Ephedra

Various ephedrine-containing Ephedra species have been used since antiquity for the treatment of the common cold, asthma, bronchitis and nasal congestion. While there are no data from clinical trials to substantiate these claims, two of the primary active constituents of Ephedra , ephedrine, and pseudoephedrine, have been approved by the FDA as ingredients in over-the-counter drugs for bronchodilation, decongestant and anti-allergic activity. Depending on the dose administered both ephedrine and pseudoephedrine can have strong stimulating activities on the central nervous system. Therefore, preparations containing Ephedra must be recognized as a drug with poten- tially serious side effects when administered in higher than the recommended dose, or if abused. The dosage range of Ephedra containing products is dependent upon the ephedrine concentration of the product. The single dose for adults should correspond to 15–30 mg total alkaloid, calculated as ephedrine, with a maximum of 300 mil- ligrams total alkaloid per day, calculated as ephedrine. For children, the single dose is 0.5 milligrams total alkaloid per kg bogy weight, to a maximum of 2 mg total alka- loid per kg of body weight. The adverse reactions associated with the ingestion of Ephedra and ephedrine-containing products include nervousness, headaches, insom- nia, dizziness, palpitations, skin flushing and tingling, and vomiting. The principal adverse effects of ephedrine are CNS stimulation, nausea, tremors, tachycardia and urinary retention. As with all other products containing ephedrine, Ephedra prepara- tions should not be administered to patients with coronary thrombosis, diabetes, glau- coma, heart disease, hypertension, thyroid disease, impaired circulation of the cerebrum, pheochromocytoma or enlarged prostate. Ephedra preparations should not be administered during pregnancy or nursing. Adverse drug interactions have been reported when Ephedra is used in combination with cardiac glycosides, halothane, guanethidine, monoamine oxidase inhibitors, ergot alkaloid derivatives or oxytocin.