#indian jointfir

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Ephedra

Scientific Names: Ephedra sinica Other Common Names: Ma huang, Indian jointfir Overall Safety: 🙁  

Therapeutic Efficacy and Considerations:

Weight Loss: 🙁 Ephedra alone has never been examined for efficacy with weight loss. Most of the “clinical evidence” touted by manufacturers used pharmaceutical ephedrine and caffeine combinations. Three published trials have compared combination products containing ephedra and herbal caffeine sources against placebo for weight loss. Although all did find a greater effect than placebo, the extent was small; most ephedra combination groups only averaged 1-2 kilograms more weight lost than the placebo groups. The safety concerns, as well as the current legal standing, of ephedra vastly outweigh the definite but small benefit of use.

Athletic Performance: 🙁 Ephedra alone, or ephedra with herbal caffeine sources, has never been studied for increasing athletic performance. Trials performed with pharmaceutical ephedrine and caffeine had inconsistent results – some found small increases in performance or time to exhaustions, while others hound no benefit. All noted significant adverse events. The evidence does not support use.

Even though ephedra is now banned in the US, these products will still be obtainable via mail and internet sources. Patients should be strongly discouraged from buying and using ephedra products for any indications and should be counseled that the use of combination products that contain caffeine or other stimulants further increases the risk of serious adverse events.

Chemistry/Pharmacology: Ephedra is a natural source of ephedrine alkaloids. Although ephedrine is the primary alkaloid discussed, the plant also contains pseudoephedrine, norephedrine, norpseudoephedrine, phenylpropanolamine, methylephedrine, and many others in varying amounts. The percentage of alkaloid content varies among the different species with Ephedra sinica having the highest content, up to 2.5%. The ephedrine alkaloids are sympathomimetics and cause vasoconstriction and bronchodilation and increases in blood pressure and heart rate. Other effects noted are variable actions on blood glucose and uterine stimulation and possibly increased platelet aggregation. Ephedra can worsen urinary retention, although it does seem to have mild diuretic action. Ephedra is often used in combination products along with caffeine, which increase stimulatory effects and increases the risk of adverse events.

Drug Interactions: May interact with CNS stimulants, MAOIs, BETA-BLOCKERS (increases sympathomimetic effects because alpha agonist effects are not opposed), ERGOT alkaloids, ANTIARRHYTHMICS, ANTIHYPERTENSIVES, and PHENOTHIAZINES (causes tachycardia and hypotension due to blocking of alpha-adrenergic effects). May potentiate the actions of thyroid supplements. May decrease the action of hypoglycemic agents. May increase the risk of psychosis when used with alcohol.

Contraindications/Precautions: Ephedra has been banned due to its association with deaths from stroke and myocardial infarction. Its use is still permitted by Traditional Oriental Medicine practitioners for the treatment of asthma and bronchial conditions. Ephedra is contraindicated in pregnancy, in children, and in patients with heart disease or hypertension, psychiatric disorders, glaucoma, BPH, urinary retention, or kidney disease.

Adverse Effects: Adverse effects that are serious and can be fatal include stroke, myocardial infarction, cerebral vasculitis, myocarditis, seizure, psychosis, mania, rhabdomyolysis, eosinophilia myalgia syndrome, and nephrolithiasis. Other adverse effects include insomnia, increased heart rate and palpitations, nausea, vomiting, diarrhea, urinary retention, anxiety, and fever. Note: A review of reports from Poison Control Centers found that ephedra-containing products, 0.82% of all herbal product sales, were responsible for 64% of adverse reactions associated with herbs.