ephedra

n.

1. Any of various gymnospermous, mostly shrubby plants of the genus Ephedra, some of which are used as a source of ephedrine.
2. A stimulant, often sold as pills or tablets, derived from a plant of this genus.

[Latin ephedra, horsetail, from Greek ephedrā, from feminine of ephedros, sitting upon : ep-, epi-, epi- + hedrā, seat.]

Español:
• Efedra, Ma huang en sus formas de dosificación oral

Ephedra, Ma Huang oral dosage forms

What are ephedra, Ma huang oral dosage forms?

EPHEDRA, MA HUANG is a dietary supplement (herbal remedy). Ephedra is usually promoted for weight loss and boosting energy. However, there is no FDA-approved medical use for this herb at this time. Most products that contain Ephedra, Ma Huang (ephedrine) also contain other herbal products. Many products also contain caffeine or herbal sources of caffeine (like guarana or kola nut). The safety and effectiveness of these combination products have not been established. NOTE: The FDA has alerted the public in December 2003 that dietary supplements containing ephedra present an unreasonable health risk of illness or injury. Consumers are urged to stop buying and using these products immediately. The FDA intends to ban the sale of Ephedra products by March 2004. Ephedra, Ma huang is available from many different manufacturers of dietary supplements.

What should I tell my health care provider before I take this medicine?

It is important for you to tell your prescriber or other health care professional that you are using ephedra, Ma huang. Some herbs exert potent effects and may interact with other drugs you are taking.

You should discuss ephedra, Ma huang with your health care professional BEFORE taking it if you have any of these conditions:
• angina or chest pain
• asthma or other lung disease
• blood vessel disease
• diabetes
• difficulty sleeping
• eating disorder like anorexia or bulimia
• glaucoma
• heart disease
• hepatitis
• high blood pressure
• irregular heart rhythm
• kidney disease
• liver disease
• mental health problems like anxiety, depression or psychosis
• overactive thyroid
• overweight and taking prescription medications for weight loss
• phenylketonuria
• pheochromocytoma
• prostate trouble
• seizures or convulsions
• trouble with urination
• an unusual or allergic reaction to ephedra, Ma huang, ephedrine, pseudoephedrine, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I take this medicine?

Talk to your health care professional prior to taking ephedra or products that contain ephedra or Ma huang. Ephedra, Ma huang is usually taken by mouth (swallowed). If ephedra, Ma huang upsets your stomach, you may want to take each dose with food. Take each dose with a large glass of water.

Ephedra, Ma huang is not for long-term use without the advice of a health care professional. The dosing suggested by manufacturers of ephedra, Ma huang may not be safe in some patients. Get advice from a health care professional regarding the dosing of Ephedra, Ma huang.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What drug(s) may interact with ephedra, Ma huang?

Do not take ephedra, Ma huang with any of the following medications:
• medicines called MAO inhibitors-phenelzine (Nardil®), tranylcypromine (Parnate®), isocarboxazid (Marplan®), selegiline (Eldepryl®)

Ephedra, Ma huang may also interact with the following medications:
• acetazolamide
• alcohol
• atropine
• caffeine
• cocaine
• corticosteroids, such as prednisone or methylprednisolone
• creatine
• digoxin
• ephedrine
• ergot alkaloids, such as ergotamine
• guarana or kola nut
• linezolid
• medicines for colds and breathing difficulties, such as pseudoephedrine
• medicines for mental depression
• medicines for heart disease or high blood pressure
• methazolamide
• oxytocin
• prescription stimulants or medicines for weight loss, like dextroamphetamine, diethylpropion, fenfluramine, phendimetrazine and sibutramine
• sodium bicarbonate
• theophylline
• thyroid hormones, such as levothyroxine

For many herbs, interactions with other medications are unknown. That is why you should always be careful when mixing herbal remedies with traditional medications. If you take any other medications or herbs, consult with your health care professional prior to taking ephedra, Ma huang.

Tell your prescriber or health care professional about all other medicines you are taking, including nonprescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check before starting or stopping any of your medicines.

What should I watch for while taking ephedra, Ma huang?

Although you can buy ephedra, Ma Huang without a prescription, check with your health care professional prior to taking ephedra. You may have a condition that might make it dangerous for you to take ephedra, Ma huang in any amounts.

Allergic reactions are possible with ephedra, Ma huang since it comes from a plant. Stop using this herb if you develop a rash or other unusual effects and contact your health care professional.

If ephedra, Ma huang makes it difficult for you to sleep at night, take your last dose a few hours before bedtime, or talk to your health care professional. You may need to stop taking ephedra, Ma huang.

Avoid consumption of caffeine-containing products, such as colas, coffee, tea and chocolate while taking ephedra, Ma huang. Many ephedra herbal products for weight loss also contain caffeine or herbal sources of caffeine (examples: guarana and kola nut). Excessive intake of caffeine may cause nervousness, nausea, fast heartbeat, irritability or other side effects. You should avoid strenuous exercise if you have been taking ephedra, Ma huang.

It is recommended that you avoid excessive consumption of alcoholic beverages while taking ephedra, Ma huang. Alcohol may increase the risk of serious side effects.

The long-term effectiveness of ephedra supplements in weight loss is not well established. Additionally, serious adverse effects have occurred even with short-term use of ephedra, even in otherwise healthy persons. There is no way to predict who may have a serious reaction to ephedra. Risks of side effects may be greater if you have a chronic health condition. Talk to your health care provider about your risk for adverse effects from ephedra, Ma huang.

Different brands of ephedra, Ma huang might contain different amounts of active ingredient. Use a brand from a reliable manufacturer and a product in which the ephedra content has been standardized. The package should list the milligram amount of ephedrine per capsule, tablet, or serving size. A standardized product is more likely to contain the same amount of herb from dose to dose. Your health care professional or pharmacist can assist you in finding a product.

If you are scheduled to have surgery, an outpatient procedure or dental work, let your surgeon or dentist know you are taking ephedra, Ma huang prior to your appointment. You may need to stop taking ephedra, Ma huang several days or weeks before your procedure or surgery.

What side effects may I notice from taking ephedra, Ma huang?

Side effects that you should report to your prescriber or health care professional as soon as possible:
Rare or Uncommon:
• chest pain
• confusion
• dizziness, or fainting spells
• hallucinations
• numbness or tingling in the hands or feet
• rapid or troubled breathing
• seizures (convulsions)
• severe, persistent, or worsening headache
• yellowing of your eyes or skin
More Common:
• anxiety, hostility, or suicidal thoughts
• excessive sweating or inability to cool down after strenuous exercise
• fast or irregular heartbeat, palpitations
• increased blood pressure
• pain or difficulty passing urine
• skin rash (persistent)
• sleeplessness (insomnia)
• tremor
• vomiting

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• agitation or nervousness
• difficulty sleeping
• dry mouth
• headache (mild)
• loss of appetite
• nausea, stomach upset
• restlessness

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open. Many herbal products are not supplied in child-proof packaging.

Store at room temperature below 30 degrees C (86 degrees F). Throw away any unused herb after the expiration date.

GENERAL INFORMATION REGARDING DIETARY SUPPLEMENTS:
Dietary supplements include amino acids, vitamins, minerals, herbs, botanicals, and other plant-derived substances, and extracts of these substances. These products are easy to identify as they must state "Dietary Supplement" on the label. A "Supplement Facts" panel is provided on the label for most products. Supplements are not drugs and are not regulated like drugs. You should note that rigid quality control standards are not required for dietary supplements. Differences in the potency and purity of these products can occur. Scientific data to support the use of a dietary supplement for a certain disease or ailment may not be available. This product is not intended to diagnose, treat, cure or prevent any disease.

The Food and Drug Administration suggests the following to help consumers protect themselves:
• Always read product labels and follow directions.
• "Natural" doesn't mean a product is safe for humans to take.
• Look for products containing ingredients with the "USP" notation. This indicates the manufacturer followed the standards of the US Pharmacopoeia.
• Supplements produced or distributed by a nationally known food or drug company are more likely to be made under tight controls as these companies have standards in place for their other products. You can write to the company for more information about how the product was made.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Description

Ephedra, also known as Ma Huang, is an herb utilized by Chinese medicine for more than 2,500 years due to its ability to remedy symptoms of asthma and upper respiratory infections. A member of the Ephedracae family of herbs (Ephedra sinica), ephedra is native to northern China and Inner Mongolia where it thrives in desert areas as a jointed, barkless plant with branches that bear few leaves and tiny yellow-green flowers that bloom in summer. While varieties of ephedra grow throughout the world, the United States version flourishes in the dry southwest.

Ephedra became popular to Mormon settlers in the early 1800s as a stimulant consumed in the form of tea in place of the coffee and black tea from which they abstained, giving the plant one of its many names, Mormon Tea. Other folk names that have resulted over time include Desert Tea, Desert Herb, and Squaw Tea. The herbal drink was named Whorehouse Tea after it was served in brothels during the 1800s due to unproven beliefs that it cured gonorrhea and syphilis.

The medicinal herb Ma Huang is made of the dried, young branchlets of ephedra. Harvested in the autumn, ephedra is reproduced from seed or by root division and the stems are dried in the sun throughout the year for production. The herb should be stored away from light. Ephedra gains its strength primarily from the alkaloid ephedrine, pseudephedrine, and norpseudephedrine. These active ingredients produce central nervous system stimulation. Other key components of ephedra include:

• tannin, an acidic substance found in the bark
• saponin, originating in the roots
• flavone, the chemical from which natural colors of many plants originate
• volatile oil

General Use

A bitter-tasting herb that has been relied upon by the Chinese throughout centuries to heal ailments from fevers and chills, to nasal and chest congestion, ephedra also maintains its prominence as a strong stimulant. Contrary to its reputation, Zen monks used the herb to promote calm concentration during meditation. However, larger amounts can make a person jittery. Today, ephedra is used in the United States as an herbal medicine to treat asthma and hay fever, and the beginnings of colds and flu. The herb is also used to raise blood pressure, cool fevers, and ease the pain of rheumatism.

While ephedrine was used in various decongestant and bronchodilator products in the United States beginning in the late 1920s through the 1940s, its potential for causing dangerous side effects led to the creation of a chemical substitute. Scientists created the equally effective, but safer, pseudephedrine that remains the active ingredient in many over-the-counter (OTC) products such as Sudafed. Primatene Mist, an OTC that contains ephedrine, is used regularly to treat asthma.

The body responds to ephedra as one of its key ingredients, ephedrine, opens bronchial passages, activating the heart and raising blood pressure while increasing metabolism. Due to its stimulating effect on the nervous system, many weight loss and energy products contain ephedra. Ephedrine increases basal metabolic rate (BMR), causing the body to burn calories faster. Dieters use ephedra-based products because they suppress the appetite and stimulate metabolism. While these diet products prove to be effective, their results are rarely permanent, and long-term use can be quite harmful. Chinese sources only recommended its use for acute situations.

As an "energy" product, ephedra increases alertness and perception. The use of ephedra in this way dates back to bodyguards of Genghis Khan, who, legend has it, fearful of being beheaded if they fell asleep on duty, consumed tea containing ephedra to stay alert. Caffeine products, such as coffee, tea, chocolate, and cola drinks, enhance the effect of energy products containing ephedra. Additional medicinal uses of ephedra include the promotion of menstruation, the decreased desire for cigarettes, and the promotion of uterine contractions. Ma Huang is also known for its ability to increase sexual sensation.

Some controversy surrounds the extended use of ephedra. It is recommended that products containing ephedra be taken only for short periods of time. Tachyphylaxis, or becoming immune to a drug's effectiveness due to overuse, and dependence on the drug may develop when taken consistently over time. Both ephedrine and Ma Huang are considered doping substances. In April 1996, the United States Food and Drug Administration (FDA) issued a warning on dietary supplements containing ephedra that were labeling themselves as safe substitutes for "street drugs," such as the illegal drug ecstasy. The FDA stated that these products could have "potentially dangerous effects on the nervous system and heart."

Ephedra is classified as a dietary supplement, and unlike pharmaceutical companies that must follow strict rules regarding safety, efficacy, and quality set by the FDA, manufacturers of supplements are not held to these guidelines. In 1994, the regulation of herbal medicine-type products in the United States changed with the passage of the Dietary Supplement Health and Education Act (DSHEA). At this time, herbal products were reclassified, along with vitamins and minerals, as dietary supplements. When classified in this grouping that falls somewhere between food and over-the-counter drugs, herbal supplement manufacturers were then able to begin making "structure-function" claims for a product on its label if there is scientific evidence supporting these claims. When appropriate, supplement manufacturers are allowed to use three types of claims: nutrient-content claims, disease claims, and nutrition support claims. These claims are made to guide the buyers of supplements, but supplement manufacturers may use the claims without FDA authorization, and are not required by law to conduct scientific studies on their products. In March 1999, the placement of a "Supplement Facts" panel became a requirement on the labels of most dietary supplements. In January 2002, The United States Pharmacopeial Convention announced it would launch a dietary supplement verification program. Though voluntary, the program would allow supplement manufacturers to provide documentation that they had a quality standard system in place, the organization would audit that system, then verify the quality of the supplement as long as the manufacturer continued to meet the criteria.

While questions surround the correct use of ephedra in the United States, the German government's Federal Institute for Drugs and Medical Devices (Commission E) certifies that ephedra herba, ephedra, and Ma Huang is an approved remedy for diseases of the respiratory tract with mild bronchospasms. Approval from Commission E, however, is not equivalent to the FDA's higher standards of drug approval. Some states in the United States have limited the use of ephedra, or banned the drug completely.

Preparations

Ephedra is available over the counter as a fluid extract, in tablet form, or as a dried bulk herb at Chinese pharmacies, Asian markets, and health food stores where it is permitted throughout the United States. When purchasing the herb, be certain to avoid those that look dry or have a greenish-brown cross section.

Chinese herbalists prepare ephedra for use by combining one part honey, four parts dried herb in combination with other herbs, and a small amount of water in a wok. The herbs are simmered over low heat until the water has evaporated and the herb begins to turn brown. Other forms of preparation include frying ephedra in vinegar or wine to improve its tonic effect on blood circulation, and toasting it to an ash so that it may increase its ability to stop bleeding.

To treat fever and chills, Chinese herbalists recommend combining ephedra with cinnamon twig and other herbs. Coughing and wheezing are remedied with a mixture of ephedra and apricot seed, while licorice is added to the herb for stomachaches. An upper respiratory infection, or congestion, is treated with a combination of ephedra and ginger. The powder form, mixed with rehmannia, is also used by the Chinese to treat kidney energy (yin) deficiency. It is recommended to consult a Chinese medicine practitioner, or physician for detailed information on mixtures of ephedra and doses of the herb.

As the United States has adopted the herb for its healing properties, the variety of ephedra preparations has increased. The average single dose of ephedrine for adults is 15–30 mg, with a maximum allowed daily dose of 300 mg per day. When consumed as a tea, 1 teaspoon (5 ml) of ephedra is boiled with 1 cup (250 ml) water for 15–20 minutes, with up to 2 cups (500 ml) of the tea allowed per day. This tea (also known as a decoction) is prescribed by herbalists for asthma. The tincture preparation is used in treatments to ease the aches and joint pains caused by rheumatism. The amount of tincture recommended is 1/4 teaspoon (1.25 ml)–1 teaspoon (5 ml) in combination with other herbs, up to three times a day.

As a dietary supplement, there is no FDA control over the manufacturing of ephedra, including what is in the pill, additional ingredients added to the pill, how it is produced, or what part of the plant it is made from. For example, when the whole ephedra plant is used for treatment, the side effects are minimal. When key ingredients, such as ephedrine, are isolated from the herb, the strength of the drug increases, therefore increasing the side effects. The potencies and purity within supplements vary greatly by brand and by bottle, resulting in the difficulty of exact dosage recommendations. It is recommended that directions on the product's label are followed exactly for proper use.

Precautions

While ephedra may be taken safely in the correct doses, the supplement has shown to be harmful to children, adolescents, older or chronically ill people, and pregnant women or women who are breastfeeding. Those with heart disease, high blood pressure, prostate enlargement, pheochromocytoma, diabetes, glaucoma, thyrotoxicosis, overactive thyroid gland (hyperthyroidism), nervousness, anorexia, insomnia, suicidal tendencies, stomach ulcers, or bulimia should not take ephedra. It is also recommended that the herb be avoided by those with diarrhea or abdominal bloating.

It should be noted that ephedra is an ingredient in many weight-loss aids. While it is effective for a dieter's purpose as it accelerates his/her metabolism, the excess stimulation can cause dangerous consequences. The strength of the herb is extremely powerful as a stimulant, with its active ingredient epinephrine mimicking the effects of adrenaline. The molecular structure of epinephrine is close to methampetamine, also known as speed, and the use of ephedra can result in a positive test for amphetamines in the urine. Regular use of ephedra has shown to lead to dependence on the herb.

Many cases of Ma Huang toxicity have been reported to the FDA and possibly serious cardiovascular effects have been associated with its use. Health Canada issued a recall for products containing more than recommended levels of ephedra in early 2002 because of serious, possibly fatal, side effects. The dose limits set by Canadian authorities were more than 8 mg of ephedrine or a label that recommended more than 8 mg per dose or 32 mg per day. It also included products recommended use exceeding seven days.

A 2002 study concluded that use of Ma Huang could be associated with serious complications including increased risk of stroke, heart attack or even sudden death and that the effects were not limited to massive doses.

Side Effects

Side effects of ephedra include insomnia, dry mouth, nervousness, irritability, headache, and dizziness. The following side effects are considered serious: increased blood pressure, increased heart rate, and heart palpitations. If these develop, the use of ephedra should be stopped and a physician should be consulted immediately.

In 2000, the FDA reported that the herb ephedra when used as a weight-loss product could result in serious side effects, including heart attack, stroke, and high blood pressure. These potentially life-threatening outcomes, especially to those people with heart problems, are a result of those products that combine ephedra with other stimulants, such as caffeine. At this time it is estimated that four million people safely use products that contain the combined ingredients of ephedra and caffeine.

Ephedra may be life threatening if taken in very high dosages (over 100 g, lethal dosage when taken orally corresponding to approximately 1–2 g L-ephedrine). Signs of poisoning by the herb include severe outbreaks of sweating, enlarged pupils, spasms and elevated body temperature, with heart failure and asphyxiation causing death. To treat the symptoms of poisoning caused by ephedra, seek medical attention immediately.

Interactions

While ephedra may be taken safely on its own, several adverse effects may result from taking the herb along with other drugs.

Drugs that may cause adverse effects if combined with ephedra include:

• methyl xanthines, such as caffeine
• beta blockers
• Dexamthasone
• Reserpine
• Amitriptyline
• urinary alklinizers, such as sodium bicarbonate
• unrinary acidifiers, for example, ammonium chloride
• monoamine oxidase inhibitors, such as heart glycosides
• secale alkaloid derivatives, such as oxytocin
• Yohimbine
• Gaunethidine, which leads to the enhancement of the sympathomimetic effect, or stimulation of the nervous system

Those who are taking any of the aforementioned drugs should avoid ephedra. The isolated drug ephedrine (the active ingredient of ephedra) has also been shown to cause side effects if combined with other drugs, including: antidepressants that increase the overall effect of ephedrine; methyldopa, due to possible increased blood pressure; and ergot preparations that may lead to serious blood pressure problems. Other substances that may cause alarming circumstances if combined with any form of ephedra include cocaine, marijuana, and caffeinated drinks. While it is known that Ma Huang taken with certain drugs and other substances may causes adverse effects, overall drug interactions with the supplement ephedra have not been thoroughly studied. It is recommended that a physician be notified before beginning the use ephedra in any form, or of any herbal supplement.

Resources

Books

Chevallier, Andrew. "Ephedra sinica." In The Encyclopedia of Medicinal Plants. New York: DK Publishing Inc., 1996.

The Editors of Time-Life Books. "Conventional and Natural Medicines." In The Medical Advisor: The Complete Guide to Alternative & Conventional Treatments. Richmond, VA: Time-Life Inc., 1996.

Fleming, Thomas. "Ephedra sinica." In PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company Inc., 1998.

Griffith, H. Winter. "Ephedrine." In Complete Guide to Prescription & Nonprescription Drugs. New York: Berkley Publishing Group, 1998.

Periodicals

Binkley, Alex. "Health Canada Issues Ephedra Recall." Food Chemical News 43, no.49 (January 21, 2002):19.

Kurtzwell, Paula. "An FDA Guide to Dietary Supplements." FDA Consumer no. 99 (September/October 1998): 2323.

Levy, Sandra. "Watch for New Seal of Approval on Dietary Supplements." Drug Topics 146, no.29 (January 7, 2002):29.

Samenuk, David. "Adverse Cardiovascular Events Temporarily Associated with Ma Huang, an Herbal Source of Ephedrine." JAMA, Journal of the American Medical Association 287, no. 12:1506.

Taylor, David. "Herbal Medicine at a Crossroads." Environmental Health Perspectives 104, no.9 (September, 1996).

Organizations

American Botanical Council. PO Box 201660, Austin, TX 78720–1660.

Food and Drug Administration, Office of Consumer Affairs. HFE-88, Rockville, MD 20857.

Herb Research Foundation. 1007 Pearl Street, Suite 200, Boulder, CO 80302.

Other

Drug Digest.http://www.drugdigest.org (January 17, 2001).

The Ephedra Site.http://ephedra.demon.nl/index.html

WebMD.http://WebMD.com

[Article by: Beth Kapes; Teresa G. Odle]

Note: click on a word meaning below to see its connections and related words.

The noun has one meaning:

Meaning #1: jointed and nearly leafless desert shrub having reduced scalelike leaves and reddish fleshy seeds
  Synonym: joint fir

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Ephedra	Metabolife With Ephedra
ephedra	ephedrine ephedra