DSI Newsletter: Ephedra

DSI Newsletters, Issue 52:
Ephedra (Ma-Huang) Natural Remedy

Warning: The FDA has ruled that ephedra poses an unreasonable health risk to consumers. Dietary supplements that contain ephedra and Ma huang are not allowed to be sold in the U.S. The rule does not pertain to traditional Chinese herbal remedies or to herbal teas. Severe side effects and drug interactions (some life-threatening) have been reported with the use of ephedra (ma-huang). These effects and interactions are caused by ephedrine, the active ingredient in ephedra. Always check with a health care provider before taking any product containing ephedra (ma-huang).
What are other names for this remedy?
Scientific and common names: Ephedra sinica, Ephedra gerardiana, Ephedra distachya, Ephedra equisetina, Ephedra shennungiana, Ephedra herba, Ephedra sinesis, ephedra, ma-huang, desert herb, herbal ecstasy, joint fir, popotillo, sea grape, teamster's tea, yellow astringent, yellow horse.
What is ephedra (ma-huang)?
Ephedra is a shrub that grows mainly in Mongolia and the bordering regions of China. The dried young branches of the ephedra shrub are harvested for medicinal use in the fall.
What is it used for?
The active ingredient in ephedra that is used in medicines is called ephedrine. The amount of ephedrine in each plant can vary so much that the same dosage of ephedra can produce very different effects. Ephedrine is a stimulant of the central nervous system.
Ephedra has been suggested as a treatment for many conditions, but it is not considered safe. Ephedra can increase risk of stroke, seizure, and heart attack and may result in death. There is no safe use for ephedra.
Be aware that uses for natural remedies are not approved by the US Food and Drug Administration (FDA). Natural remedies are classified as dietary supplements by the FDA. They are not subject to the same scrutiny and regulations as prescription medicines.
How is it taken?
Ephedra is taken as a tablet, capsule, or liquid. It can also be prepared as a tea to drink. Follow the directions printed on the product label or given by your health care provider.
What should I watch out for?
Do not take ephedra if you have:

a thyroid problem

an eating disorder (anorexia or bulimia)

an enlarged prostate gland

chest pain

diabetes

glaucoma

heart disease

high blood pressure

kidney stones

pheochromocytoma (tumor of the adrenal gland)

trouble urinating

problems with anxiety or restlessness.

You can become dependent on ephedra if you use it for a long time. Ephedra should be taken for short periods of time only.
Females of childbearing age: Do not take this remedy if you are pregnant or breast-feeding. It may cause premature labor.
Remember when using any natural remedy:

"Natural" does not always mean safe.

Natural remedies affect your body and may interact with prescription medicines.
Talk to your health care provider or pharmacist about any natural remedies that you are using or considering.

Natural products are not standardized. They may have different strengths and effects. Some remedies may be contaminated. Be careful which products you use.

If your health care provider has not given you specific instructions, follow the directions that come with the package. Do not take more or take it longer than recommended. Ask your health care provider or pharmacist about anything you do not understand.

If you are pregnant or breast-feeding, get the approval of your health care provider before you take any natural remedy.

Do not give natural remedies to infants, children, or the elderly without advice from your health care provider.

What are the possible side effects?
Along with its desirable effects, this remedy may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the remedy. Tell your health care provider if you have any side effects that continue or get worse.
Serious (report these to your health care provider right away): Severe headache with no known cause; weakness, numbness, or tingling in the face, arm, or leg, especially on one side of the body; trouble walking, dizziness, loss of balance, or coordination; getting tired easily; nosebleeds; chest pain; shortness of breath; seizures, irregular heart beat, loss of consciousness.
Other: Minor headache, irritability, confusion, restlessness, nausea or vomiting, sleeplessness, trouble urinating.
Large doses may cause heart rhythm problems or big increases in blood pressure.
What products might interact with this remedy?
When you take this remedy with prescription medicines, it can change the way this remedy or any of the medicines work. Nonprescription medicines, vitamins, other natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Do NOT take ephedra if you are also taking:

aspirin

amitriptyline (Elavil)

caffeine, found in coffee, black tea, green tea, cola and some sports drinks, and herbal products such as kola nut, guarana, and mate

corticosteroids such as dexamethasone (Decadron) and prednisone (Deltasone)

diabetes medications such as: glipizide (Glucotrol), glyburide (Micronase, DiaBeta), metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), acarbose (Precose), and repaglinide (Prandin)

digitalis, digoxin (Lanoxin), digitoxin (Crystodigin)

ergotamine (Ergomar, DHE-45, Migranal)

halothane (a type of anesthetic)

guanethidine (Ismelin)

MAO inhibitor antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) (Do not take an MAO inhibitor and this medicine within 14 days of each other)

oxytocin (Pitocin, Syntocinon)

pseudoephedrine (found in many cough and cold formulas such as Sudafed) reserpine (Serpasil)

theophylline.

Keep a list of all your medicines (prescription, nonprescription, supplements, natural remedies, and vitamins) with you. Be sure that you tell all health care providers who treat you about all the products you are taking.

Keep all natural remedies and medicines out of the reach of children.

Sincerely:

Joseph Saponaro, MD, DABIM, FACP, CPI, CCI, CCTI, CCRC, CCRP
Board Certified Internist, JPMC
Principal Investigator, DSI
Diplomat American Board of Internal Medicine
Fellow American College of Physicians
Certified Physician Investigator by the AAPP
Certified Clinical Investigator by the DIA
Certified Clinical Trial Investigator by the ACRP
Certified Clinical Research Coordinator by the ACRP
Certified Clinical Research Professional by SoCRA
Member: The American College of Preventive Medicine
Founder, www.CertifiedResearchers.com
Member, Jupiter Medical Center IRB
Expert Medical Witness, www.ExpertMD.MD

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