Drug Interaction Report

Hydrocortisone and Echinacea: Interaction Details

A pharmacist-reviewed analysis of the Hydrocortisone and Echinacea 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

Hydrocortisone

Ala-Cort Alkindi Alkindi Sprinkle® Alocane Anti-Itch Anucort-HC Anusol HC Aquanil HC Aquaphor Itch Relief
+

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
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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 439 documented Hydrocortisone interactions, 265 are rated moderate — including this one.
Onset
delayed
Evidence
theoretical
Severity
Moderate

What happens

Decreased effectiveness of corticosteroids

Interaction Deep Dive

Theoretically, Echinacea may antagonize the immunosuppressive effect of corticosteroids. 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 corticosteroids 7.

Why it happens (mechanism)

Immune system stimulation by Echinacea

Common questions

Can I take Hydrocortisone and Echinacea together?

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

How serious is the Hydrocortisone and Echinacea 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 Hydrocortisone or Echinacea 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: In 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. PubMed
  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. DOI
  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. PubMed
  7. Newall CA, Anderson LA, & Phillipson JDNewall CA, Anderson LA, & Phillipson JD: Herbal Medicines: A Guide for Health-care Professionals, Pharmaceutical Press, London, 1996.
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Hydrocortisone

Keep reading about Hydrocortisone

All Hydrocortisone interactions (439) Hydrocortisone drug information
Also serious with: Mifepristone Desmopressin Ensitrelvir Desmopressin Nasal
Echinacea

Keep reading about Echinacea

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

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Hydrocortisone + Activated Charcoal Grapefruit Lily-of-the-valley St. John's Wort Acacia Rigidula Active Hexose Correlated Compound (ahcc) Adrafinil African Wild Potato + 197 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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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.