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Ephedrine

What is Ephedrine, Ephedra and Ma Huang?

These terms are used to refer to the same substance derived from the plant Ephedra. (There are many common names for these evergreen plants, including squaw tea and Mormon tea.) Ephedra is a shrub-like plant that is found in desert regions in central Asia and other parts of the world. The dried greens of the plant are used medicinally. Ephedra is a stimulant containing the herbal form of ephedrine, an FDA-regulated drug found in over-the-counter asthma medications.

In the United States, ephedra and ephedrine are sold in health food stores under a variety of brand names. Ephedrine is widely used for weight loss, as an energy booster, and to enhance athletic performance. These products often contain other stimulants, such as caffeine, which may have synergistic effects and increase the potential for adverse effects. Ephedra is often touted as the "herbal fen-phen."

Ephedra's main active medical ingredients are the alkaloids ephedrine and pseudoephedrine. The ephedras also contain various tannins and related chemicals.The stem contains 1-3% total alkaloids, with ephedrine accounting for 30-90% of this total. The concentrations of these alkaloids depends upon the particular species of ephedra used.

Ephedrine alkaloids are amphetamine-like compounds used in OTC and prescription drugs with potentially lethal stimulant effects on the central nervous system and heart. The FDA has received more than 800 reports of adverse effects associated with use of products containing ephedrine alkaloid since 1994. These serious adverse effects, include hypertension (elevated blood pressure), palpitations (rapid heart rate), neurophathy (nerve damage), myopathy (muscle injury), psychosis, stroke, memory loss, heart rate irregularities, insomnia, nervousness, tremors, seizures, heart attacks, and death. The agency has proposed to prohibit the marketing of dietary supplements containing 8 milligrams or more of ephedrine alkaloids per serving.

FDA statement on street drugs containing botanical ephedrine

FDA is warning consumers not to purchase or consume ephedrine-containing dietary supplements with labels that often portray the products as apparent alternatives to illegal street drugs such as "ecstasy." Possible adverse effects of ephedrine range from clinically significant effects such as heart attack, stroke, seizures, psychosis, and death, to clinically less significant effects that may indicate the potential for more serious effects (for example, dizziness, headache, gastrointestinal distress, irregular heartbeat, and heart palpitations). Ingredient panels on these products may list ma huang, Chinese ephedra, ma huang extract, ephedra, Ephedra sinica, ephedra extract, ephedra herb powder, or epitonin, all of which indicate a source of ephedrine.

Original FDA statement on Epedrine Regulation

The Food and Drug Administration proposed to reduce risks associated with dietary supplement products containing ephedrine alkaloids by limiting the amount of ephedrine alkaloids in products and requiring labeling and marketing measures that give adequate warning and information to consumers.

Ephedrine alkaloids are amphetamine-like compounds with potentially powerful stimulant effects on the nervous system and heart. Hundreds of consumer illnesses and injuries associated with the use of these products have been reported.

The proposal would not ban dietary supplements that contain ephedrine alkaloids.

"Consumers should be aware that just because a product is labeled 'natural' or from an herbal source it is not guaranteed to be safe," said Dr. Michael Friedman, Deputy Commissioner of Food and Drugs. "The effects of ephedrine alkaloids are potentially powerful ones. We urge people to talk to their doctors before using dietary supplements containing ephedrine alkaloids, and to always use them with caution."

Because ephedrine alkaloids are heart and nervous system stimulants, certain individuals including those with hypertension, heart conditions and neurologic disorders, should avoid their use. Pregnant women, too, should avoid the use of dietary supplements with ephedrine alkaloids.

The proposal would prohibit the marketing of dietary supplements containing 8 milligrams or more of ephedrine alkaloids per serving. Labeling that recommends or suggests conditions of use that would result in an intake of 8 mg or more in a 6-hour period or a total daily intake of 24 mg or more also would not be allowed.

In addition, the proposal would require label statements instructing consumers not to use the product for more than 7 days, and would not allow label claims for uses for which long-term intake would be necessary to achieve the purported effect. These safety measures are based on the fact that long-term intake of ephedrine alkaloids increases the likelihood of serious adverse events.

Another measure in the proposal would apply to products with claims that encourage short-term excessive intake to enhance the claimed effect, such as energy enhancement. Such products would be required to bear a labeling statement that "Taking more than the recommended serving may result in heart attack, stroke, seizure or death."

The proposal also would prohibit the use of other stimulant ingredients such as botanical sources of caffeine with ephedrine alkaloids because the combination increases the stimulant effects of ephedrine alkaloids and the chance of consumer injury.

Dietary supplement products containing ephedrine alkaloids are currently sold for a variety of purposes including weight loss, increased energy and body building.

Since 1994, the agency has received and investigated more than 800 reports of adverse events associated with the use of these products. Reported adverse events range from episodes of high blood pressure, irregularities in heart rate, insomnia, nervousness, tremors and headaches, to seizures, heart attacks, strokes and death. Most events occurred in young to middle aged, otherwise healthy adults using the products for weight control and increased energy.

Ephedrine alkaloids in dietary supplements are usually derived from one of several species of herbs of the genus Ephedra, sometimes called Ma huang, Chinese Ephedra and epitonin. Other botanical sources include Sida cordifolia.

The proposed measures were developed based on the FDA's review of its adverse event reports, the scientific literature, and public comments reviewed by the agency, including comments generated by an October 1995 advisory working group public meeting and an August 1996 public meeting of the FDA's Food Advisory Committee. These experts suggested a number of steps the agency might take to reduce injuries associated with use of dietary supplements containing ephedrine alkaloids.

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