In February of 2004, the Food and Drug Administration (FDA) issued a final rule prohibiting the sale of dietary supplements containing ephedrine alkaloids (ephedra). Also known as Ma huang, the FDA has determined such supplements pose an unreasonable risk of illness or injury to consumers and the rule is effective 60 days from the date of publication.
The FDA’s final puts manufacturers on notice that dietary supplements containing ephedrine alkaloids present an unreasonable risk of illness or injury. Consequently, this ruling affects all currently marketed dietary supplements containing ephedrine alkaloids. The extent of the rule does not pertain to traditional Chinese herbal remedies. Affected are all dietary supplements that contain a source of ephedrine alkaloids, such as ephedra, Ma huang, Sida cordifolia and pinellia.
Ephedra, or ephedrine sulfate, is a naturally occurring substance derived from plants. Its principal active ingredient is ephedrine, which when chemically synthesized is regulated as a drug under the Federal Food, Drug, and Cosmetic Act. In recent years ephedra products have been widely promoted to boost weight loss, sports performance, and energy. In addition, ephedra is enormously popular with dieters because it suppresses appetite and boosts energy. It is known under many names including Desert or Mormon tea.
Ephedra’s active medicinal ingredients are the alkaloids ephedrine and pseudoephedrine. Both ephedrine and its synthetic counterparts stimulate the (CNS) central nervous system, dilate the bronchial tubes, increase blood pressure, and heart rate. Pseudoephedrine (the synthetic form) is a popular over-the-counter remedy for nasal congestion.
Ephedra is listed as one of the original 365 herbs from the classical first century A.D. text on Chinese herbalism by Shen Nong. The Chinese have used ephedra medicinally for over 5,000 years. While the active constituent, ephedrine, was first isolated in 1887, it was not until 1924 that the herb became popular with physicians in the U.S. for its broncho-dilating and decongesting properties.
Popular in China, ephedra is known as Tsaopen-Ma Huang. Its active ingredient, ephedrine, is the main component in the well-known asthma remedy Primatene. Ephedra grows mainly in Mongolia and the bordering area of China.
Ephedra is used as a stimulant and for mild respiratory disorders, including asthma and bronchitis. In Asian medicine, it is used for fever, swelling, and bone pain. Ephedrine, the principle alkaloid, a popular ingredient in many “herbal” weight loss and body building formulas, decongestants, “legal high” alternatives, and ephedrine-based pep pills.
Ephedra is available in crushed herb form, tinctures, and as a liquid extract. Be sure to follow manufacturer directions as potencies vary.
General guidelines for adults are as follows:
Tea: Use 1 to 4 grams of crushed Ephedra; take 3 times daily.
Liquid extract: 1 to 3 milliliters (about one-quarter to one-half teaspoonful) 3 times daily.
Tincture (1:1): The usual single dose is 5 grams (1 teaspoonful).
Tincture (1:4): 6 to 8 milliliters (about 1 to 11/2 teaspoonfuls) 3 times daily.
Do not exceed the manufacturer’s recommended dosage because ephedra can be very harmful to your health.
Ephedra’s value for respiratory problems derives from the calming effect it has on spasms in the bronchial walls. At the same time, ephedra stimulates the nervous system, and boosts the rate and strength of heart contractions. It also tends to discourage the growth of bacteria.
Ephedra has many potential side effects including sleeplessness, restlessness, irritability, headache, nausea, vomiting, urinary disorders, and rapid heartbeat. Higher doses can stimulate a sharp rise in blood pressure and disrupt heart rhythm.
Chronic use can lead to tolerance and dependence, requiring ever larger doses to obtain earlier effects. Due to these dangers, ephedra should only be used for short periods of time.
Combining ephedra with certain other drugs can increase, decrease, alter the effects, and induce potentially serious problems. Ephedra should not be combined with:
*heart drugs such as digitalis or digoxin (Lanoxin) because ephedra is more likely to disturb heart rhythm.
*the blood pressure medication guanethidine (Ismelin)as ephedra can seriously magnify the herb’s stimulative effects.
*drugs classified as MAO inhibitors, such as the antidepressants Nardil and Parnate and the Parkinson’s disease medication Eldepryl.
*ergot-based migraine drugs such as Ergomar and Wigraine with Ephedra can induce high blood pressure.
Because of its effect on the heart, ephedra can be very dangerous when taken in excessive amounts.
Do not take ephedra if you have high blood pressure, glaucoma, weakened blood vessels in the brain, prostate cancer, an overactive adrenal gland, or a thyroid disorder. It’s generally wise to avoid ephedra if you have any condition that makes you anxious or restless.
Adverse CNS effects associated with ephedrine toxicity include anxiety, insomnia, restlessness, psychosis and seizures. The major cardiovascular toxicity includes hypertension and tachyarrhythmias. If you experience any of these symptoms, seek medical attention immediately. According to the New England Journal of Medicine, a number of deaths resulting from symptoms of ephedra toxicity have been reported.
Ephedra’s toxic effects are primarily due to ephedrine, and to a lesser extent, pseudoephedrine. Both stimulate the adrenergic system and ephedrine toxicity may be noticeable with doses only 2 to 3 times the therapeutic range.
Doses of more than 100 grams (about 3 ounces) can be life-threatening. Symptoms of overdose include severe sweating, enlarged pupils, spasms, and increased body temperature. Death results from heart failure and suffocation.
If you suspect an overdose, seek emergency treatment immediately.
According to a recent report on 20/20, many ephedra fans believe it is not a drug because the active ingredient comes from a plant. However, ephedra is a stimulant that increases the heart rate, blood pressure, and speeds up brain activity. There is little doubt ephedra is addictive or habit forming, particularly due to the ever increasing number of people taking it in high dosages, however unwittingly.
Extended use can lead to tolerance and dependence, requiring ever increasing doses to obtain an effect. Due to these dangers, you should only take ephedra for short periods of time.
Tolerance is a diminished response to a drug. It is the effect of cellular adaptive changes or enhanced drug metabolism that develops over days, weeks, or months from the extended use of a medication. Ephedra users are susceptible to tolerance.
If you have been a long term ephedra user, and/or taking larger quantities than recommended by the manufacturer, consult your physician to help you discontinue this medication in a careful and safe manner.
If you are a long term ephedra user, do not stop taking it without first checking with your doctor. Suddenly stopping this medicine may cause dangerous withdrawal side effects; your doctor will gradually taper your dosage before stopping completely.
A moderate to severe addiction may necessitate an in patient detox in a hospital or medical supervised setting. Treatment will ultimately depend on the degree of addiction.
However a person chooses to free themselves from the clutches of a drug, there is one constant each needs: Support. Narcotics Anonymous remains a successful choice for many addicts, with world-wide availability. The “information age” has produced numerous on line support forums, popular with many recovering addicts, useful to some addicts as their sole means of support and for others, as adjunct therapy. Drug addiction is treatable, with help out there for everyone.