Ephedra/Ma-Huang
(Ephedra sinica)

Interactions

Drug/Herb Interactions • Central nervous system stimulants • Decongestants • MAO inhibitors • Oral and inhaled anti-asthmatic medications

Warning: Not intended for use by anyone under the age of 18. Do not use this product if you are pregnant or nursing. Consult a health care professional before using this product if you have heart disease, thyroid disease, diabetes, high blood pressure, psychiatric condition, difficulty in urinating, prostate enlargement, or seizure disorder, if you are using a monoamine oxidase inhibitor (MAOI) or any other prescription drug, or you are using an over-the-counter drug containing ephedrine, pseudoephedrine or phenylpropanolamine (ingredients found in certain allergy, asthma, cold/cough and weight control products). Exceeding recommended serving will not improve results and may cause serious adverse health effects. Discontinue use and call a health care professional immediately if you experience rapid heartbeat, dizziness, severe headache, shortness of breath, or similar symptoms.(2)

Ephedra has been used traditionally for thousands of years in China. Its uses include acute nephritis, asthma and other lung problems, colds and flu, fever, chills, lack of perspiration, headache, nasal congestion, wheezing, and cough among others.(3, 4) Recently, ephedra supplements have been under scrutiny due in part to the irresponsible use of ephedra products by some individuals and also due to the inappropriate advertising of ephedra products by some manufacturers. In fact, ephedra has been reviewed and in some cases regulated by several State Boards of Pharmacy for appropriate control and dosage of the supplement.(5) A recent laboratory animal study of one of the “herbal ecstasy” products reported that this ephedra product may actually produce an amphetamine-like stimulus.(6)

The safe dosage of ephedra and ephedra-containing products has been heavily debated. The quantity of ephedra alkaloids in dietary supplements, as reported on package labels, is typically around 8 to 25mg per serving, and the usual dosage frequency is two to three times per day and not more than 4 times per day. However, some products may contain larger or smaller amounts of ephedra alkaloids than are listed on the product label. In one study, 11 of 20 supplements tested either failed to list the alkaloid content on the label or had more than a 20 percent difference (either lower or higher) between the amount listed on the label and the actual amount.(7) It is also important to realize that usually the ephedra weight loss products contain other stimulating ingredients, such as caffeine, guarana and bitter orange (citrus aurantium) which contains synephrine.

There have not been many clinical studies conducted on this traditionally used herb. A recent review of 140 reports of adverse events related to the use of dietary supplements containing ephedra alkaloids was conducted. These reports were submitted to the FDA between June 1, 1997, and March 31, 1999. Thirty-one percent of cases were considered to be definitely or probably related to the use of supplements containing ephedra alkaloids, and 31 percent were deemed to be possibly related. Among the adverse events that were deemed definitely, probably, or possibly related to the use of supplements containing ephedra alkaloids, 47 percent involved cardiovascular symptoms and 18 percent involved the central nervous system. Hypertension was the single most frequent adverse effect (17 reports), followed by palpitations, tachycardia, or both (13); stroke (10); and seizures (7). Ten events resulted in death, and 13 events produced permanent disability, representing 26 percent of the definite, probable, and possible cases. It is worth noting that several of the reports reviewed in the study involved individuals with pre-existing medical condi

Symptoms of overdosage include heart palpitations, extreme nervousness, sweating, enlarged pupils, severe headache, dizziness, dyspnea, elevated body temperature, and ultimately death.(17)

There has been a report of hepatitis associated with the use of ephedra.(18)

Pregnancy/Breast-Feeding
Use is contraindicated in pregnancy and lactation.

Age Limitations
This dietary supplement should not be used by anyone under 18 years of age.