Ephedra

Background

• Ephedra is a low evergreen shrub with small, scaly leaves. The herb usually comes from the stem and branches of the Ephedra sinica species. 
• Ephedra has a long history of medicinal use in China and India to treat colds, fever, headaches, congestion, coughing, wheezing, and other conditions.
• The U.S. Food and Drug Administration (FDA) banned the sale of dietary supplements containing ephedrine alkaloids (stimulant compounds found in Ephedra sinica and some other plants) in the United States in 2004. Prior to the ban, ephedra was an ingredient in some dietary supplements promoted for weight loss, increased energy, and enhanced athletic performance. 

How Much Do We Know?

• Almost no new research on ephedra in people has been performed in the years since its use in dietary supplements was banned in the United States. Prior to the ban, substantial research had been done on ephedra’s short-term effects on weight loss and its harmful effects.

What Have We Learned?

• Prior to the ban, research showed that dietary supplements containing ephedrine alkaloids (usually in combination with caffeine) had modest short-term effects on weight loss. However, this benefit was considered insufficient to outweigh the serious risks of these supplements. No studies had assessed long-term effects on weight. The evidence regarding athletic performance was insufficient to allow any conclusions to be reached.

What Do We Know About Safety?

• The FDA has banned dietary supplements containing ephedrine alkaloids because they have serious safety risks. Even in relatively low doses and short-term use, ephedra has been linked to harmful effects like high blood pressure, heart attack, seizure, stroke, and psychosis. Ephedra can be life-threatening or disabling in some people. 
• Ephedra can also cause anxiety, dizziness, dry mouth, headache, heartburn, insomnia, irritability, nausea, personality changes, and other symptoms. 
• It isn’t possible to determine who would be at the greatest risk of using ephedra today. There are theoretical reasons to suspect that ephedra might interact with other stimulants like caffeine. People with conditions like cardiovascular disease have also been considered at higher risk for severe harm. 
• The use of ephedra during pregnancy or while breastfeeding is considered unsafe. It’s also considered unsafe for children.

Keep in Mind

• Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.
• Federal Regulation of Herbal Products
  • Depending on what’s in them, how they’re intended to be used, and how they’re administered (orally or topically), herbal products are regulated in a variety of ways. Many herbal products intended for oral use are marketed as dietary supplements. The rules for making and distributing dietary supplements are less strict than those for drugs.
  • Unlike drugs, dietary supplements are not approved by the U.S. Food and Drug Administration (FDA) before they are sold to the public. When public health concerns arise about the safety of a dietary supplement or an ingredient including an herb, the FDA can take action to protect the public. Manufacturers and distributors of supplements are responsible for evaluating the safety and labeling of their products before marketing to ensure that they meet all regulatory requirements.

For More Information

• Using Dietary Supplements Wisely
• Know the Science: How Medications and Supplements Can Interact
• Know the Science: How To Make Sense of a Scientific Journal Article

Key References