Ephedrine benefits and side effects

Ephedrine (ma huang), found in the herb, ephedra, has been used for thousands of years to treat asthma, bronchitis and hay fever (1).

It has a dangerous track record.

As a dietary supplement, it also has been promoted for weight loss and as an athletic performance enhancer (2), but the side effects seem to outweigh the benefits.

Benefits

The benefits of ephedrine vary depending on whether it is the synthetic form of ephedrine compounds (pseudoephedrine), or the natural form derived from the herb itself (ephedrine alkaloids).

Pseudoephedrine can provide upper and lower respiratory relief.  The synthetic compound has been used in medical preparations for the treatment of asthma, cough, bronchitis, allergic rhinitis, sinusitis and nasal congestion.

Pseudoephedrine is a vasoconstrictor that works by narrowing blood vessels in the nasal passages to decrease swelling and congestion. It provides relief for nasal congestion caused by colds, allergies and hay fever. It can also temporarily relieve sinus pressure (3).

Pseudoephedrine is manufactured in a laboratory and is regulated as a drug.

Ephedrine alkaloids may help with weight loss, but come with a warning. Ephedrine alkaloids, present in the herb ephedra, are found in over-the-counter products for weight loss, and are regulated as dietary supplements (4). Until 2004, ephedrine was sold as an energy booster, weight loss supplement and as a performance enhancer frequently used by athletes. While there has been some evidence that suggests that this herbal supplement may improve weight, the lack of scientific information regarding its efficacy, along with reports of serious, sometimes fatal side effects as a result of its use, led the FDA to ban the sale of all over-the-counter dietary supplements containing ephedrine alkaloids in 2004 (5).

Researchers from Harvard stress that just because a supplement is made from natural sources, does not mean it is necessary safe (6). Ephedra use is also banned by the National Collegiate Athletic Association, International Olympic Committee and National Football League (7). This ban does not pertain to teas (which are regulated as food) or to herbal remedies prescribed by a physician who practices traditional Chinese medicine (8).

Side effects

Ephedrine alkaloids work by stimulating the heart, lungs and nervous system (9). Ephedrine encourages fat loss by increasing the amount of fat available for fuel as well as by increasing heat expenditure (10). As a result, several serious and life-threatening side effects may occur.

Ephedra may cause cardiovascular problems. Studies reveal that the use of it may lead to irregular heartbeat or long QT interval syndrome (a disorder of the heart’s electrical activity resulting in sudden, dangerous arrhythmias) (11, 12).

Ephedra can be troublesome for diabetics. It may interfere with blood sugar control, and could raise high blood pressure and increase circulation problems in people with diabetes (13).

Use of this herb may have neurological repercussions. Ephedra has been shown to make essential tremor (a neurological disorder characterized by involuntary and rhythmic shaking) worse (14).

Ephedra can stimulate the thyroid. In addition, it has been shown to  worsen the symptoms of an already overactive thyroid (15).

Ephedra may bring on a seizure. It can also make seizures worse in some people who are prone to them. Of the 33 cases of seizures reported to the FDA over 7 years that were linked to dietary supplements, 27 cases involved ephedra. (16)

Use of ephedra has been linked to hemorrhagic stroke. Doses greater than 32 mg per day may more than triple the risk for bleeding within the brain (17).

Ephedra should not be used during pregnancy. It has been linked to several cases of severe side effects (18) in pregnant and breast-feeding women.

Other potentially dangerous side effects that might occur include, angina (chest pain) (19), high blood pressure (20) and kidney stones (21).

Ephedra can also cause less serious side effects including dizziness, restlessness, anxiety, irritability, headache, loss of appetite, nausea and vomiting (22). These side effects might be more likely if ephedra is used for a prolonged period or taken in high doses. Taking ephedra with other stimulants such as caffeine may increase the chances of experiencing dangerous side effects (23).

In 2015, The New England Journal of Medicine published the results of a study performed by a group of Illinois researchers stating, “There is a direct relation between the FDA’s ban on ephedra sales and a sharp reduction in ephedra-related adverse events reported to U.S. poison centers. The number of poisonings resulting in major effects or deaths has decreased by more than 98 percent since 2002.” (24) The study further reported, “The 2004 FDA ban has proved to be a very effective means of limiting the availability of ephedra and therefore its potential toxicity in the United States” (25).

Recommended dosage

There is no recommended dosage for ephedrine alkaloids.

Any use of ephedrine alkaloids in dietary supplements for the use of weight loss or performance enhancement is strictly banned and not recommended for use by the FDA.

According to the FDA, “Dietary supplements that contain ephedrine alkaloids present an unreasonable risk of illness or injury under conditions of use recommended or suggested in the labeling, or if no conditions of use are recommended or suggested in the labeling, under ordinary conditions of use.” (26).

The recommended dosage of pseudoephedrine, for the treatment of nasal and sinus congestion or congestion of the eustachian tubes, is determined by a healthcare professional based on the user’s age, health and other factors. (27, 28).

When treating nasal or sinus congestion in adults and children age 12 and over, the typical recommended oral dose is 60 milligrams (mg) taken every four to six hours; not exceeding more than 240 mg in a 24-hour period. For extended-release capsules or tablets, the recommended dosage is 120 mg every 12 hours; not taking more than 240 mg in 24 hours (29).

Use pseudoephedrine exactly as directed on the label, or as prescribed by a doctor.

Recap

According to the FDA, the risks for serious side effects, such as heart problems, stroke, high blood pressure and even death far outweigh any potential minor weight loss benefit that comes with the use of ephedra or ephedrine alkaloids. The FDA banned all over-the-counter supplements containing ephedra in 2004. Any decision to use ephedra products should be made with careful consideration and under the care of a treating physician.

Unlike ephedrine alkaloids which are derived from the ephedra herb, synthetic ephedrine compounds, such as pseudoephedrine, are manufactured in a laboratory and are regulated as a drug. They are used for the treatment of nasal and sinus congestion associated with colds or allergies.

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