Natural Products

Ephedra

Efficacy

• Indications with proven efficacy:
  Mild obstructive pulmonary problems (asthma, bronchitis)
  Nasal congestion
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  Weight loss (with caffeine)
• Also used for these other indications, but with no proof of efficacy:
  Edema (diuretic effect)
  Muscle and joint pain

Security

• Risk of Drug Interactions: High
• Adverse Effects: Frequent

What is it?

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.

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) or homeopathic medicine number (DIN-HM) 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 plants content varies 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 http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

Ephedra was found effective to relieve nasal congestion and mild obstructive pulmonary problems.

• Nasal congestion, mild obstructive pulmonary problems:
  In adults, the usual dose is 15 to 30 mg of total alkaloids every 6 hours. The total daily dose should not exceed 300 mg. Administer over a few days only, do not exceed 7 days. This is higher than safe doses determined by Health Canada.

There is insufficient reliable information to conclude that ephedra is effective in any other indication.

Is it safe?

• Taking ephedra is not without risks. It is contraindicated in people with anxiety, hypertension, heart disease, glaucoma, urinary retention, prostate problems, anorexia, diabetes and several other medical conditions! It also causes several side effects, such as insomnia, irritability, headaches, nausea and vomiting, urinary problems and palpitations (increased heart rate). It should not be used in children.
• 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.
• 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.

Clinical notes

• Because ephedra causes several side effects and there are other standardized, better-tolerated products readily available to treat asthma and nasal congestion, the use of ephedra cannot be recommended.

References

1. Blumethal M et al. The Complete German Commission E monographs, 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Facts and Comparisons, The Lawrence review of Natural Products, 2000
4. Lexi-comp, Natural Therapeutics Pocket Guide, 2000-2001
5. Health Canada, Ephedra/Ephedrin - Warning, January 9, 2002
6. Passeportsanté.net. Éphédra. http://www.passeportsante.net
7. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002
8. Barnes J. et Al. Herbal Medicines, 2nd edition, Pharmaceutical Press, 2002
9. Taylor J. CE: Phytomedicinals: Uses, precautions, and drug interactions. Drug Topics 2003;1:79