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Ephedra Herb Description - Drug Interactions, Dosage and Some of its Useful Properties

Taxonomic Class

Ephedraceae

Common Trade Names

Multi-ingredient preparations: Herbal Fen-Phen, Power Trim, Ultimate Energizer, Up Your Gas

Common Forms

Available as crude extracts of root and aerial parts, powders, tablets (about 7 mg), and teas.

Source

There are many species of ephedra, the most common being Ephedra siniea (ma huang) and E. nevadensis. Other forms include E. trifurea, E. equisetina, and E. distaehya. The ephedras are evergreen plants with a pinelike odor. Pharmaceutical properties result from components in the seeds and stems.

Chemical Components

The primary active ingredient is the alkaloid ephedrine. Not all ephedra species contain ephedrine, but of those that do, most contain 0.5% to 2.5% alkaloids. E. equisetina contains the most ephedrine, whereas the American species, E. nevadensis and E. trifurea, lack the agent. Other alkaloids commonly found in ephedra species include methylephedrine, methyl pseudoephedrine, pseudoephedrine, norpseudoephedrine (cathine), norephedrine, ephedine, ephedroxane, and pseudoephedroxane. Other compounds include a volatile oil (varies in components, depending on source), ephedrans, catechin, gallic acid, tannins, flavonoids, inulin, dextrin, starch, pectin and some common plant acids, sugars, and trace minerals. The root contains ephedradines, feruloylhistamine, moakonine, and mahuannins. The woody stems contain the alkaloids, which are almost always absent from the fruit and root.

Actions

Most of ephedra's activity stems from the ephedrine component, which produces amphetamine-like actions. Ephedrine acts as a CNS stimulant, produces mydriasis, enhances myocardial contraction and increases heart rate, causes bronchodilation, decreases GI motility, and stimulates peripheral vasoconstriction with an associated elevation in blood pressure. Pseudoephedrine is similar in adrenergic activity but less potent than ephedrine. It also possesses stronger diuretic properties than ephedrine. A Chinese abstract reports that the agent can preserve renal function and correct certain electrolyte imbalances in rats . E. altissima yields several mutagenic N-nitrosamines in vitro. The significance of this finding is unclear. Transitorine, a component of E. transitoria, has demonstrated antibacterial properties against some common bacteria .

Reported Uses

Ephedra has been used in Chinese medicine for several years for arthralgia, bronchial asthma, chills, colds, coughs, edema, fever, flu, headaches, and nasal congestion. In the West, it is commonly used for its CNS stimulant properties ("natural ecstasy") and as an appetite suppressant ("natural fenphen"). There is little debate that the vasoconstrictive effects of ephedra (primarily from ephedrine and pseudoephedrine) may be useful in conditions marked by edematous tissues and congested membranes. Standardized pharmaceuticals that contain pseudoephedrine or phenylpropanolamine are preferred to crude ephedra products.

Dosage

American species of ephedra (E. nevadensis and E. trifurea) that do not contain ephedrine alkaloids are used for teas. Herbalists typically recommend placing 1/2 oz of dried branches in 1 pt of boiling water and steeping this mixture for 10 to 20 minutes.

Adverse Reactions

• CNS: anxiety, confusion, dizziness, headache, insomnia, nervousness, psychosis, restlessness, seizure, CVA.

• CV: arrhythmias, cardiac arrest, hypersensitivity myocarditis myocardial infarction.

• GI: constipation (caused by tannin content).

• GU: urine retention, uterine contractions.

• Skin: exfoliative dermatitis.

Interactions

• Beta blockers: May increase sympathomimetic effects on vasculature from unopposed alpha agonist effect, increasing risk of hypertension. Avoid administration with ephedra.

• Ephedra alkaloids, MAO inhibitors: May increase risk of hypertensive crisis. Avoid administration with ephedra.

• Phenothiazines: May block alpha effects of ephedra, causing hypotension and tachycardia. Avoid administration with ephedra.

• Theophylline: May increase risk of GI and CNS adverse effects. Avoid administration with ephedra.

Contraindications And Precautions

Ephedra is contraindicated in pregnant patients because of the risk of uterine stimulation and in diabetic patients because of its hyperglycemic effects. Use cautiously in patients with arrhythmias, angina and other cardiac disorders, hypertension, and prostatic enlargement and in those with a history of cerebrovascular disease.

Special Considerations

Alert: The FDA advises people using the herb to take less than 8 mg every 6 hours and no more than 24 mg daily. They further advise that ephedra products not be used for more than 7 consecutive days.

Some ephedra-related adverse effects appear to be dose-related.

Closely monitor younger patients taking ephedra for adverse reactions. Many of the heart attacks, seizures, and strokes reported to the FDA occurred in previously healthy young adults.

Alert: The FDA has found more than 800 cases, including 17 deaths, from adverse reactions associated with ephedrine products.

• Monitor the patient for behavioral or mood changes.

• Recommend standard pharmaceutical formulations of ephedrine and pseudoephedrine for patients with a valid need for these compounds.

• Advise the patient with cardiac disease, diabetes, hypertension, or prostatic enlargement to avoid using ephedra.

• Advise the diabetic patient to monitor his blood glucose level closely.

• Caution the patient to watch for adverse reactions (especially chest pain, dizziness, fainting, palpitations, and shortness of breath), and advise him to quickly seek medical attention if they occur.

• Some herbal mixtures may contain ma huang or ephedra as one of many ingredients. The alkaloids contained in ma huang may be considered "banned substances" within specific guidelines put forth by collegiate, Olympic, or professional sports committees for competitive play.

• Advise the patient to take less than 8 mg of ephedra every 6 hours and not to exceed 24 mg daily. Also, stress that it is not wise to use the product for more than 7 consecutive days .

• Urge the patient to avoid ephedra combination products that contain caffeine or guarana.

points of Interest

The FDA has issued warnings against the use of ephedra as an appetite suppressant and advises that ingestion more than the recommended amount can result in heart attack, seizure, stroke, or death. The FDA prohibits the marketing of ephedrine with other CNS stimulants, such as caffeine and yohimbine.

Commentary

Unquestionably, the principal components in some ephedra species can playa valid role in medicine, especially in the treatment of edema and congestion. With standardized formulations of the active constituents available OTC and because of the dramatic variability in ephedra content seen with dietary supplements, the ingestion of the herbal product seems unwarranted.