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Ephedra



Background

Ephedra is an evergreen shrub-like plant native to central Asia, and Mongolia; it also grows in the southwestern United States.

People have used ephedra for centuries in China for colds, fever, flu, headaches, asthma, nasal congestion, and wheezing.

The U.S. Food and Drug Administration (FDA) banned the sale of dietary supplements containing ephedrine alkaloids (compounds found in some ephedra species) in the United States in 2004. It was an ingredient in some dietary supplements marketed for weight loss, increased energy, and enhanced athletic performance.

The dried stems and leaves of the ephedra plant have been used to create capsules, tablets, extracts, and teas.

How Much Do We Know?

A large amount of research led to ephedrine alkaloids becoming main oral asthma medications in the 1940s and 1950s. Ephedra also has been used as a weight-loss agent and energy enhancer for athletic performance. However, the increasing number of reported adverse events caused the FDA to ban dietary supplements that contain ephedrine alkaloids.

What Have We Learned?

According to the FDA, there is little evidence of ephedra’s effectiveness, except for short-term weight loss. However, the increased risk of heart problems and stroke outweighs any benefits.

What Do We Know About Safety?

The FDA banned the U.S. sale of dietary supplements containing ephedrine alkaloids. It found that these supplements had an unreasonable risk of injury or illness—particularly cardiovascular complications—and a risk of death. The ban does not apply to traditional Chinese herbal remedies.

Using ephedra may worsen many health conditions such as heart disease and kidney disease. Ephedra has been associated with stroke. It also may contribute to increased blood sugar levels.

Ephedra may intensify or cause seizures in people with seizure disorders.

Taking ephedra may also cause anxiety, dizziness, difficulty urinating, dry mouth, headache, irritation of the stomach, nausea, psychosis, restlessness, sleep problems, and tremors. Some of these side effects may be associated with long-term use of ephedra.

Women who are pregnant or breastfeeding and children should avoid taking ephedra.

Ephedra use may lead to serious health problems when used with other dietary supplements or medicines.

Combining ephedra with caffeine increases the risk of potentially serious side effects.

Keep in Mind

Tell all your health care providers about any complementary or integrative health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Key References

  • Ephedra. In: Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:110-117.
  • Ephedra. Natural Medicines Web site. Accessed at naturalmedicines.therapeuticresearch.com on April 1, 2015.
  • Fleming RM. Safety of ephedra and related anorexic medications. Expert Opinion on Drug Safety. 2008;7(6):749-759.
  • Kim EJ, Chen Y, Huang JQ, et al. Evidence-based toxicity evaluation and scheduling of Chinese herbal medicines. Journal of Ethnopharmacology. 2013;146(1):40-61.
  • Lee MR. The history of ephedra (ma-huang). Journal of the Royal College of Physicians of Edinburgh. 2011;41(1):78-84.
  • Manore MM. Dietary supplements for improving body composition and reducing body weight: where is the evidence? International Journal of Sport Nutrition and Exercise Metabolism. 2012;22(2):139-154.
  • Rasmussen CB, Glisson JK, Minor DS. Dietary supplements and hypertension: Potential benefits and precautions. Journal of Clinical Hypertension. 2012;14(7):467-471.
  • Thurn AL, Betz JM. Ephedra. In: Coates P, Betz JM, Blackman MR, et al., eds. Encyclopedia of Dietary Supplements. 2nd edition. New York, NY: Informa Healthcare; 2010:250-255.
  • U.S. Food and Drug Administration. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk. Federal Register. 2004;69(28):6788-6854.
  • Yen M, Ewald MB. Toxicity of weight loss agents. Journal of Medical Toxicology. 2012;8(2):145-152.

-NIH



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