Ephedra Side Effects and Warnings

Safety Issues

While ephedra is an herb with a long history of use in Chinese herbal medicine, Chinese tradition attaches numerous warnings: It should only be used by very robust people, for certain specific purposes, and only for a short period of time. These ancient warnings seem to have been disregarded in the transition of ephedra use from Asia to the United States, where it is now often sold for continuous use by overweight, relatively unhealthy people. Herbal products containing ephedra caused the majority (64%) of reported adverse effects from herbs in the US. This proportion is particularly impressive given that less than 1% of all herbal products sold in the US contain ephedra. On a per-use basis, for example, ephedra has 720 times the risk of causing harm as ginkgo biloba.

There are many reasons for this high rate of risk. While it is possible for healthy individuals under physician supervision to use ephedrine or ephedrine/caffeine combinations safely, in individuals with heart disease, and even occasionally in those with no known heart conditions, ephedrine can cause serious disturbances of the heart rhythm and possibly sudden death; strokes have also occurred. ¹ Use of herbal ephedra, as opposed to ephedrine, may present additional dangers. As noted above, there is no ready way to be sure of the dose of the drugephedrine you are getting when you purchase the herbephedra, creating potential risk of overdosage. In addition, some ephedra products contain potentially more toxic chemicals related to ephedrine, such as (+)-norpseudoephedrine. ² Besides heart problems and strokes, use of ephedra has been associated with severe inflammation of the liver (in at least one case requiring a liver transplant) ³ and of the heart. ⁴ In these cases, it appears likely that ephedra (or an unidentified contaminant in the herb) triggered an autoimmune reaction.

In addition, people taking ephedra or ephedrine may develop an unusual form of kidney stones that actually contain ephedrine. ⁵ Temporary psychosis has also been linked to use of ephedra. ⁶ Finally, there are indications that certain preparations of ephedra may be toxic to the nervous system. ⁷ Based on the known risks of ephedrine, ⁸ as well as the evidence described above, ephedra should definitely not be taken by a person with:

• Cardiovascular disease, including:

• Angina
• Abnormalities of heart rhythm
• Hardening of the arteries
• High blood pressure
• High cholesterol
• Intermittent claudication
• History of stroke
• Enlargement of the prostate
• Diabetes
• Hepatitis
• Myocarditis
• Vasculitis
• Diseases of the nervous system
• Glaucoma
• Hyperthyroidism

Ephedra may be particularly risky for:

• Young children
• Pregnant or nursing women
• People with kidney disease
• People with liver disease

Furthermore, one should never combine ephedra with monoamine-oxidase inhibitors (MAO inhibitors), such as Nardil (phenelzine), or fatal reactions may develop.

Interactions You Should Know About

If you are taking:

• MAO inhibitors : Do not take ephedra.
• Any stimulant drugs (including caffeine): Do not take ephedra except under physician supervision.