Ephedra

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What other names is Ephedra known by?

Alcaloïde d'Éphédrine, Belcho, Cao Mahuang, Desert Herb, Efedra, Éphédra, Éphédra Américain, Éphédra Chinoise, Ephedra distachya, Ephedra equisetina, Éphédra Européen, Ephedra gerardiana, Ephedra intermedia, Ephedra shennungiana, Ephedra sinensis, Ephedra sinica, Ephedra Sinisa, Ephedra vulgaris, Ephedrae Herba, Éphèdre, Ephedrine, Éphédrine, Ephedrine Alkaloid, Épitonin, Herbal Ecstasy, Joint Fir, Ma Huang, Ma-Huang, Mahuang, Mahuanggen (ma huang root), Muzei Mahuang, Popotillo, Raisin de Mer, Sea Grape, Teamster's Tea, Thé de Désert, Yellow Astringent, Yellow Horse, Zhong Mahuang.

What is Ephedra?

Ephedra is an herb. Usually, the branches and tops are used to make medicine, but the root or whole plant can also be used. Ephedra is banned in the U.S. due to safety concerns.

Mormon tea and ephedra are often confused. Mormon tea or American ephedra comes from Ephedra nevadensis, and ephedra or ma huang comes primarily from Ephedra sinica. Mormon tea lacks the chemicals (notably ephedrine) that give ephedra its effects and potentially serious side effects.

Ephedra is used for weight loss and obesity and to enhance athletic performance. It is also used for allergies and hay fever; nasal congestion; and respiratory tract conditions such as bronchospasm, asthma, and bronchitis. It is also used for colds, flu, swine flu, fever, chills, headache, inability to sweat, joint and bone pain, and as a "water pill" to increase urine flow in people who retain fluids.

There has been a lot of debate about the safety of ephedra and legal wrangling over its status. In June 1997, the FDA proposed restrictions on the ephedrine content of dietary supplements, new warning labels for products that contain the active ingredients in ephedra, and a ban on combination products containing ephedra and other natural stimulants, such as guarana and cola nut, both of which contain significant amounts of caffeine. These proposals were dropped after the link between ephedra use and serious adverse effects was challenged by the General Accounting Office (GAO) and the dietary supplement industry. According to the Dietary Supplement Health and Education Act of 1994, FDA must prove a supplement is unsafe before it can be withdrawn from the market. The FDA reviewed numerous adverse event reports involving ephedra-containing products, with 140 of the reports receiving in-depth clinical review by FDA and outside experts. Findings from experts outside the FDA support the FDA's initial finding that ephedra is likely the cause of many of the events noted in the reports.

On December 30, 2003, the FDA announced the ban of ephedra products in the U.S., effective April 2004. In April 2005, the dietary supplement industry successfully challenged the FDA ban on ephedra. A year after the ban on ephedra began, a federal judge in Utah struck down the FDA's action saying that FDA didn't prove that low doses of ephedra are harmful. In August 2006, an appeals court reversed the Utah judge's decision and upheld the FDA's ban of ephedra-containing dietary supplements.

Ephedra use is banned by the National Collegiate Athletic Association, International Olympic Committee, and National Football League.

Ephedra is sometimes marketed as a recreational drug "herbal ecstasy." The FDA has announced that ephedra products marketed as recreational drugs are unapproved and that misbranded drugs can be taken by the authorities.

Is Ephedra effective?

There is some scientific evidence that ephedra can help asthma, bronchitis, bronchospasm, and other breathing problems. But large and possibly unsafe doses are needed. Using ephedra for these conditions is not worth the risk, since there are many safer alternative treatments.

Ephedra is often promoted for weight loss, but it is not safe or effective for this use.

There isn't enough information to know if ephedra is effective for the other conditions people use it for, including: improving athletic performance, allergies, nasal congestion, colds, flu, fever and many more.

Possibly Effective for...

  • Obesity. Ephedra can produce modest weight loss when used with exercise and a low-fat diet, but it can cause serious side effects, even in healthy people who follow product dosage directions. Taking ephedra seems to produce weight loss of approximately 0.9 kg (about 2 pounds) per month for up to 6 months. It is not known if weight loss continues beyond this time frame or if weight returns after ephedra is discontinued.
    Caffeine may provide additional weight loss. The combination of ephedra, cola nut, and willow bark may also cause modest weight loss in overweight and obese people. Early research suggests that a specific combination product containing ephedra, guarana, and 17 other vitamins, minerals, and supplements (Metabolife 356) might help reduce weight by approximately 2.7 kg (about 6 pounds) over 8 weeks when used with a low-fat diet and exercise. Taking 90 mg of ephedra in combination with caffeine from 192 mg of cola nut per day for six months seems to cause a modest weight reduction (5.3 kg or about 12 pounds) in overweight people with a body mass index (BMI) between 25 and 40. This combination, along with limiting fat intake to 30 percent of calories and moderate exercise, also seems to reduce body fat, lower "bad" low-density lipoprotein (LDL) cholesterol, and raise "good" high-density lipoprotein (HDL) cholesterol. However, even in carefully screened and monitored otherwise healthy adults, ephedra combinations can cause small changes in blood pressure and heart rate. There are serious concerns about the safety of these products since they combine significant amounts of the stimulants ephedra and caffeine and are often taken without monitoring for harmful side effects.

Possibly Ineffective for...

  • Exercise performance. Some research suggests that taking ephedra with caffeine is no more effective than taking caffeine alone for improve exercise performance.

Insufficient Evidence to Rate Effectiveness for...

  • Allergies.
  • Asthma and other breathing disorders.
  • Nasal congestion.
  • Colds.
  • Flu.
  • Fever.
  • Other conditions.
More evidence is needed to rate the effectiveness of ephedra for these uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

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How does Ephedra work?

Ephedra contains a chemical called ephedrine. Ephedrine stimulates the heart, the lungs, and the nervous system.

Are there safety concerns?

Do not take products that contain ephedra or its active ingredients. Ephedra is LIKELY UNSAFE for adults and children. Ephedra can cause severe life-threatening or disabling conditions in some people. Ephedra use is linked to high blood pressure, heart attacks, muscle disorders, seizures, strokes, irregular heartbeat, loss of consciousness, and death. These side effects might be more likely if ephedra is used in high doses or long-term. Doses greater than 32 mg per day might more than triple the risk for bleeding within the brain (hemorrhagic stroke). The risk for serious side effects seems to be greater than any potential benefit. Ephedra is banned in the U.S.

Ephedra can also cause less serious side effects including dizziness, restlessness, anxiety, irritability, heart pounding, headache, loss of appetite, nausea, vomiting, and others.

Do not use ephedra with other stimulants such as caffeine. This might increase the chance of having side effects, including life-threatening ones. Sources of caffeine include coffee, tea, kola nut, guarana, and mate.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Ephedra is LIKELY UNSAFE. Ephedra has been linked to several cases of severe side effects. Do not use it.

Chest pain (angina): Ephedra can stimulate the heart and this could make chest pain worse. Don't use it.

Irregular heartbeat or long QT interval syndrome: Ephedra can stimulate the heart and might make irregular heartbeat worse. Do not use it.

Anxiety: Large doses of ephedra might make anxiety worse. Do not use it.

Diabetes: Ephedra might interfere with blood sugar control, and could raise high blood pressure and increase circulation problems in people with diabetes. Do not use it.

A movement disorder called essential tremor: Ephedra might make essential tremor worse. Do not use it.

High blood pressure: Ephedra might make high blood pressure worse. Do not use it.

Overactive thyroid and related conditions: Ephedra might stimulate the thyroid and make the symptoms of overactive thyroid worse. Do not use it.

Kidney stones: Ephedra and its active ingredient ephedrine can cause kidney stones. Do not use ephedra or ephedrine.

Narrow-angle glaucoma: Ephedra might make this condition worse. Do not use it.

An adrenal gland tumor (pheochromocytoma): Ephedra might make the symptoms of this condition worse. Do not use it.

Seizure disorders: Ephedra might bring on a seizure or make one worse in some people who are prone to seizures. Of the 33 cases of seizures reported to the FDA over 7 years that were linked to dietary supplements, 27 cases involved ephedra.

Are there any interactions with medications?



Medications that can cause an irregular heartbeat (QT interval-prolonging drugs)
Interaction Rating: Major Do not take this combination.

Ephedra can increase the speed of your heartbeat. Taking ephedra along with medications that can cause an irregular heartbeat might cause serious side effects including heart attack.

Some medications that can cause an irregular heartbeat include amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn), ibutilide (Corvert), procainamide (Pronestyl), quinidine, sotalol (Betapace), thioridazine (Mellaril), and many others.



Methylxanthines
Interaction Rating: Major Do not take this combination.

Ephedra can simulate the body. Methylxanthines also stimulate the body. Taking ephedra along with methylxanthines might cause side effects such as jitteriness, nervousness, a fast heartbeat, high blood pressure, and anxiety.

Methylxanthines include aminophylline, caffeine, and theophylline.



Stimulant drugs
Interaction Rating: Major Do not take this combination.

Stimulant drugs speed up the nervous system and can make you feel jittery and speed up your heartbeat. Ephedra can also speed up the nervous system. Taking ephedra along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with ephedra.

Some stimulant drugs include diethylpropion (Tenuate), epinephrine, phentermine (Ionamin), pseudoephedrine (Sudafed), and many others.



Dexamethasone (Decadron)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

The body breaks down dexamethasone (Decadron) to get rid of it. Ephedra might increase how quickly the body breaks down dexamethasone (Decadron). Taking ephedra along with dexamethasone (Decadron) might decrease the effectiveness of dexamethasone (Decadron).



Ergot derivatives
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ephedra can increase blood pressure. Ergot derivatives can also increase blood pressure. Taking ephedra with ergot derivatives might increase blood pressure too much.

Some of these ergot derivatives include bromocriptine (Parlodel), dihydroergotamine (Migranal, DHE-45), ergotamine (Cafergot), and pergolide (Permax).



Medications for asthma (Beta-adrenergic agonists)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ephedra can stimulate the heart. Some medications for asthma can also stimulate the heart. Taking ephedra with some medications for asthma might cause too much stimulation and cause heart problems.

Some medications for asthma include albuterol (Proventil, Ventolin, Volmax), metaproterenol (Alupent), terbutaline (Bricanyl, Brethine), and isoproterenol (Isuprel).



Medications for depression (MAOIs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ephedra contains chemicals that stimulate the body. Some medications used for depression can increase these chemicals. Taking ephedra with these medications used for depression might cause serious side effects including fast heartbeat, high blood pressure, seizures, nervousness, and others.

Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.



Medications for diabetes (Antidiabetes drugs)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Ephedra might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, ephedra might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.



Medications used to prevent seizures (Anticonvulsants)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Medications used to prevent seizures affect chemicals in the brain. Ephedra may also affect chemicals in the brain. By affecting chemicals in the brain, ephedra may decrease the effectiveness of medications used to prevent seizures.

Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others.

Dosing considerations for Ephedra.

The appropriate dose of ephedra depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for ephedra. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.

Reviewed on 3/29/2011 12:35:40 PM

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