4-Way Fast Acting, A-hydroCort, Acanthopanax senticosus, Acarbose, Accubron Syrup, Accupril, Accurbron, Acebutolol, Aceon, Acetaminophen and Aspirin and Caffeine powder, Acetaminophen and Pseudoephedrine, Acetaminophen, Aspirin, Caffeine Oral, Acetaminophen, Caffeine, and Dihydrocodeine, Acetasol HC, Acetazolamide, Acetazolamide Injection, Acetazolamide Sustained-Release, Acetic Acid and Hydrocortisone Eardrops, Acetohexamide, Acrivastine and Pseudoephedrine, Actifed Daytime Allergy, Actoplus Met, Actos, Adalat, Adalat CC, Adrenalin, Advil Cold & Sinus, Advil Flu & Body Ache, Afeditab CR, Afrin Children's Pump Mist, Agoral Liquid, Ah-chew D, AK-Dilate, AK-Nefrin, AK-Pred, AK-Spore H.C. 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depMedalone, dihydroergotoxine, dihydrogenated ergot alkaloids, Ear-Eze, Econopred, Econopred Plus, Edecrin, Efidac 24 Hour Relief, Eldepryl, Eleuthero, Eleutherococcus senticosus, Elixomin, Elixomin Elixir, Elixophyllin, Elixophyllin Elixir, Enalapril, Endafed, Enduron, Enerjets, Entuss D Oral Liquid, Enzone, Ephedrine Injection, Ephedrine Nasal Spray, Ephedrine Sulfate, Ephedrine Sulfate Injection, Ephedrine Tablets, Epifoam, Epifrin, Epinephrine Inhalation Aerosol, Epinephrine Inhalation Solution, Epinephrine Injection, Epinephrine injection (auto-injector), Epinephrine Ophthalmic, EpiPen, EpiPen Jr, Epitol, Eprosartan, Equetro, Ercaf, Ergo-Caff, Ergoloid Mesylates Sublingual Tablets, Ergoloid Mesylates Tablets, Ergomar, Ergometrine, Ergonovine, Ergonovine Injection, Ergotamine and Caffeine Rectal Suppositories, Ergotamine Sublingual Tablets, Ergotamine Tartrate and Caffeine, Ergotrate, Ergotrate Injection, Esidrix, Eskalith, Eskalith CR, Ethacrynic Acid, Ethosuximide Capsules, Ethosuximide Oral Solution, Ethotoin, Etrafon, European Buckthorn, European Mistletoe, Excedrin Extra Strength, Excedrin Migraine, Exlax, Exlax Chocolated, Ezide, Fazoclo, Felbamate, Felbamate Oral Suspension, Felbatol, Felbatol Oral Suspension, Felodipine, Fexofenadine and Pseudoephedrine, Five Fingers, Flowery Knotweed, Fluoxetine and Olanzapine, Fluphenazine, Fluphenazine Injection, Fluphenazine Oral Concentrate or Elixir, Flutex, Flux Root, Fo-Ti, Folergot-DF, Fortamet, Fosinopril, Fosphenytoin, Frangula Bark, Furosemide, Furosemide Injection, Furosemide Oral Solution, Gabapentin, Gabapentin Oral Solution, Gan Cao, Garden ginger, Genaphed, Geodon, Geodon Injection, Gerimal, Gingembre, Ginger, Ginseng, American, Ginseng, Panax, Glaucon, GlaucTabs, Glimepiride, Glipizide, Glipizide and Metformin, Glipizide Extended-Release, Glossy Buckthorn, Glucophage, Glucophage XR, Glucotrol, Glucotrol XL, Glucovance, Glyburide, Glyburide and Metformin, Glycyrrhiza glabra, Glynase, Glyset, Golden Bough, Goody's Extra Strength Headache Powder, Guaifenesin, Hydrocodone, and Pseudoephedrine, Guiatuss CF Syrup, Guigai, Hagedorn, Haldol Decanoate Injection, Haldol Injection, Haldol Oral Concentrate, Haldol Tablets, Haloperidol Decanoate Injection, Haloperidol Lactate Injection, Haloperidol Oral Concentrate, Haloperidol Tablets, Hardhay, Hartshorn, Haw, Hawthorn, HC Tussive D Syrup, He Shou Wu, Hedgethorn, Hemorrhoidal HC, Hemril-HC Uniserts, Herb de la Croix, Hexadrol, Hexadrol Injection, Hexadrol Liquid, Hexatuss, Highwaythorn, Histex HC, Histex SR capsules, Histinex D Oral Liquid, Histinex PV Syrup, Histussin D, Histussin D Syrup, Horsetail, Humalog, Humalog Mix 75/25, Humulin, Humulin 50/50, Humulin 70/30, Hydergine, Hydergine Sublingual Tablets, Hydro-Tussin HC Syrup, Hydro-Tussin HD, Hydro-Tussin XP, Hydrochlorothiazide, Hydrocodone and Phenylephrine, Hydrocodone and Pseudoephedrine Liquid, Hydrocodone, Potassium Guaiacolsulfonate and Pseudoephedrine, Hydrocortisone and Pramoxine Rectal Aerosol Foam, Hydrocortisone and Pramoxine Topical, Hydrocortisone and Pramoxine Topical Aerosol Foam, Hydrocortisone Dental Paste, Hydrocortisone Injection, Hydrocortisone Oral, Hydrocortisone Rectal Foam or Enema, Hydrocortisone Suppositories, Hydrocortisone Tablets, Hydrocortisone Topical, Hydrocortisone, Chloroxylenol and Pramoxine Eardrops, Hydrocortisone, Neomycin, and Polymyxin Otic, Hydrocortone, Hydrocortone Acetate, Hydrocortone Phosphate, HydroDIURIL, Hydron PSC Liquid, Hygroton, Hypericum, Hypericum perforatum, Hyphed Liquid, Hytone, Ibuprofen and Pseudoephedrine Suspension, Ibuprofen and Pseuodoephedrine, Iletin II, Iletin II Mixed, Imber, Indapamide, Inderal, Inderal IV, Inflamase Forte, Inflamase Mild, Insulin - Mixed, Insulin glulisine, Insulin injection, Insulin Lispro, Iofed, Iofed PD, Irbesartan, Isocarboxazid, Isoptin, Isoptin Injection, Isoptin SR, Isradipine, Isradipine Extended-Release Tablets, Jamaican ginger, Japanese Ginseng, Johimbi, 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Serentil, Serentil Injection, Serentil Oral Concetrate, Seroquel, Shave-grass, Shigoka, Siberian Ginseng, Silfedrine, Children's, Silkweed, Simply Stuffy, Sinustop, SJW, Slo-bid Gyrocaps, Slo-Phyllin, Slo-Phyllin Gyrocaps, Slo-Phyllin Syrup, Smilace, Smilax, Smilax aristolochiifolia, Smilax officinalis, Smilax regelii, Smilax sarsaparilla, Solu-Cortef, Solu-Medrol, Soluspan Injection, Sonazine Concentrate, Sonazine Syrup, Sotalol, Spastrin, Spironolactone, Spironolactone and Hydrochlorothiazide, St. John's Wort, Su-Tuss HD, Sudafed, Sudafed PE, Sudafed Sinus and Cold, Sudafed Sinus Headache, Sudafed, Children's Non-Drowsy, Sular, Sustaire, Swallow-wort, Sweet Root, Symbyax, Synalgos-DC, Synthroid, Synthroid Injection, T-Phyl, Taiga, Tapazole, Taztia XT, Tegretol, Tegretol Suspension, Tegretol XR, Telmisartan, Tenoretic, Tenormin, Tenormin Injection, Teveten, Thalitone, Theo-24, Theo-Dur, Theo-Sav, Theo-X, Theobid Duracaps, Theochron, Theoclear L.A., Theoclear-80, Theoclear-80 Syrup, Theolair, Theolair Injection, Theolair Solution, Theolair SR, Theophylline ER, Theophylline Injection, Theophylline Oral Solution, Syrup, or Suspension, Theophylline Tablets or Capsules, Theospan-SR, Theostat 80, Theostat-80 Syrup, Theovent, Thor-Prom, Thorazine, Thorazine Concentrate, Thorazine Injection, Thorazine Spansule, Thorazine Suppositories, Thorazine Syrup, Thorny Pepperbush, Throw-wort, Thyrolar, Tiamate, Tiazac, Timolol Ophthalmic, Timolol Oral, Timoptic, Timoptic-XE, Tipton Weed, Toadpipe, TobraDex, Tobramycin and Dexamethasone Ophthalmic, Tolazamide, Tolbutamide, Tolinase, Topamax, Topiramate, Toprol XL, Torsemide Injection, Torsemide Oral, Touch-Me-Not, Touro Allergy capsules, Touro CC Tablets, Trandate, Trandate Injection, Trandolapril, Tranylcypromine, Tri Nasal, Tri-Otic, Tri-Statin, Triacet, Triamcinolone Acetonide Dental, Triamcinolone Injection, Triamcinolone Nasal Inhalation, Triamcinolone Nasal Spray, Triamcinolone Oral, Triamcinolone Oral Inhalation, Triamcinolone Oral Syrup, Triamcinolone Topical, Triaminic Allergy Congestion, Triamterene, Triamterene and Hydrochlorothiazide, Triavil, Triderm, Trilafon, Trilafon Concentrate, Trilafon Injection, Trileptal, Trileptal Suspension, Triostat, Tuber Root, Tuss S Syrup, Tussend, Tussend Syrup, Tussi-12 D suspension, Tussi-12 D tablets, Tylenol Sinus, UAD Otic, ULTRAbrom capsules, ULTRAbrom PD capsules, Uni-Dur, Uniphyl, Unithroid, Univasc, Valproate Sodium, Valproate Sodium Syrup, Valproic Acid Capsules, Valproic Acid Delayed or Extended-Release or Sprinkle Capsule, Valproic Acid Injection, Valproic Acid Oral Syrup, Valsartan, Vanquish, Vascor, Vasotec, Velosulin, Verapamil, Verapamil Extended-release, Verapamil Injection, Verelan, Verelan PM, Vicks 44D Cough & Head Congestion, Vicks Sinex Ultra Fine Mist, Viscum, Viscum album, Vivarin, Vogelmistel, VoSoL HC, Waythorn, White Root, Whitethorn, Wigraine, Wigraine Suppositories, Wild Pepper, Wild Root, Xalcom, Yohimbe, Z-Cof DM Syrup, Zarontin, Zarontin Oral Solution, Zaroxolyn, Zebeta, Zestoretic, Zestril, Zingiber officinale, Ziprasidone, Ziprasidone Injection, Zone-A Forte, Zoto-HC, ZTuss, ZTuss Expectorant liquid, Zyprexa, Zyprexa Injection, Zyprexa Zydis, Zyprexa Zydis Injection, Zyrtec-D.
Scientific Name: Ephedra
Other Names: Ephedra sinica, Epitonin, Herbal Ecstasy, Ma Huang, Mahuang, Muzei, Popptillo
Who is this for?
NOTE: Effective in April 2004, the U.S. Food and Drug Administration (FDA) banned the sale of ephedra in the United States. Even though the ban did not go into effect immediately, all individuals using ephedra products were urged to stop taking them.
The risks associated with taking ephedra are not worth whatever small effectiveness it may have. Taking ephedra for any reason is discouraged strongly.
Ephedra contains active ingredients called alkaloids with the main one being ephedrine. If ephedrine is produced in the laboratory, it is considered to be a drug by the FDA. Ephedrine and some of the other alkaloids in ephedra are central nervous system (CNS) stimulants that have been included in products for weight loss. In studies, some participants using ephedra experienced small to moderate weight loss. However, the results were mostly short-term and the side effects from ephedra caused a significant number of individuals to stop taking ephedra before the studies were scheduled to end.
Ephedra was also sold to improve exercise performance. However, clinical studies found that, at best, ephedra provides only limited enhancement of performance for short periods of time. Due to the possibly severe side effects associated with using ephedra, the U.S. military and several athletic organizations, including the International Olympic Committee (IOC), the U.S. National Football League (NFL), and the National Collegiate Athletic Association (NCAA) prohibited its use well before the FDA ban was announced.
While it has a tightening effect on blood vessels near the surface of the skin, ephedrine also widens bronchioles, which are small airways in the lungs. Therefore, it has been used in the past to relieve stuffy nose and chest tightness caused by allergies and colds. Formerly, ephedra was also used in drugs to treat asthma, but medications with greater effectiveness and less potential for side effects are now available.
When should I be careful taking it?
The use of ephedra is discouraged strongly.
Even though ephedra's risks have caused it to be forbidden to sell in the United States, some individuals will continue to take it. Certain individuals, though, should be particularly careful to avoid its use.
Using ephedra is not recommended.
Some evidence suggests that children are more likely to have side effects such as nausea and restlessness from taking ephedra. Children should not be given ephedra.
When ephedra is taken with other CNS stimulants, such as caffeine, the risk of side effects increases.
Ephedra is known to pass into breast milk and to cause changes in the heart rate and rhythm of breast-feeding infants. Women who are breast-feeding should not take it.
What side effects should I watch for?
Note: Not all of the severe effects associated with ephedra occurred in individuals with known medical conditions. Many side effects some very serious ones were experienced by healthy, young or middle-aged individuals who took low doses of ephedra for short periods of time.
Ephedra has been identified as the cause of over 150 deaths in the United States. Thousands of non-fatal side effects have also been attributed to its use. Some of ephedra's more serious potential side effects include:
Less Severe Side Effects
Taking ephedra has also been associated with:
Stopping ephedra does not guarantee that side effects will also stop. In some reported cases, side effects such as mental disturbances or high blood pressure continued for several months after individuals stopped taking ephedra.
What interactions should I watch for?
Ephedra has been shown to increase the elimination of a corticosteroid drug, dexamethasone, from the body. As a result the effects of dexamethasone may be reduced. Whether other corticosteroids are affected in similar ways is not known. Corticosteroids are used for a wide range of inflammatory conditions including arthritis, asthma, cancer, eye conditions, and skin infections.
Taking ephedra with the heart drug, digoxin (Lanoxin) may cause potentially dangerous changes in heart rhythm.
Drugs for High Blood Pressure
Due to the probability that it may raise blood pressure, ephedra is believed to decrease the effects of drugs that lower blood pressure. Some blood pressure-lowering drugs include:
Drugs that Affect the Acidity of Urine
Drugs that change the levels of acid in the urine may interfere with the way ephedra is eliminated from the body, potentially increasing the risk of side effects. Drugs that change urinary acid levels include sodium bicarbonate, citric acid, and ammonium chloride.
Ergot products are taken mainly to relieve migraine headaches. They work by constricting blood vessels in the brain. Since ephedra also tightens those blood vessels, they may become too narrow and high blood pressure or more serious conditions can result. Some ergots are:
Other ergot products that should not be taken with ephedra include ergonovine (Ergotrate), used to stop excessive bleeding after childbirth; ergoloid mesylates (Gerimal, Hydergine), used to enhance cognitive function; and bromocriptine (Parlodel), used to treat a number of conditions including Parkinson's disease.
Because blood sugar levels may either increase or decrease when ephedra is taken, insulin may not work as well to control diabetes.
Monoamine Oxidase Inhibitors
Dangerously high blood pressure may result if ephedra is taken with a type of antidepressants called monoamine oxidase inhibitors (MAOIs), which include:
Selegiline (Eldepryl), a drug which is related to the MAOIs and which is used for Parkinson's disease, also should not be taken with ephedra.
Oral Antidiabetes Drugs
In some studies, ephedra altered the amount of sugar in the blood. Blood sugar levels went up or down in unpredictable ways. Therefore, the effectiveness of oral drugs taken to control diabetes may be affected when ephedra is taken.
Theophylline, a drug sometimes used to treat asthma, can cause side effects such as headaches, heart rhythm changes, insomnia, nausea, and seizures. If ephedra is taken at the same time as theophylline or related drugs, the risk of these and other side effects may increase. Some brand names for theophylline and related drugs are:
Ephedra can increase the amount of thyroid hormone produced by the body. Taking it can interfere with therapy for both high and low thyroid levels. Ephedra should be avoided by individuals with thyroid conditions.
Aspirin may increase the effects and possibly the risk of side effects from ephedra.
Some non-prescription products for colds and allergies contain pseudoephedrine or other ingredients that may have side effects similar to those caused by ephedra. If ephedra is taken at the same time as one of the ingredients similar to it, both the effects and the side effects of ephedra may be increased.
Central nervous system (CNS) stimulation may be increased if ephedra is taken at the same time as other herbal products that also excite the CNS. Results could include anxiety, dizziness, headache, insomnia, restlessness, and changes in the ability to concentrate. Some CNS-stimulating herbal products are:
Caffeine including caffeine in beverages such as coffee, soft drinks, and tea increases the CNS stimulating effect of ephedra. Even though several commercial weight loss products combined ephedra with caffeine to increase the weight loss effect, the combination may have caused excessive nervousness and irritability along with other signs of over-stimulation in some individuals.
Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.
Should I take it?
Many different types of ephedra plants grow all over the world, mainly as short bushy evergreens with small leaves and yellowish flowers. Generally, ephedra grows well in sandy, rocky, or other marginally unproductive areas. The plants smell somewhat like pine trees. The bark, stems, and sometimes the roots are used in medicine.
Traditional Asian healers have been using ephedra for hundreds of years to treat conditions as diverse as arthritis and fever. In the western world, ephedra has been a treatment for asthma and other breathing conditions, including allergies and colds. Most recently, it was promoted for losing weight and improving physical performance. Neither of these effects was believed to be great or long-lasting, however; and the risk of serious side effects is too great for ephedra to be recommended for any purpose.
Dosage and Administration
Ephedra should not be taken.
Many different types of the ephedra plant grow in various parts of the world. The amounts of active chemicals in ephedra cannot be guaranteed because they depend on which type of ephedra plants are used and how the plants are grown, harvested, processed, and stored. In addition, the makers of herbal preparations are not required to prove the safety or effectiveness or even the content of their products in the same ways that pharmaceutical manufacturers must provide proof. At least one laboratory analysis showed significant variations in the ephedra content listed on the labels of several commercial products and the actual amount of ephedra in the packages.
A recent study found that doses of ephedra above 32 mg per day were three times as likely as lower doses to result in hemorrhagic strokes (bleeding in the brain). In theory, the longer ephedra is taken, the higher the risk of severe side effects. However, many of the most severe side effects, including death, have been reported when individuals took small amounts of ephedra for short periods of time. In another small study, just one dose of a weight-loss product that contains ephedra, caffeine, and several other ingredients raised blood pressure and caused heart rhythm changes in overweight but otherwise healthy young adults.
The risks associated with the use of ephedra are too great to recommend that it be used for any purpose.
Although ephedra products were used widely to promote weight loss and to increase athletic ability, no substantial evidence exists to support these uses. Most studies of its use were small and none lasted longer than 6 months.
The use of ephedra should be avoided by all individuals, especially:
Serious side effects of ephedra include:
In addition, ephedra can cause:
Ephedra can interfere with:
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(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)