Ephedra Side Effects

Ephedra is an used in various types of alternative medicine. For example, in traditional Chinese medicine, it is said to have been used for over 4000 years for asthma, bronchitis, joint symptoms, inability to perspire, swelling, and pain in the bones.

More recently, it has been used as a folk remedy in Germany, Japan, India, and other countries for the common cold, bronchial asthma, hay fever, and allergy.

In contemporary China, ephedra is often a component of a multi-herb cold formula made by boiling ephedra with cinnamon twig, licorice root and almond.

Aside from respiratory ailments, ephedra is also found in herbal preparations marketed for weight loss, athletic performance, and physical and mental stimulation. It is currently banned in the United States.

How is Ephedra Thought to Work?

The main constituents of ephedra, notably ephedrine and pseudo-ephedrine, are plant alkaloids that are thought to be responsible for the ephedra's medicinal action. These alkaloids are believed to cross the barrier protecting the brain from unwanted chemicals in the blood and mimic activity of the sympathetic nervous system ("fight or flight") by interacting with various neurotransmitter receptors. Specifically, it is thought to enhance the release of the neurotransmitter norepinephrine and stimulate alpha- and beta-adrenergic receptors.

The problem with this non-specific stimulation of adrenergic receptors is that while the desired receptors (beta-2) in the lungs are stimulated to open the airways, other types of receptors are also stimulated, including beta-1 receptors in the heart that increase heart rate and force of contraction, and alpha-1 receptors that increase blood pressure and decrease circulation to the renal system and other parts of the body.

Epinephrine, which is similar to ephedrine but much more active and short-acting, was a conventional treatment for asthma, but it has been largely replaced by current asthma medications which are able to act more selectively on beta-2 receptors.

Possible Side Effects of Ephedra

Due to the limited research, little is known about the side effects of ephedra use. Some of the potential adverse effects may include:

  • nausea
  • headache; dizziness
  • irritation of the stomach; diarrhea
  • anxiety; psychosis
  • kidney stones
  • tremors
  • dry mouth
  • irregular or rapid heart rhythms; heart damage
  • high blood pressure
  • restlessness; nervousness; sleeping problems
  • decreased appetite
  • flushing; sweating
  • increased urination

Use of ephedra has also been associated with stroke, seizures, psychosis and death.

The risk of side effects and adverse effects appears to be greater in people with preexisting conditions, such as heart disease, high blood pressure; heart rate disorders; thyroid disease; hypoglycemia; glaucoma; anxiety; glaucoma; pheochromocytoma; diabetes; kidney disease or kidney stones; mental illness or a history of mental illness; enlarged prostate; cerebral insufficiency and a history of seizures, stroke, or transient ischemic attacks.

People with these health conditions should avoid ephedra. People with allergies to ephedra, ephedrine, or pseudo-ephedrine should also avoid ephedra.

Ephedra is believed to increase the risk of heat stroke, because it increases metabolism and impairs the body's ability to lose heat.

Ephedra shouldn't be taken two weeks before or after surgery. It shouldn't be used by pregnant or nursing women or children. People with anorexia nervosa or bulimia should avoid ephedra because it affects appetite.

It's important to keep in mind that supplements haven't been tested for safety and dietary supplements are largely unregulated. In some cases, the product may deliver doses that differ from the specified amount for each herb. In other cases, the product may be contaminated with other substances such as metals. Also, the safety of supplements in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications has not been established. You can get further tips on using supplements here.

Disclaimer: The information contained on this site is intended for educational purposes only and is not a substitute for advice, diagnosis or treatment by a licensed physician. It is not meant to cover all possible precautions, drug interactions, circumstances or adverse effects. You should seek prompt medical care for any health issues and consult your doctor before using alternative medicine or making a change to your regimen.

Possible Drug interactions

Stimulants -- Ephedra should not be combined with other substances with a stimulant effect, such as caffeine and Sudafed (pseudoephedrine hydrochloride), as it may have an additive effect. Herbs known to contain caffeine include green tea, kola nut, guarana and yerba mate, while bitter orange is a stimulant.

Aerolate, T-Phyl, and Uniphyl (theophylline) -- a medication used for asthma, emphysema and chronic bronchitis

Amphetamines, such as those used for narcolepsy or attention deficit hyperactivity, such as Adderall (dextroamphetamine)

Antidepressants, particularly monoamine oxidase inhibitors (MAOIs), such as Marplan (isocarboxazid), Nardil (phenelzine) and Parnate (tranylcypromine), due to an increased risk of high blood pressure and stroke; tricyclic antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline)

St. John's Wort

Aspirin (acetylsalicylic acid)

Blood pressure medication

Diabetes medications, such as insulin, Glucophage (metformin), Diabeta, Glynase, Micronase (glyburide)

Narcotics, such as codeine

Pitosin (Oxytocin) or Secale Alkaloid Derivatives

Factors That May Increase the Risk of Adverse Effects

1. Use of ephedra for unproven purposes. An herb with a long history of clinical use, ephedra became controversial in the United States over the past decade because of its use for unapproved purposes such as for weight loss, as a mental stimulant, to enhance athletic performance and even as a component of an illicit drug.

As a result, adverse reaction reports became increasingly common, and the FDA and government officials tried to limit the use of ephedra in supplements, the level of alkaloids per dose and per day, and, in some states, access to ephedrine-containing products until it was finally banned in the U.S.


Effects of ephedra are multiplied when combined with caffeine and aspirin. One of the main problems with the use of ephedra in weight loss and athletic performance preparations is that caffeine (or other methylxanthines) is often added to the preparations to increase the weight loss and stimulating effect of ephedra. In the study to be published next month, it appears that many of the ephedra-containing products studied may have contained caffeine, a combination which may be more likely to result in an adverse event. Commercial products often contain caffeine or caffeine-containing herbs such as cola (Cola nitida), guarana (Paullinia cupana), and mate (Ilex paraguariensis).

In addition, few products warn against having drinks containing caffeine, such as coffee or cola, while taking ephedra.

White willow (Salix alba) and other herbs similar to aspirin have also been found in ephedra preparations.

3. Self-prescription of ephedra without professional supervision. Ephedra has very important clinical uses and has a long history of use for treating respiratory disorders.

However, each person's condition is unique and the guidance of an appropriately trained health practitioner should be sought when considering any herbal treatment. For example, someone may not recognize guarana as a caffeine-containing herb when reading the label, or may take St. John's Wort with ephedra, unaware that it should not be taken with ephedra.

4. Improper labeling and warnings. Herb industry groups and the American Herbal Products Association attempted to establish label warnings and dose limits in 1994. In 1997, the FDA proposed further regulation to prohibit the sale of ephedra for unproven purposes and to restrict herbal supplements from containing more than 8 mg of total ephedra alkaloids per dose, with a recommended total dose of no more than 24 mg per day. This proposal was criticized in 1999 by the U.S. General Accounting Office (GAO), a government monitoring agency. The GAO's report, entitled Dietary Supplements: Uncertainties in Analyses Underlying FDA's Proposed Rule on Ephedrine Alkaloids, questioned the reliability of methods used to gather adverse effect information and establish dosing guidelines.

The actual amount of ephedra in the herb preparation can also vary widely from the quantity stated on the label, especially with manufacturers of questionable quality control methods.


Ephedra has a long history of traditional and clinical use as a safe herb. Traditionally, it is only used in combination with other herbs.

The supplement industry must standardize labeling and dosage guidelines and avoid the addition of caffeine or aspirin to products containing ephedra.

Consumers should be educated in avoiding the use of ephedra for unproven purposes other than respiratory disorders and seek the guidance of appropriately trained health practitioners when considering the use of ephedra.

Published 12/21/03

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