From Cathy Wong,
Your Guide to Alternative Medicine.
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Possible Drug interactions

Stimulants -- Ephedra should not be combined with other substances with a stimulant effect, such as caffeine and Sudafed (pseudoephedrine hydrochloride), as it may have an additive effect. Herbs known to contain caffeine include green tea, kola nut, guarana and yerba mate, while bitter orange is a stimulant.

Aerolate, T-Phyl, and Uniphyl (theophylline) -- a medication used for asthma, emphysema and chronic bronchitis

Amphetamines, such as those used for narcolepsy or attention deficit hyperactivity, such as Adderall (dextroamphetamine)

Antidepressants, particularly monoamine oxidase inhibitors (MAOIs), such as Marplan (isocarboxazid), Nardil (phenelzine) and Parnate (tranylcypromine), due to an increased risk of high blood pressure and stroke; tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline)

St. John's Wort

Aspirin (acetylsalicylic acid)

Blood pressure medication

Diabetes medications, such as insulin, Glucophage (metformin), Diabeta, Glynase, Micronase (glyburide)

Narcotics, such as codeine

Pitosin (Oxytocin) or Secale Alkaloid Derivatives

Factors That May Increase the Risk of Adverse Effects

1. Use of ephedra for unproven purposes. An herb with a long history of clinical use, ephedra became controversial in the United States over the past decade because of its use for unapproved purposes such as for weight loss, as a mental stimulant, to enhance athletic performance and even as a component of an illicit drug. As a result, adverse reaction reports became increasingly common, and the FDA and government officials tried to limit the use of ephedra in supplements, the level of alkaloids per dose and per day, and, in some states, access to ephedrine-containing products until it was finally banned in the U.S.

2. Effects of ephedra are multiplied when combined with caffeine and aspirin. One of the main problems with the use of ephedra in weight loss and athletic performance preparations is that caffeine (or other methylxanthines) is often added to the preparations to increase the weight loss and stimulating effect of ephedra. In the study to be published next month, it appears that many of the ephedra-containing products studied may have contained caffeine, a combination which may be more likely to result in an adverse event. Commercial products often contain caffeine or caffeine-containing herbs such as cola (Cola nitida), guarana (Paullinia cupana), and mate (Ilex paraguariensis).

In addition, few products warn against having drinks containing caffeine, such as coffee or cola, while taking ephedra.

White willow (Salix alba) and other herbs similar to aspirin have also been found in ephedra preparations.

3. Self-prescription of ephedra without professional supervision. Ephedra has very important clinical uses and has a long history of use for treating respiratory disorders. However, each person's condition is unique and the guidance of an appropriately trained health practitioner should be sought when considering any herbal treatment. For example, someone may not recognize guarana as a caffeine-containing herb when reading the label, or may take St. John's Wort with ephedra, unaware that it should not be taken with ephedra.

4. Improper labeling and warnings. Herb industry groups and the American Herbal Products Association attempted to establish label warnings and dose limits in 1994. In 1997, the FDA proposed further regulation to prohibit the sale of ephedra for unproven purposes and to restrict herbal supplements from containing more than 8 mg of total ephedra alkaloids per dose, with a recommended total dose of no more than 24 mg per day. This proposal was criticized in 1999 by the U.S. General Accounting Office (GAO), a government monitoring agency. The GAO's report, entitled Dietary Supplements: Uncertainties in Analyses Underlying FDA's Proposed Rule on Ephedrine Alkaloids, questioned the reliability of methods used to gather adverse effect information and establish dosing guidelines.

The actual amount of ephedra in the herb preparation can also vary widely from the quantity stated on the label, especially with manufacturers of questionable quality control methods.

Conclusion

Ephedra has a long history of traditional and clinical use as a safe herb. Traditionally, it is only used in combination with other herbs.

The supplement industry must standardize labeling and dosage guidelines and avoid the addition of caffeine or aspirin to products containing ephedra.

Consumers should be educated in avoiding the use of ephedra for unproven purposes other than respiratory disorders and seek the guidance of appropriately trained health practitioners when considering the use of ephedra.

Published 12/21/03