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Ephedra (Ephedra spp.), ma huang

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Also listed as: Ma huang
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Attribution

Related Terms
  • 6-hydroxykynurenic acid, amp II, amsania, brigham tea, budshur, cao ma huang (Chinese), cathine, chewa, Chinese ephedra, Chinese joint fir, D-pseudoephedrine, desert herb, desert tea, dextro-rotatory, Ephedra altissima, Ephedra americana, Ephedra anti-syphilitica, Ephedra distachya, Ephedra equisetina, Ephedra fasciculata, Ephedra geradiana, Ephedra helvetica, Ephedra intermedia, Ephedra major, Ephedra nevadensis, Ephedra shennungiana, Ephedra sinica, Ephedra trifurca, Ephedra viridis, Ephedra vulgaris, Ephedraceae (family), ephedra herba, ephedrae herba, ephedrine, ephedrine alkaloids, epitonin, European ephedra, Gnetales, herba ephedrae, herbal ecstasy, horsetail, hum, huma, Indian joint fir, intermediate ephedra, isoephedrine, joint fir, khama, khat, L-ephedrine, levo-rotatory ephedrine, mahoŕng, máhuáng, mahuuanggen, Mao (Chinese), mao-kon, methylephedrine, methylpseudoephedrine, Mexican tea, môc tac ma hoŕng, Mongolian ephedra, Mormon tea, mu-tsei-ma-huang, muzei mu huang, natural ecstasy, norephedrine, norpseudoephedrine, phenylpropanolamine, phok, popotillo, pseudo-ephedrine, pseudoepehdrine, quinoline, san-ma-huang, sea grape, shrubby, soma, song tuę ma hoŕng, squaw tea, synephrine, tannins, teamster's tea, trun aa hoŕng, tsao-ma-huang, tutgantha, yellow astringent, yellow horse, zhong ma huang.
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  • Note: There are approximately 40 species of ephedra.

Background
  • In 2003, there was a death of a U.S. major league baseball pitcher which was thought to be related to ephedra. The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths. On February 6, 2004, the FDA issued a rule prohibiting the sale of dietary supplements containing ephedrine alkaloids (ephedra). This rule was issued because supplements with ephedra present a serious risk of illness or injury.
  • In 2005 this rule was struck down in Utah but reversed again four months later. Ephedra is currently banned throughout the United States. It remains unclear whether ephedra will re-appear on the market, despite serious safety risks, including heart events or death.
  • Ephedra sinica, a species of ephedra (ma huang), contains ephedrine and pseudoephedrine. Ephedra has been found to stimulate the nervous system, increase airflow into the lungs and constrict blood vessels. In combination with caffeine, ephedra appears to cause weight loss. However, effects of ephedra or ephedrine monotherapy have been mixed. Ephedrine has been widely studied for asthma and low blood pressure. However, quality research of commercial supplements with ephedra is lacking.
  • Major safety concerns have been associated with ephedra or ephedrine use, including high blood pressure, increased heart rate, nervous system excitation, irregular heartbeat, heart attack, and stroke.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


In human research, ephedra caused weight loss when used in combination with caffeine. The research on ephedra alone is limited and results are mixed. The amounts of ephedra in commercially available products varied widely and numerous adverse effects have been reported. Further research is necessary.

B


Early studies suggest that ephedrine nasal spray may help treat symptoms of nasal allergies. Additional research is needed before a firm conclusion can be made.

C


Ephedra contains the chemicals ephedrine and pseudoephedrine, which are bronchodilators (expand the airways for easier breathing). It has been used and studied to treat asthma and chronic lung diseases in both children and adults. Other treatments, such as inhalers (for example albuterol), are more commonly recommended due to safety concerns with ephedra or ephedrine. Further research is needed.

C


Early research demonstrates mixed findings regarding the effects of ephedra on athletic performance. Further research is needed in this area.

C


Chemicals in ephedra may stimulate the heart, increase heart rate, and raise blood pressure. Ephedrine, a component of ephedra, is sometimes used in hospitals to help control blood pressure. However, the effects of over-the-counter ephedra supplements lack sufficient study. Further research is needed.

C


Limited research shows that ephedra in combination with other herbs commonly used in traditional Chinese medicine (TCM) may be beneficial for infections of the upper respiratory tract (nose, throat, and mouth). Further research of ephedra alone is needed before conclusions can be made.

C


Early research suggests that ephedra may increase sexual arousal in women. Further well-designed research is needed to confirm these results.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Alertness, anaphylaxis (a severe allergic reaction), anti-inflammatory, antiviral, appetite suppressant, arthritis, bed-wetting, body building, colds, cough, depression, diaphoretic (causing sweating), diuretic (increasing urine flow), fatigue, fevers, flu, gonorrhea, gout, hives, joint pain, kidney disease, kidney inflammation, liver spots, metabolic enhancement, narcolepsy (daytime sleep attacks), nasal congestion, neuromuscular disorders (nerve and muscle disorders), shortness of breath, skin conditions (freckles), stimulant, swelling, syphilis, uterine stimulant, water retention.

Dosing

Adults (18 years or older)

  • Note: The U.S. Federal Government has banned the sale of ephedra since 2004. Ephedra may cause serious adverse effects at any dose, particularly when used with other drugs, such as caffeine. Because of serious safety concerns, ephedra cannot be suggested in any dose.
  • Traditionally, herbalists have suggested a wide range of doses (8-100 milligrams ephedra by mouth three times daily). Previously, over-the-counter drugs containing ephedra advised taking 12.5-25 milligrams ephedra by mouth every four to six hours and not to exceed 150 milligrams in 24 hours.
  • For allergic nasal symptoms, a 1% ephedrine-saline liquid has been used as a nose wash every 48 hours for four weeks.
  • For athletic performance enhancement, 1 milligram of ephedrine per kilogram body weight has been taken by mouth 90 minutes prior to exercise once weekly for four weeks.
  • For low blood pressure, 5-45 milligrams ephedrine has been injected into the vein or muscle.
  • For sexual arousal, 50 milligrams of ephedrine sulfate has been taken by mouth prior to exposure to erotic stimuli.
  • For weight loss, 2 grams of ephedra extract has been taken by mouth three times daily for eight weeks, 20-50 milligrams of ephedrine has been taken by mouth three times daily for 2-3 months.

Children (younger than 18 years)

  • Ephedrine is not recommended in children due to the risk of toxicity and death.
  • For asthma, 24-25 milligrams ephedrine or 0.65-2.1 milligrams ephedrine per kilogram has been taken by mouth every 6-8 hours for 1-8 weeks.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in people with a known allergy or sensitivity to ephedra, ephedrine, or pseudoephedrine (Sudafed®). Signs of allergy may include rash, itching, or red, flaking skin.

Side Effects and Warnings

  • The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths. The U.S. Federal Government has banned the sale of ephedra in the United States since 2004.
  • Ephedra may affect blood sugar levels. Caution is advised when using medications that may also affect blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Ephedra may cause high blood pressure. Caution is advised in people taking drugs that affect blood pressure.
  • Use cautiously in people sensitive to stimulants or in combination with other known stimulant agents (e.g. coffee).
  • Use cautiously in people with kidney, thyroid, liver, or peptic ulcer disease.
  • Use cautiously in people with heart disease, such as structural heart disease, irregular heart rhythms, clogged arteries, high blood pressure, stroke, or in those taking agents for the heart.
  • Use cautiously in people with glaucoma, problems with the stomach or intestines, or seizure disorders.
  • Use cautiously in people with depression, anxiety disorders, anorexia/bulimia, a history of suicidal ideation, or previous use of monoamine oxidase inhibitor (MAOI) anti-depressants.
  • Use cautiously in people that have difficulty urinating or have an enlarged prostate.
  • Avoid use during major medical procedures (such as surgery), as ephedra may decrease effectiveness of anesthetics. Discontinue use at least one week prior to major surgery or other procedures.
  • Avoid using doses higher than suggested or using for a long duration (over seven days), due to risk of toxicity.
  • Avoid use in children due to risk of toxicity and death.
  • Avoid use during pregnancy or breastfeeding since ephedra may pass into breast milk.
  • Avoid in people with known allergy or sensitivity to ephedra or its parts.
  • Adverse effects of ephedra may include abdominal discomfort, agitation, anxiety, blindness (transient), blood clots, bloody diarrhea, brain disease, breathing difficulties, changes in liver enzymes, chest tightness, clogged arteries, confusion, constipation, contractions of the uterus, damage, damage to the heart muscle, death, delirium, depression, diarrhea, dizziness, dry mouth, dull headedness, euphoria, exaggerated reflexes, excitation, fainting, fluid build-up in the lungs, hallucinations, headache, hearing loss, heart attack, heart problems, heartburn, inability to urinate, increased thyroid hormone, increased urination, inflammation of the heart, insomnia, irregular heart rhythms, irritability, liver damage, liver inflammation, loss of appetite, loss of consciousness, low potassium levels in the blood, kidney failure, kidney stones, mania, muscle aches, muscle breakdown, nausea, obsessive-compulsive disorder (OCD), organ failure, overly active reflexes, painful urination, Parkinson's disease-like symptoms, psychosis, rapid heartbeat, restlessness, satiety, seizures, shortness of breath, skin inflammation, skin tingling, spasm in blood vessels, stomach pain, stroke, suicidal ideas, tiredness, tremor, vomiting, weakened and enlarged heart, weakness, and weight loss.

Pregnancy and Breastfeeding

  • Avoid in pregnant and breastfeeding women. Ephedra may cause uterine contractions or problems in babies such as crying, increased heart rate, irritability, and sleep difficulties.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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