Ephedra
OTHER NAME(S): Chinese ephedra, ephedra, Ephedra sinica, ma huang
Overview
Ephedra refers to a plant called Ephedra sinica. Due to serious safety concerns, the FDA banned the sale of any products containing ephedra in 2004. Common side effects of ephedra include dizziness, headache, fast heartbeat, nausea, vomiting, nervousness, upset stomach, and trouble sleeping. Serious side effects are less common but include high blood pressure, heart attack, stroke, liver damage, and seizures. Any benefits of ephedra are not expected to outweigh its risks. Before using an ephedra product, make sure to tell your health care provider about any health conditions you have or medicines you are taking.
Uses
What is ephedra used for?
Ephedra (Ephedra sinica) may be used for various reasons, but its benefits for any use are not well defined. It can also cause serious health problems.
Note: The FDA prohibits the sale of products that contain ephedra. The FDA does not consider ephedra to be a legal dietary ingredient in the U.S. Learn more about the legal status of ephedra here.
How does ephedra work (mechanism of action)?
Ephedra refers to a plant called Ephedra sinica. The stems and roots of the plant are used in the traditional medicine system in China, where ephedra is known as ma huang. This plant contains chemicals known as ephedrine alkaloids, which have stimulant-like effects in the body.
Before 2004, ephedra was available in the U.S. in the form of dietary supplements. Many of these products were marketed as energy boosters, as well as for weight loss and physical performance. But due to serious safety concerns, the FDA banned the sale of all products containing ephedra. See the Side Effects section for more information.
Herbal products, such as ephedra, naturally contain many different chemicals. The amounts of each chemical in a specific ephedra product may vary. Some, none, or all of these chemicals may have certain effects on the body. These effects may change depending on how much of each chemical is found in the product you are using.
How should I store ephedra?
You should store ephedra according to the product label. Most natural ingredients should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.
Side Effects
What are the most common side effects of ephedra?
The most common side effects of ephedra are listed below. These side effects may vary depending on the dose you are taking or the specific product you are using. Tell your health care provider if you have any of these side effects that bother you.
- Diarrhea
- Dizziness
- Headache
- Fast heartbeat
- Nausea or vomiting
- Nervousness or anxiety
- Upset stomach
- Trouble sleeping (especially if you take it later in the day or close to bedtime)
There may be other side effects of ephedra that are not listed here. Contact your health care provider if you think you are having a side effect. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of ephedra?
While less common, the most serious side effects of ephedra are described below, along with what to do if they happen.
Severe Allergic Reactions. Ephedra may cause allergic reactions, which can be serious. Stop taking ephedra and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching or skin rash
- Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Heart Attack and Stroke.Ephedra can increase your risk of a heart attack or stroke that can lead to death. This risk is higher in people who already have heart disease, who use high doses of ephedra, or who do heavy physical activity. Get emergency help if you have any of the following symptoms of a heart attack or stroke.
- Chest pain or pressure
- Fast or abnormal heartbeat
- Trouble breathing
- Pain in your back, jaw, throat, or arm
- Sweating, upset stomach, vomiting, or dizziness
- Sudden weakness on one side of your body
- Sudden and severe headache
- Slurred speech or trouble understanding speech
Increased Blood Pressure (Hypertension). Ephedra may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while taking this medicine.
If you measure your blood pressure and the top number (systolic) is 180 or higher or the bottom number (diastolic) is 120 or higher, get medical attention right away. Increases in blood pressure may not be noticeable, but look out for and tell your health care provider right away if you have any of the following symptoms of severely high blood pressure.
- Sudden severe headache
- Chest pain
- Dizziness or confusion
- Trouble breathing
- Nausea or vomiting
- Blurry or other changes to vision
- Anxiety
- Buzzing in the ears
- Nosebleed
- Feeling of skipped heartbeats
Liver Damage.Liver damage, also called hepatotoxicity, can happen when taking ephedra. Call your health care provider right away if you have any of the following symptoms of liver damage.
- Nausea or vomiting
- Stomach or belly pain
- Fever
- Weakness or unusual tiredness
- Itching
- Loss of appetite
- Light-colored poop
- Dark-colored urine (pee)
- Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
Seizures.Some people who have taken ephedra have had seizures. This may be more likely to happen in people who take high doses of ephedra or who have a history of seizures. There are many different types of seizures, and some of them are not easy to recognize. Stop taking ephedra and call your health care provider if you have any of the following signs that a seizure is happening or could happen.
- Muscle twitching, jerking, spasms, tremors, or other uncontrolled movements
- Stiffening of your arms and legs
- Feeling anxious, nervous, confused, or a sense of dread
- Feeling dizzy or lightheaded
- Falling or losing consciousness
Precautions
Who should not use ephedra?
Allergies to Ingredients. People who are allergic to any of the following should not take ephedra.
- Ephedra
- Ephedra sinica
- Ma huang
- Any of the ingredients in the specific product
Ask your health care provider if you are not sure what ingredients are in an ephedra product.
What should I know about ephedra before using it?
The U.S. federal government has banned the sale of any products containing ephedra due to serious safety concerns. However, ephedra products and products containing ephedrine alkaloids may still be available for purchase online. Ephedra products that are purchased online are not regulated and have not been tested to see if they contain the ingredients mentioned on labels.
Keep ephedra out of the reach of children.
Herbal products, such as ephedra, naturally contain many different chemicals. The amount of each chemical in a specific ephedra product can change for many reasons, including the area where the plant was grown, the weather during growth, the time of year it was harvested, and the way the plant was processed after being harvested. If you switch to a new bottle or a different brand, you may not have the same effects or side effects because of this variability. Talk to your health care provider if you have questions or concerns.
What should I tell my health care provider before using ephedra?
Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and supplements you are using. This will help them know if ephedra is right for you.
In particular, make sure that you discuss any of the following.
Current and Past Health Conditions.Tell your health care provider if you have any of the following.
- Anxiety
- Heart disease
- Heart rhythm problems
- High blood pressure
- Liver problems
- Mental health problems, including psychosis, mania, paranoia, or suicidal thoughts
- Raynaud’s disease
- Seizures
Other Medicines and Supplements.Ephedra may interact with other medicines and supplements. Before taking ephedra, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and supplements you are using. See the Interactions section for more details.
Pregnancy. It is not known if or how ephedra could affect pregnancy or harm a fetus. However, there is some concern that ephedra may increase the risk of a miscarriage. Tell your health care provider if you are pregnant or plan to become pregnant.
Breastfeeding. It is not known if ephedra passes into breast milk, but ephedra may make it harder for you to produce milk. Also, ephedra can cause harm to an infant or small child. Tell your health care provider if you are breastfeeding or plan to breastfeed.
Interactions
Does ephedra interact with foods or drinks?
Ephedra can have stimulant-like effects. Taking ephedra with caffeine, which is also a stimulant, may increase the risk of side effects. Caffeine is found in many common foods and drinks, such as coffee, tea, soda, chocolate, and some protein bars.
It is unknown if drinking alcohol will affect ephedra, but drinking alcohol while taking ephedra may increase your risk for side effects. It is best to limit the amount of alcohol that you drink.
Does ephedra interact with medicines (drug interactions)?
Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before taking ephedra.
- A medicine for high blood pressure
- A monoamine oxidase inhibitor (MAOI) within the past two weeks, which is a medicine usually used for depression or Parkinson’s disease
- A stimulant, such as amphetamine, lisdexamfetamine, or methylphenidate, which is a medicine commonly used to treat attention deficit hyperactivity disorder (ADHD)
- Any product that contains caffeine, which is often found in medicines or supplements for reducing water weight (diuretics), staying awake, relieving headaches, and managing hangovers
- Theophylline (Elixophyllin, Theo-24), which is a medicine for asthma or certain other breathing problems
The interactions between ephedra and medicines are not fully understood. As with most natural ingredients, the research on drug interactions with ephedra is incomplete. Always check with your health care provider before taking ephedra with any medicines.
Dosing
What should I do if I accidentally use too much ephedra?
If you or someone else has used too much ephedra, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
Products containing ephedra have been banned in the U.S. due to serious safety concerns. However, ephedra products can still be purchased online. If you purchase an ephedra product, read the product label closely and speak with a health care provider about how to use ephedra safely. Do not use double or extra doses, even if you miss a dose.
References
- Clinical Pharmacology and Therapeutics: “Interaction of ephedrine and theophylline.”
- Health Psychology Research: “Clinically relevant drug interactions with monoamine oxidase inhibitors.”
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]: “Ephedra.”
- National Cancer Institute NCI Dictionary of Cancer Terms: “Ephedra.”
- National Center for Complementary and Integrative Health: “Ephedra.”
- National Institutes of Health Office of Dietary Supplements: “Ephedra,” “Ephedra and Ephedrine Alkaloids for Weight Loss and Athletic Performance Fact Sheet for Health Professionals.”
- Operation Supplement Safety: “Ephedra: Unsafe and illegal in dietary supplements.”
- United States General Accounting Office: “Dietary Supplements Containing Ephedra: Health Risks and FDA’s Oversight.”
- World Health Organization (WHO): “Hypertension.”