Ephedra's therapeutic uses
Ephedra, particularly the Chinese herb ma huang, is known for its therapeutic uses in treating various health conditions, most notably asthma. The active compounds in Ephedra, ephedrine and pseudoephedrine, were isolated in the early 20th century and have been utilized in conventional medicine for respiratory issues and as decongestants. Historically, ma huang was also employed for short-term relief of conditions like eczema, hay fever, and narcolepsy. Despite its longstanding use, concerns about safety have emerged, leading to the recommendation against the use of herbal ephedra, particularly due to its association with serious side effects like rapid heartbeat and high blood pressure.
While ephedrine and caffeine combinations have shown some efficacy in weight loss, they pose significant risks and should only be used under medical supervision. The FDA has banned the sale of dietary supplements containing ephedra due to these safety concerns, particularly given the herb's potential to cause severe health complications. Additionally, misuse of ephedra for recreational purposes has contributed to its notoriety and associated dangers. Individuals with certain health conditions, including cardiovascular diseases, are advised to avoid ephedra entirely due to the risks involved. Overall, while Ephedra has therapeutic applications, its safety profile raises substantial concerns that warrant caution and medical guidance.
Ephedra's therapeutic uses
DEFINITION: Natural plant product used to treat specific health conditions.
PRINCIPAL PROPOSED USE: Asthma
Overview
The Chinese herb ma huang is a member of a primitive family of plants that look like thin, branching, connected straws. A related species, Ephedra nevadensis, grows wild in the American Southwest and is widely called Mormon tea. However, only the Asian species of ephedra contains the active compounds ephedrine and pseudoephedrine.
Ma huang was traditionally used by Chinese herbalists during the early stages of respiratory infections and was also used for the short-term treatment of certain kinds of asthma, eczema, hay fever, narcolepsy, and edema. Japanese chemists isolated ephedrine from ma huang at the turn of the twentieth century, and it soon became a primary treatment for asthma in the United States and abroad. Ephedra’s other major ingredient, pseudoephedrine, became the decongestant Sudafed.
Therapeutic Dosages
The dosage of ephedra should be adjusted according to the amount of ephedrine it provides. For adults, no more than twenty-five milligrams (mg) should be taken at one time, and a total daily intake of 100 mg should not be exceeded. However, a survey of ephedra-containing dietary supplements found that ephedrine content as listed on the label was frequently incorrect. In addition, other chemicals were often present that could increase safety risks. For this reason, experts recommend against the use of herbal ephedra.
Therapeutic Uses
Although it can still be found in a few over-the-counter drugs for asthma and sinus congestion (in a safer form than the banned dietary supplements), physicians seldom prescribe ephedrine anymore. The problem is that ephedrine mimics the effects of adrenaline and causes symptoms, such as rapid heartbeat, high blood pressure, agitation, insomnia, nausea, and loss of appetite. The newer asthma drugs are much safer and easier to tolerate.
Meaningful evidence suggests ephedrine/caffeine combinations can assist in weight loss. However, because of safety risks, experts strongly recommend that individuals seek a physician’s supervision before attempting to lose weight with ephedrine/caffeine combination therapy. Experts also recommend not using herbal sources of ephedrine, which are now banned, for weight loss.
One highly preliminary study has been used to claim that ephedrine is helpful for women with sexual dysfunction. However, this trial was very small, enrolled women without sexual problems, and only examined sexual responsiveness to visual stimuli; at this time, experts recommend that women with sexual dysfunction avoid using ephedra. Another study examined the possible benefits of ephedrine for treatment of female sexual dysfunction caused by antidepressants in the selective serotonin reuptake inhibitor (SSRI) family, such as Prozac. Ephedrine failed to prove more effective than placebo.
There is no meaningful evidence that ephedra enhances sports performance. It should also be noted that persons taking ephedra or ephedrine may test positive for methamphetamine (speed) on drug screening.
Scientific Evidence
Evidence suggests that ephedrine/caffeine combinations can aid weight loss and help keep the weight off for up to six months. However, the benefits are modest.
For example, in a double-blind, placebo-controlled trial, 180 overweight persons were placed on a weight-loss diet and given either ephedrine/caffeine (twenty mg/200 mg), ephedrine alone (twenty mg), caffeine alone (200 mg), or placebo three times daily for twenty-four weeks. The results showed that the ephedrine/caffeine treatment significantly enhanced weight loss, resulting in a loss of more than thirty-six pounds, compared with only twenty-nine pounds in the placebo group, a seven-pound difference. Neither ephedrine nor caffeine alone produced any benefit. Contrary to some reports, participants did not develop tolerance to the treatment. For the entire six months of the trial, the treatment group maintained the same relative weight-loss advantage over the placebo group.
A few side effects were seen in this study, primarily insomnia, dizziness, and tremor, but they tended to fade away after a few weeks. Keep in mind that participants were screened prior to the study and were eliminated if they had high blood pressure or any other serious disease, or if they used medications or illegal drugs that might interact with stimulants.
Another study compared ephedrine/caffeine with the no-longer-available drug dexfenfluramine (Redux), related to fenfluramine of fen-phen fame. A total of 103 overweight individuals were enrolled in this fifteen-week, double-blind trial. All were placed on a weight-loss diet. Half were given ephedrine/caffeine at the usual dose, while the others were given fifteen mg of dexfenfluramine. The results showed comparable weight loss in both groups.
Finally, a double-blind, placebo-controlled trial enrolled 225 heavy smokers who wanted to quit but were afraid of gaining weight. At twelve weeks after quitting smoking, individuals taking ephedrine and caffeine had gained significantly less weight. At that point, the dosage was gradually reduced, and the difference between the groups declined. Contrary to the hopes of the experimenters, ephedrine/caffeine use did not help individuals quit smoking. Benefits have also been seen in smaller studies using herbal sources of ephedrine.
Experts do not know exactly how ephedrine/caffeine work. However, caffeine has actions that cause fat breakdown and enhance metabolism. Ephedrine suppresses appetite and increases energy expenditure. The combination appears to produce synergistic effects, with appetite suppression probably the most important overall factor.
Safety Issues
On December 30, 2003, the US Food and Drug Administration (FDA) issued a consumer alert regarding the safety of dietary supplements containing ephedra. The FDA determined that consuming these supplements poses an unnecessary risk of illness or injury, and that consumers should stop buying and using ephedra products immediately. The FDA also notified manufacturers and marketers of these dietary supplements that effective sixty days (March 2004) after the publication of its final ruling, the sale of all products containing ephedra in the United States would be banned. This ruling was temporarily overturned in April 2005 but was later upheld the following year, making it illegal to sell products containing ephedra.
While ephedra is an herb with a long history of use in Chinese herbal medicine, Chinese tradition attaches numerous warnings: it should be used only by very robust people, for certain specific purposes, and only for a short period of time. These ancient warnings seem to have been disregarded in the transition of ephedra use from Asia to the US, where it was often sold for continuous use by overweight, relatively unhealthy people. Herbal products containing ephedra caused the majority (64 percent) of reported adverse effects from herbs in the US. This proportion is particularly impressive given that less than 1 percent of all herbal products sold in the US contain ephedra. On a per-use basis, for example, ephedra has 720 times as much risk of causing harm as ginkgo biloba.
There are many reasons for this high rate of risk. While it is possible for healthy individuals under physician supervision to use ephedrine or ephedrine/caffeine combinations safely, in individuals with heart disease, and even occasionally in those with no known heart conditions, ephedrine can cause serious disturbances of the heart rhythm and possibly sudden death or a stroke. Use of herbal ephedra, as opposed to ephedrine, may present additional dangers. There is no ready way to be sure what dose of the drug ephedrine individuals are getting when they purchase the herb ephedra, which creates a potential risk of overdosage. In addition, some ephedra products contain potentially more toxic chemicals related to ephedrine, such as (+)-norpseudoephedrine.
Besides heart problems and strokes, use of ephedra has been associated with severe inflammation of the liver (in at least one case requiring a liver transplant) and of the heart. In these cases, it appears likely that ephedra (or an unidentified contaminant in the herb) triggered an autoimmune reaction.
Additionally, people taking ephedra or ephedrine may develop an unusual form of kidney stones that actually contain ephedrine. Temporary psychosis has also been linked to use of ephedra. Finally, there are indications that certain preparations of ephedra may be toxic to the nervous system.
Based on the known risks of ephedrine and the evidence described above, ephedra should not be taken by persons with cardiovascular disease, including angina, abnormalities of heart rhythm, hardening of the arteries, high blood pressure, high cholesterol, intermittent claudication, myocarditis, vasculitis, or history of stroke; enlargement of the prostate; diabetes; hepatitis; diseases of the nervous system; glaucoma; or hyperthyroidism.
Ephedra may be particularly risky for young children, pregnant or nursing women, people with kidney disease, and people with liver disease. Furthermore, one should never combine ephedra with monoamine-oxidase (MAO) inhibitors, such as Nardil (phenelzine), or fatal reactions may occur.
The ephedra plant can also be used to create the substance methamphetamine. Starting around 2015, methamphetamine producers in Afghanistan switched from using synthetic pseudoephedrine to ephedrine derived from the plant ephedra, which grew in abundance around the country. Due to a lack of legal constraints on the ephedra plant and other ingredients used to produce methamphetamine, usage grew exponentially in the country. In 2022, authorities in the country had seized as much methamphetamine as they had heroine, which was around 4,665 kilograms each. Used as a recreational drug, ephedra can be extremely dangerous and potentially lethal.
Important Interactions
Persons taking MAO inhibitors should not take ephedra, and persons taking any stimulant drugs, including caffeine, should not take ephedra except under physician supervision.
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