Side effects associated with ephedra include anxiety, confusion, dependency, dizziness, headache, insomnia, irritability, mania, motor restlessness, nervousness, psychosis, seizure, arrhythmias, cardiac arrest, hypertension, hypotension, MI, palpitations, stroke, tachycardia, nausea, constipation, uterine contractions, urinary disorders, hyperglycemia, hypoglycemia, and dermatitis.
When used with beta blockers such as propranolol, ephedra may enhance sympathomimetic effects on vasculature from unopposed alpha-agonist effects, thus increasing risk of hypertensive effects. Concurrent use with cardiac glycosides or halothane may disturb heart rhythm. Additive pharmacodynamic effects may be seen when ephedra is used with CNS stimulants such as dextroamphetamine. An increased sympathomimetic effect may be observed with guanethidine. MAO inhibitors used with ephedra may pose risk of hypertensive crisis. Oxytocin and secale alkaloid derivatives can also increase blood pressure. Concurrent use with theophylline may increase risk of GI and CNS adverse effects. When ephedra is used with caffeine or yohimbe, an additive sympathomimetic and CNS stimulation may be noted.
Pregnant patients should avoid use because of the risk of inducing uterine contractions and the unknown effects of the herb on the fetus. Those with glaucoma, pheochromocytoma, thyrotoxicosis, underlying CV disease, or a history of cerebrovascular disease should avoid use. Diabetic patients should avoid use because of potential hyperglycemic effects. Those with sleep, mood, anxiety, and psychotic disorders should use with caution.
Safety Risk Pills containing ephedra have been combined with other stimulants like caffeine and sold as "natural" stimulants in weight-loss products. Deaths from overstimulation have been reported.
Clinical considerations
Compounds containing ephedra have been linked to several deaths and more than 800 adverse effects, many of which appear to be dose related.
Monitor patient's pulse and blood pressure.
Ephedra shouldn't be used for more than 7 consecutive days because of the risk of tachyphylaxis and dependence.
Patients with eating disorders may abuse this herb.
Signs and symptoms of toxic reaction include diaphoresis, dilated pupils, muscle spasms, fever, and cardiac and respiratory failure.
If overdose occurs, perform gastric lavage and administer activated charcoal. Treat spasms with diazepam, replace electrolytes with LV. fluids, and prevent acidosis with sodium bicarbonate infusions.
Advise patient not to use this herb in place of getting the proper medical evaluation of a prolonged illness.
Advise patient with thyroid disease, hypertension, CV disease, or diabetes to avoid using ephedra.
Advise patient to watch for adverse reactions, particularly chest pain, shortness of breath, palpitations, dizziness, and fainting.
Instruct patient to store ephedra away from direct light.
Advise patient to keep this and other herbal products out of children's reach.
Tell patient to remind pharmacist of any herbal or dietary supplement that he's taking when obtaining a new prescription.
Advise patient to consult his health care provider before using an herbal preparation because a conventional treatment with proven efficacy may be available.
Safety Risk Dosages high, enough to produce psychoactive or hallucinogenic effects are toxic to the heart and shouldn't be used.
by Franchis Adam
