmic interactions (545) Cyclosporine Ophthalmic drug information
Also serious with: Dronedarone Elagolix Ensitrelvir Ezetimibe
Echinacea

Keep reading about Echinacea

All Echinacea interactions (23)
Also serious with: Atogepant Cariprazine Amlodipine Lumateperone

Check another combination

Our instant two-drug interaction checker is almost here.

Coming soon

The instant two-drug checker is on its way.

In the meantime, browse the directory below to look up any drug and see its documented interactions.

Still have questions about this combination?

Every question gets a real answer from a licensed pharmacist — free, and usually within a day.

Ask the pharmacist
This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.