May 6, 2006
Q: The ephedra ban has been lifted. What is ephedra and is it safe or dangerous? - Layperson
A: These terms are used to refer to the same substance derived from the plant Ephedra. (There are many common names for these evergreen plants, including squaw tea and Mormon tea.) Ephedra is a shrub-like plant that is found in desert regions in central Asia and other parts of the world. The dried greens of the plant are used medicinally. Ephedra is a stimulant containing the herbal form of ephedrine, an FDA-regulated drug found in over-the-counter asthma medications.
Ephedra (Ephedra sinica), also known as Ma-Huang, is an herbal stimulant drug composed of two active compounds (pseudoephedrine and ephedrine) that are ingredients in many over-the-counter products. The FDA regulates ephedrine, the synthesized form of ephedra. Ephedrine can be produced by chemical synthesis and in its pure form (ephedrine sulfate) is a bitter tasting, white, crystalline powder. Ephedrine and pseudoephedrine stimulate the opening of air passages in the lungs and are used as decongestants for the short-term treatment of asthma, bronchitis, and certain allergic reactions. Ephedrine and pseudoephedrine are also used in dietary supplements that claim to promote weight loss and enhance athletic performance. The active compounds are structurally related to amphetamines; they play similar, although less potent, roles in stimulating the central nervous system. Ephedrine is often the primary ingredient found in illegally synthesized drugs, including methamphetamines.
Ephedra is a genus of gymnosperm shrubs, the only genus in the family Ephedraceae and order Ephedrales. These plants occur in dry climates over a wide area mainly in the Northern Hemisphere, across southern Europe, north Africa, southwest and central Asia, southwestern North America, and, in the Southern Hemisphere, in South America south to Patagonia. They are also called Joint-pine, Jointfir, or Mormon-tea. The Chinese name is ??, má huáng, which means "yellow hemp". Ephedra is also sometimes called sea grape (from the French raisin de mer), although that is also a common name for Coccoloba uvifera.
The following list of species is from the Gymnosperm Database page for Ephedra.
The Chinese botanical ephedra, or ma-huang, is sold as a dietary supplement in the United States. Ephedra is the common name for three principal species: Ephedra sinica, Ephedra equisentina, and Ephedra intermedia. The active compounds in the plant's stem (about 1.32% by weight) are the phenylalanine-derived alkaloids ephedrine, pseudoephedrine, phenylpropanolamine (norephedrine), and cathine (norpseudoephedrine).
Alkaloid content and composition vary by species and growth conditions; total alkaloid content can vary from 0.5% to 2.3%. Ephedrine, the most potent alkaloid, can account for up to 90% of the total alkaloid content and pseudoephedrine can account for up to 27%. The pharmacologic activity of an ephedra sample depends on its alkaloid composition. North American ephedra species, such as E. nevadensis (known as Mormon tea), contain little or no ephedrine or other alkaloids.
Ephedrine is a mixed sympathomimetic agent that enhances the release of norepinephrine from sympathetic neurons and stimulates alpha and beta receptors. Ephedrine stimulates heart rate, thereby increasing cardiac output. It causes peripheral constriction resulting in an increase in peripheral resistance that can lead to a sustained rise in blood pressure. It relaxes bronchial smooth muscle and is used as a decongestant and for temporary relief of shortness of breath caused by asthma.
Ephedrine acts as a stimulant in the central nervous system. Of the ephedra alkaloids, ephedrine is the most potent thermogenic agent. It may function as an anorectic by acting on the satiety center in the hypothalamus.
Persons with a known allergy to ephedra, ephedrine or pseudoephedrine (Sudafed®) should avoid ephedra.
Some people may experience abdominal discomfort (nausea, vomiting, diarrhea, loss of appetite, constipation), anxiety, dizziness, headache, tremor, insomnia, dry mouth, delirium, or fainting. Ephedra may also cause irritability, euphoria, hallucinations, seizures, or stroke, as well as low potassium levels in the blood, exaggerated reflexes, weakness, muscle aches, muscle damage, depression, mania, agitation, suicidal ideas, or Parkinson's disease-like symptoms. Persons with prior strokes or transient ischemic attacks (TIAs/"mini-strokes"), tremor, or insomnia should avoid ephedra. Individuals with a history of a psychiatric illness, especially if treated with monoamine oxidase inhibitors (MAOIs), must first discuss ephedra with a qualified healthcare provider before taking supplements. Examples of MAOIs include isocarboxazid (Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®).
Ephedra can cause chest tightness, irregular heart rhythms, damage to the heart muscle, high blood pressure, heart attack, inflammation of the heart, fluid retention in the lungs, breathing difficulties, dilated cardiomyopathy left ventricular systolic dysfunction, coronary dissection, thrombosis, or cardiac arrest. Ephedra should be used with extreme caution in persons with a history of heart disease, heart rate disorders, or high blood pressure. Other side effects may include liver damage, kidney stones, difficulty passing urine or pain when urinating, increased urine production, or contractions of the uterus. These potential effects may limit the use of ephedra by people with kidney disease or enlarged prostate. Individuals with thyroid gland disorders or glaucoma should use ephedra cautiously. In theory, ephedra may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a qualified healthcare provider, and medication adjustments may be necessary.
When used for prolonged periods, even at recommended doses, ephedra may lead to weight loss, difficulty sleeping, anxiety, obsessive compulsive disorder (OCD) flare, high blood pressure, dry mouth, irregular heart rhythms, and heart damage.
It has been recommended that ephedra, Ma huang, use be stopped at least one week prior to major surgical or diagnostic procedures.
Pregnancy & Breastfeeding
Ephedra should not be used during pregnancy, due to risks to the mother and fetus. Ephedrine crosses the placenta, and has been found to increase fetal heart rate. Ephedra may induce uterine contractions.
Ephedra should not be used during breastfeeding, due to risks to the mother and child. Ephedrine crosses into breast milk and has been associated with irritability, crying, and insomnia in infants.
Food Drug Interactions: MAO inhibitors, digoxin, caffeine, over-the-counter cold remedies,
Containdication to Use: Allergies, Pregnancy/Nursing, Grave's Disease(hyperactive thyroid),
Diabetes, high blood pressure, heart disease, liver disease, obesity, and prostate disease
With proper precautions as mentioned above, ephedra is relatively safe. Consult the appropriate healthcare professional knowledgeable in the use of ephedra.
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DISCLAIMER: The information in this column, is NOT intended to diagnose and/or treat any health related issues and is provided solely for informational purposes only. Consult the appropriate healthcare professional before making any changes to your healthcare regime. Even what may seem like simple changes in the diet for example, can interact with, and alter, the efficiency of medications and/or the body's response to the medications. Many herbs and supplements exert powerful medicinal effects. Neither the author, nor the website designers, assume any responsibility for the reader's use or misuse of this information.