Ephedra

Related Terms

6-hydroxykynurenic acid, amp II, amsania, brigham tea, budshur, cao ma huang (Chinese), cathine, chewa, Chinese ephedra, Chinese joint fir, D-pseudoephedrine, desert herb, desert tea, dextro-rotatory, Ephedra altissima, Ephedra americana, Ephedra anti-syphilitica, Ephedra distachya, Ephedra equisetina, Ephedra fasciculata, Ephedra geradiana, Ephedra helvetica, Ephedra intermedia, Ephedra major, Ephedra nevadensis, Ephedra shennungiana, Ephedra sinica, Ephedra trifurca, Ephedra viridis, Ephedra vulgaris, Ephedraceae (family), ephedra herba, ephedrae herba, ephedrine, ephedrine alkaloids, epitonin, European ephedra, Gnetales, herba ephedrae, herbal ecstasy, horsetail, hum, huma, Indian joint fir, intermediate ephedra, isoephedrine, joint fir, khama, khat, L-ephedrine, levo-rotatory ephedrine, maho?ng, m?hu?ng, mahuuanggen, Mao (Chinese), mao-kon, methylephedrine, methylpseudoephedrine, Mexican tea, m?c tac ma ho?ng, Mongolian ephedra, Mormon tea, mu-tsei-ma-huang, muzei mu huang, natural ecstasy, norephedrine, norpseudoephedrine, phenylpropanolamine, phok, popotillo, pseudo-ephedrine, pseudoepehdrine, quinoline, san-ma-huang, sea grape, shrubby, soma, song tu? ma ho?ng, squaw tea, synephrine, tannins, teamster's tea, trun aa ho?ng, tsao-ma-huang, tutgantha, yellow astringent, yellow horse, zhong ma huang.
Select combination products: Acceleration?, AllerClear?, AllerPlus?, Andro Heat?, Better BodyEnergy for Life?, Bio Trim?, Biovital Plus?, Bladderwrack-Dandelion Virtue?, Bofu-tsusho-san, Bofutsushosan, Breathe-Aid Formula?, Breath Easy?, Cordephrine XC?, Diet Fuel?, Dymetadrine Xtrem?, EPH-833?, Ephedra 1000?, Ephedra Plus?, Guarana-Gotu Kola Virtue?, Herba Fuel?, Herbal Decongestant Expectorant Capsules?, Herbalife-Thermojetics Original Green?, Hydroxycut?, Letigen?, Mahuang zhisou, Metabolife 356?, Metabolift?, Metaboloss?, MetaboTRIM?, Naturafed?, Naturally Ripped?, Naturatussin 1?, Nettle-Reishi Virtue?, Power Thin?, ProLab Stoked?, Pro-Ripped Ephedra?, Respa-Herb?, Respiratory Support Formula?, Ripped Fuel?, Ripped Fuel Extreme?, Shegan mahuang, Shoseiryuto (TJ-19), SinuCheck?, SinuClear?, SnoreStop?, Super Stinger?, Thermadrene?, Thermic Blast?, Thermicore?, Thermo Cuts?, ThermoDiet?, Thermogen?, TrimSpa?, Ultra Diet Pep?, Virgin Earth?, Xenadrine?, Xenadrine? RFA, Xenadrine? RFA-1, Yellow Jacket?.
Note: There are approximately 40 species of ephedra.

Background

In 2003, there was a death of a U.S. major league baseball pitcher which was thought to be related to ephedra. The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths. On February 6, 2004, the FDA issued a rule prohibiting the sale of dietary supplements containing ephedrine alkaloids (ephedra). This rule was issued because supplements with ephedra present a serious risk of illness or injury.
In 2005 this rule was struck down in Utah but reversed again four months later. Ephedra is currently banned throughout the United States. It remains unclear whether ephedra will re-appear on the market, despite serious safety risks, including heart events or death.
Ephedra sinica, a species of ephedra (ma huang), contains ephedrine and pseudoephedrine. Ephedra has been found to stimulate the nervous system, increase airflow into the lungs and constrict blood vessels. In combination with caffeine, ephedra appears to cause weight loss. However, effects of ephedra or ephedrine monotherapy have been mixed. Ephedrine has been widely studied for asthma and low blood pressure. However, quality research of commercial supplements with ephedra is lacking.
Major safety concerns have been associated with ephedra or ephedrine use, including high blood pressure, increased heart rate, nervous system excitation, irregular heartbeat, heart attack, and stroke.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


In human research, ephedra caused weight loss when used in combination with caffeine. The research on ephedra alone is limited and results are mixed. The amounts of ephedra in commercially available products varied widely and numerous adverse effects have been reported. Further research is necessary.

 B


In human research, ephedra caused weight loss when used in combination with caffeine. The research on ephedra alone is limited and results are mixed. The amounts of ephedra in commercially available products varied widely and numerous adverse effects have been reported. Further research is necessary.

 B


Early studies suggest that ephedrine nasal spray may help treat symptoms of nasal allergies. Additional research is needed before a firm conclusion can be made.

 C


Early studies suggest that ephedrine nasal spray may help treat symptoms of nasal allergies. Additional research is needed before a firm conclusion can be made.

 C


Ephedra contains the chemicals ephedrine and pseudoephedrine, which are bronchodilators (expand the airways for easier breathing). It has been used and studied to treat asthma and chronic lung diseases in both children and adults. Other treatments, such as inhalers (for example albuterol), are more commonly recommended due to safety concerns with ephedra or ephedrine. Further research is needed.

C


Ephedra contains the chemicals ephedrine and pseudoephedrine, which are bronchodilators (expand the airways for easier breathing). It has been used and studied to treat asthma and chronic lung diseases in both children and adults. Other treatments, such as inhalers (for example albuterol), are more commonly recommended due to safety concerns with ephedra or ephedrine. Further research is needed.

C


Early research demonstrates mixed findings regarding the effects of ephedra on athletic performance. Further research is needed in this area.

 C


Early research demonstrates mixed findings regarding the effects of ephedra on athletic performance. Further research is needed in this area.

 C


Chemicals in ephedra may stimulate the heart, increase heart rate, and raise blood pressure. Ephedrine, a component of ephedra, is sometimes used in hospitals to help control blood pressure. However, the effects of over-the-counter ephedra supplements lack sufficient study. Further research is needed.

C


Chemicals in ephedra may stimulate the heart, increase heart rate, and raise blood pressure. Ephedrine, a component of ephedra, is sometimes used in hospitals to help control blood pressure. However, the effects of over-the-counter ephedra supplements lack sufficient study. Further research is needed.

C


Limited research shows that ephedra in combination with other herbs commonly used in traditional Chinese medicine (TCM) may be beneficial for infections of the upper respiratory tract (nose, throat, and mouth). Further research of ephedra alone is needed before conclusions can be made.

 C


Limited research shows that ephedra in combination with other herbs commonly used in traditional Chinese medicine (TCM) may be beneficial for infections of the upper respiratory tract (nose, throat, and mouth). Further research of ephedra alone is needed before conclusions can be made.

 C


Early research suggests that ephedra may increase sexual arousal in women. Further well-designed research is needed to confirm these results.

 C


Early research suggests that ephedra may increase sexual arousal in women. Further well-designed research is needed to confirm these results.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years or older)
Note: The U.S. Federal Government has banned the sale of ephedra since 2004. Ephedra may cause serious adverse effects at any dose, particularly when used with other drugs, such as caffeine. Because of serious safety concerns, ephedra cannot be suggested in any dose.
Traditionally, herbalists have suggested a wide range of doses (8-100 milligrams ephedra by mouth three times daily). Previously, over-the-counter drugs containing ephedra advised taking 12.5-25 milligrams ephedra by mouth every four to six hours and not to exceed 150 milligrams in 24 hours.
For allergic nasal symptoms, a 1% ephedrine-saline liquid has been used as a nose wash every 48 hours for four weeks.
For athletic performance enhancement, 1 milligram of ephedrine per kilogram body weight has been taken by mouth 90 minutes prior to exercise once weekly for four weeks.
For low blood pressure, 5-45 milligrams ephedrine has been injected into the vein or muscle.
For sexual arousal, 50 milligrams of ephedrine sulfate has been taken by mouth prior to exposure to erotic stimuli.
For weight loss, 2 grams of ephedra extract has been taken by mouth three times daily for eight weeks, 20-50 milligrams of ephedrine has been taken by mouth three times daily for 2-3 months.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Ephedra may raise blood pressure. Caution is advised in people taking drugs that affect blood pressure.
Ephedra may lower blood sugar levels, although ephedra-caffeine combinations may increase blood sugar. Caution is advised when using medications that may also alter blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
Ephedra may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
Ephedra may also interact with acidifying agents, agents eliminated by the kidneys, agents that affect the immune system, agents that affect the stomach or intestines, agents that alter heart rate, agents that cause muscle breakdown, agents that lower seizure threshold, agents toxic to the liver, alcohol, alkalinizing agents, anesthetics, antiadrenergic drugs (alpha blockers), antiadrogens, antiasthma agents, antidepressant agents (monoamine oxidase inhibitors, tricyclic antidepressants, selective serotonin reuptake inhibitors), antigout agents, anti-inflammatory agents, aspirin, cardiac glycosides, cholesterol agents, central nervous system stimulants, diuretics (increasing urine flow), ergot derivatives, hormonal agents, methylxanthines (theophylline, caffeine), oxytocics, phenothiazines, phenylpropranolamine, steroids, thyroid hormones, and weight loss agents.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography

Chen WL, Tsai TH, Yang CC, et al. Effects of ephedra on autonomic nervous modulation in healthy young adults. J.Ethnopharmacol. 8-9-2010;130(3):563-568.
Chen ZX and Hu GH. [Effect of modified shegan mahuang decoction on cytokines in children patients with cough and variant asthma]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2010;30(2):208-210.
Choi JH, Chung MJ, and Oh DH. Classification of Sasang constitutional body types using immunostimulatory activities of constitution-specific herbal extracts in human primary immune cells. J.Med.Food 2012;15(9):824-834.
Cohen PA and Ernst E. Safety of herbal supplements: a guide for cardiologists. Cardiovasc.Ther. 2010;28(4):246-253.
Flanagan CM, Kaesberg JL, Mitchell ES, et al. Coronary artery aneurysm and thrombosis following chronic ephedra use. Int.J.Cardiol. 2-18-2010;139(1):e11-e13.
Hallas J, Bjerrum L, Stovring H, et al. Use of a prescribed ephedrine/caffeine combination and the risk of serious cardiovascular events: a registry-based case-crossover study. Am.J.Epidemiol. 10-15-2008;168(8):966-973.
Hasani-Ranjbar S, Nayebi N, Larijani B, et al. A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J.Gastroenterol. 7-7-2009;15(25):3073-3085.
Jing H, Luo L, Li H, et al. Ephedrine controls heart rhythms by activating cardiac I(ks) currents. J.Cardiovasc.Pharmacol. 2010;55(2):145-152.
Kim HJ, Park JM, Kim JA, et al. Effect of herbal Ephedra sinica and Evodia rutaecarpa on body composition and resting metabolic rate: a randomized, double-blind clinical trial in Korean premenopausal women. J.Acupunct.Meridian.Stud. 2008;1(2):128-138.
Martinez-Quintana E, Rodriguez-Gonzalez F, and Cuba-Herrera J. [Myocardial necrosis and severe biventricular dysfunction in the context of chronic ephedrine abuse]. Adicciones. 2010;22(1):25-28.
Palamar J. How ephedrine escaped regulation in the United States: a historical review of misuse and associated policy. Health Policy 2011;99(1):1-9.
Retamero C, Rivera T, and Murphy K. "Ephedra-free" diet pill-induced psychosis. Psychosomatics 2011;52(6):579-582.
Singh A, Rajeev AG, and Dohrmann ML. Cardiomyopathy associated with ephedra-containing nutritional supplements. Congest.Heart Fail. 2008;14(2):89-90.
Thomas JE, Munir JA, McIntyre PZ, et al. STEMI in a 24-year-old man after use of a synephrine-containing dietary supplement: a case report and review of the literature. Tex.Heart Inst.J. 2009;36(6):586-590.
Vigano M, Lampertico P, and Colombo M. Acute hepatitis following assumption of a herbal remedy. Eur.J.Gastroenterol.Hepatol. 2008;20(4):364-365.