Ephedrine

Aka: Ephedrine, Ephedra, Ma Huang

1. Precautions
   1. Serious adverse effects including death may occur
   2. FDA investigated 800 serious reactions in 1999 alone
      1. Serious reactions despite 75% were under age 50 years
      2. Life threatening reactions occurred at dose <5 mg/day
2. Contraindications
   1. Absolute
      1. Hypertension
      2. Diabetes Mellitus
      3. Concurrent MAO inhibitor use
      4. Heart disease
      5. Hyperthyroidism
      6. Psychiatric condition
      7. Glaucoma
      8. Prostatic hypertrophy
      9. Seizure disorder
   2. Relative
      1. Risks outweigh any benefits of Ephedrine
      2. Use at any dose in healthy patients may be unsafe
3. Marketed Products containing Ephedrine
   1. Herbal Fen-Phen (Weight loss)
   2. Herbal Prozac (Depression)
   3. Herbal Ecstasy
4. Indications (Purported Uses)
   1. Respiratory conditions including Asthma
      1. Long history of use in China
      2. Used in United States since 1930s (e.g. Primatene)
   2. Herbal Stimulant for increased athletic performance
   3. Increased sexual sensation or heightened awareness
   4. Weight loss
5. Mechanism
   1. Sympathomimetic
6. Adverse effects (Sympathomimetic effects)
   1. Insomnia
   2. Headache
   3. Nervousness
   4. Tremor or other motor disturbance
   5. Hypertension
   6. Glaucoma
   7. Hyperglycemia
   8. Nephrolithiasis
   9. Cardiac arrhythmia
   10. Myocardial Infarction
   11. Hypersensitivity Myocarditis
   12. Seizure
   13. Cerebrovascular Accident
   14. Predisposes to Heat Exhaustion and Heat Stroke
7. Drug Interactions
   1. Caffeine
   2. Decongestants (e.g. Pseudoephedrine or Sudafed)
   3. Stimulants
   4. Monoamine Oxidase Inhibitors, combined effects:
      1. Hypertension
      2. Coma
      3. Hyperpyrexia
8. References
   1. Ang-Lee (2001) JAMA 286:208-16
   2. Cupp (1999) Am Fam Physician 59(5):1239-44
   3. Nadir (1996) Am J Gastroenterol 91(7):1436-8
   4. Zink (1998) Am Fam Physician 58(5):1133-40