Background

Ephedra is a stimulant herb usually from the stem and branches of Ephedra sinica. Most ephedra species contain the chemical ephedrine. It's banned in the US.

The ephedrine in ephedra is responsible for its therapeutic effects and also its serious safety concerns. It stimulates the heart, lungs, and nervous system.

People use ephedra for weight loss and athletic performance. It's also used for allergies, nasal congestion, asthma, common cold, headache, and many other conditions, but there is no good scientific evidence to support these uses. Ephedra is also unsafe.

Ephedra has been banned by the US FDA since April 2004. It's also banned by the National Collegiate Athletic Association (NCAA), International Olympic Committee (IOC), and National Football League (NFL). Don't confuse ephedra with Mormon tea. Mormon tea comes from Ephedra nevadensis, an Ephedra species that doesn't contain ephedrine.

Safety Safety definitions

When taken by mouth: Ephedra is likely unsafe. Ephedra can cause severe side effects, such as high blood pressure, heart attacks, seizures, strokes, irregular heartbeat, and death. Taking ephedra with other stimulants like caffeine increases the risk of severe side effects. Do not take products that contain ephedra or its active ingredients.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Ephedra is likely unsafe when taken by mouth while pregnant or breast-feeding. It's been linked to several cases of severe side effects. Do not use it.

Children: Ephedra is likely unsafe when taken by mouth in children. It can cause severe life-threatening side effects.

Anxiety: Large doses of ephedra might make anxiety worse. Do not use it.

Diabetes: Ephedra might interfere with blood sugar control in people with diabetes. Do not use it.

A movement disorder called essential tremor: Ephedra might make essential tremor worse. Do not use it.

Heart conditions: Ephedra can stimulate the heart, making chest pain and irregular heartbeat worse. Do not use it.

High blood pressure: Ephedra might make high blood pressure worse. Do not use it.

Overactive thyroid and related conditions: Ephedra might stimulate the thyroid and make the symptoms of overactive thyroid worse. Do not use it.

Kidney stones: Ephedra and its active ingredient ephedrine can cause kidney stones. Do not use it.

Narrow-angle glaucoma: Ephedra might make this condition worse. Do not use it.

Pheochromocytoma: Ephedra might make the symptoms of this condition worse. Do not use it.

Seizure disorders: Ephedra might bring on a seizure in some people who are prone to seizures. Do not use it.

Effectiveness

Dosing & administration

Despite being banned in the US, ephedra is still found in some dietary supplements. Supplements containing ephedra are often marketed for athletic performance and weight loss. The active chemical in ephedra, ephedrine, can cause serious, life-threatening side effects.

Interactions with pharmaceuticals

Dexamethasone (Decadron)

Interaction Rating=Moderate Be cautious with this combination.

Ephedra might increase how quickly the body breaks down dexamethasone. Taking ephedra along with dexamethasone might decrease the effects of dexamethasone.

Ergot derivatives

Interaction Rating=Moderate Be cautious with this combination.

Ephedra can increase blood pressure. Ergot derivatives can also increase blood pressure. Taking ephedra with ergot derivatives might increase blood pressure too much.

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)

Interaction Rating=Moderate Be cautious with this combination.

Some medications are changed and broken down by the liver. Ephedra might change how quickly the liver breaks down these medications. This could change the effects and side effects of these medications.

Medications for asthma (Beta-adrenergic agonists)

Interaction Rating=Moderate Be cautious with this combination.

Ephedra can stimulate the heart. Some medications for asthma can also stimulate the heart. Taking ephedra with these medications might cause too much stimulation and cause heart problems.

Medications for depression (MAOIs)

Interaction Rating=Moderate Be cautious with this combination.

Ephedra contains chemicals that stimulate the body. Some medications used for depression can increase these chemicals. Taking ephedra with these medications might cause serious side effects including fast heartbeat and very high blood pressure.

Some common MAOIs include phenelzine (Nardil), selegiline (Zelapar), and tranylcypromine (Parnate).

Medications for diabetes (Antidiabetes drugs)

Interaction Rating=Moderate Be cautious with this combination.

Ephedra might increase blood sugar levels. Taking ephedra along with diabetes medications might reduce the effects of these medications. Monitor your blood sugar closely.

Medications that can cause an irregular heartbeat (QT interval-prolonging drugs)

Interaction Rating=Major Do not take this combination.

Ephedra might affect electrical currents in the heart. This can increase the risk of having an irregular heartbeat. Some medications can have this same effect. Taking ephedra with these medications might increase the risk for a serious heart issue.

Medications that can harm the liver (Hepatotoxic drugs)

Interaction Rating=Moderate Be cautious with this combination.

Ephedra might harm the liver. Some medications can also harm the liver. Taking ephedra along with a medication that can harm the liver might increase the risk of liver damage.

Medications used to prevent seizures (Anticonvulsants)

Interaction Rating=Moderate Be cautious with this combination.

Ephedra may increase the risk of seizures. Therefore, taking ephedra may decrease the effects of medications used to prevent seizures. This might increase the risk of seizures.

Methylxanthines

Interaction Rating=Major Do not take this combination.

Ephedra can simulate the body. Methylxanthines also stimulate the body. Taking ephedra along with methylxanthines might cause side effects such as jitteriness, nervousness, a fast heartbeat, high blood pressure, and anxiety.

Stimulant drugs

Interaction Rating=Major Do not take this combination.

Stimulants, such as amphetamines and cocaine, speed up the nervous system. By speeding up the nervous system, stimulant medications can increase blood pressure and speed up the heartbeat. Ephedra also speeds up the nervous system. Taking ephedra along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure.

Interactions with herbs & supplements

Caffeine-containing herbs and supplements: Ephedra can stimulate the body. Using ephedra with other stimulants might increase the risk of more serious side effects such as high blood pressure, heart attack, stroke, and death. There are several reports of serious life-threatening events in people taking ephedra together with caffeine and other stimulants. Examples of supplements that contain caffeine include black tea, coffee, green tea, guarana, and yerba mate.
Ergot: Ephedra can increase blood pressure. Ergot can also increase blood pressure. Taking ephedra with ergot might increase blood pressure too much.
Herbs and supplements that might cause an irregular heartbeat (QT interval-prolonging products): Ephedra might affect electrical currents in the heart. This can increase the risk of having an irregular heartbeat. Taking ephedra with other supplements with similar effects might increase the risk for a serious heart issue. Examples of supplements with this effect include bitter orange, ephedra, grapefruit, iboga, and Panax ginseng.
Herbs and supplements that might harm the liver: Ephedra might harm the liver. Taking it with other supplements that can also harm the liver might increase the risk of liver damage. Examples of supplements with this effect include garcinia, greater celandine, green tea extract, kava, and kratom.

Interactions with foods

Taking ephedra along with caffeinated coffee or tea might stimulate the body too much and increase the risk of developing serious and harmful side effects.