Ephedra
Ma Huang
*** Important warning ***
Health Canada is reminding consumers not to use products containing Ephedra or ephedrine, either alone or in combination with caffeine and other stimulants, for purposes of weight loss, body building or increased energy. Use of these products may have serious, possibly fatal, adverse effects.
Consumers should use Ephedra/ephedrine products only for the approved indication of nasal decongestion.
Efficacy
- Indications with proven efficacy:
Nasal congestion (popular use) - Indications with possible, but poorly documented efficacy:
Mild obstructive pulmonary problems (asthma, bronchitis)
Weight loss - with caffeine (popular use) - Other indications with no proof of efficacy:
Edema - diuretic effect
Muscle and joint pain
Security
- Risk of Drug Interactions: High
- Adverse Effects: Frequent
Description
Part of the plant used: above ground part (particularly stem)
Plants from the genus Ephedra have been used for over 5000 years in traditional Chinese medicine to treat asthma. Today, young dried branches, harvested in the fall, are used to treat mild respiratory tract problems. Young branches contain active alkaloids, mostly ephedrine and pseudoephedrine. These alkaloids can stimulate the sympathetic nervous system, increasing blood pressure and heart rate. They also cause vasoconstriction, which can reduce congestion, and induce bronchodilation. Ephedra is also used as a stimulant for the central nervous system, in the same manner as caffeine. The various ephedra species usually contain 0.5 to 2.5% active alkaloids.
Direction of use
- Nasal congestion:
Used doses: 8 mg of ephedrine or 400 mg of Ephedra per dose up to a maximum of 32 mg of ephedrine or 1600 mg of Ephedra per day (doses recommended by Health Canada). Administer over a few days only, do not exceed 7 days.
There is insufficient reliable information to conclude that ephedra is effective in any other indication.
Precautions
- Side effects
Taking ephedra is not without risks. It causes several side effects, such as insomnia, irritability, headaches, nausea and vomiting, urinary problems, palpitations (increased heart rate) and increases blood pressure. It should not be used in children. Side effects can be of importance. - Contraindications
It is contraindicated in people with anxiety, hypertension, heart disease, glaucoma, urinary retention, prostate problems, anorexia, diabetes and several other medical conditions. - Interactions
Ephedra interacts with several drugs, such as antidiabetic agents, digoxin, ergotamine, monoamine oxydase inhibitors (MAOI), caffeine, theophylline and several others. People who take these drugs should not take ephedra. Before taking ephedra, check with your pharmacist to make sure that there are no interactions with your regular medication. - Pregnancy and breastfeeding
Ephedra is contraindicated in pregnant women. Ephedrine appears to stimulate uterine contractions and could induce labor before term. Since there is no safety data available concerning its use during breast-feeding, lactating women should not use ephedra.
Warning
In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.
Medicinal plant contents vary naturally from plant to plant - just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.
For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.
References
- Blumethal M et al. The Complete German Commission E monographs, 1998
- Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2010
- Facts and Comparisons, The Lawrence review of Natural Products, 2000
- Health Canada, Ephedra/Ephedrin - Warning, March 11, 2008
- Passeportsanté.net. Éphédra. www.passeportsante.net
- Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002
- Barnes J. et Al. Herbal Medicines, 2nd edition, Pharmaceutical Press, 2002
- Taylor J. CE: Phytomedicinals: Uses, precautions, and drug interactions. Drug Topics 2003;1:79
- Natural Therapeutics Pocket Guide, 2000-2001
- The Review of Natural Products, 6th Edition, 2010
- Health Canada, Natural Products Database
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