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Ephedra Side Effects

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Updated September 04, 2013

Ephedra is an important herb in traditional Chinese medicine, with over 4000 years of clinical use as a herbal therapy for asthma, bronchitis, cough with difficulty breathing, joint symptoms, inability to perspire, swelling and pain in the bones.

More recently, it has been used as a folk remedy in China, Germany, Japan, and India for the common cold, bronchial asthma, hay fever and allergy. In contemporary China, ephedra is often a component of a multi-herb cold formula made by boiling ephedra with cinnamon twig, licorice root and almond.

The World Health Organization found the following uses of ephedra preparations to be supported by clinical data: treatment of nasal congestion due to hay fever, allergic rhinitis, common cold, sinusitis, and as a bronchodilator in treatment of bronchial asthma.

Aside from respiratory ailments, ephedra is also found in herbal preparations marketed for weight loss, athletic performance and physical and mental stimulation. It is currently banned in the United States.

How is Ephedra Thought to Work?

The main constituents of ephedra, notably ephedrine and pseudoephedrine, are plant alkaloids that are thought to be responsible for the ephedra's medicinal action. These alkaloids are believed to cross the barrier protecting the brain from unwanted chemicals in the blood and mimic activity of the sympathetic nervous system ("fight or flight") by interacting with various neurotransmitter receptors. Specifically, it is thought to enhance the release of the neurotransmitter norepinephrine and stimulates alpha- and beta-adrenergic receptors. The problem with this non-specific stimulation of adrenergic receptors is that while the desired receptors (beta-2) in the lungs are stimulated to open the airways, other types of receptors are also stimulated, including the beta-1 receptors in the heart that increase heart rate and force of contraction, and the alpha-1 receptors that increase blood pressure and decrease circulation to the renal system and other parts of the body.

Epinephrine, which is similar to ephedrine but much more active and short-acting, is a conventional treatment for asthma, but it has been largely replaced by current asthma medications which are able to act more selectively on beta-2 receptors.

Possible Side Effects of Ephedra
  • nausea
  • headache; dizziness
  • irritation of the stomach; diarrhea
  • anxiety; psychosis
  • kidney stones
  • tremors
  • dry mouth
  • irregular or rapid heart rhythms; heart damage
  • high blood pressure
  • restlessness; nervousness; sleeping problems
  • decreased appetite
  • flushing; sweating
  • increased urination

Use of ephedra has also been associated with stroke, seizures, psychosis and death.

The risk of side effects and adverse effects appears to be greater in people with preexisting conditions, such as heart disease, high blood pressure; heart rate disorders; thyroid disease; hypoglycemia; glaucoma; anxiety; glaucoma; pheochromocytoma; diabetes; kidney disease or kidney stones; mental illness or a history of mental illness; enlarged prostate; cerebral insufficiency and a history of seizures, stroke, or transient ischemic attacks. People with these health conditions should avoid ephedra. People with allergies to ephedra, ephedrine, or pseudoephedrine should also avoid ephedra.

Ephedra is believed to increase the risk of heat stroke, because it increases metabolism and impairs the body's ability to lose heat.

Ephedra shouldn't be taken two weeks before or after surgery. It shouldn't be used by pregnant or nursing women or children. People with anorexia nervosa or bulimia should avoid ephedra because it affects appetite.

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