Ephedrine HCL (ephedra) on Steroids Rx.com
|Ephedrine is an alkaloid which acts like a sympathomimetic agent. It was once used widely as an appetite suppressant and a nasal decongestant. It has a structure very similar to amphetamine. In Europe, Ephedrine was once widely extracted from the ephedra plant and used to treat a wide range of respiratory ailments. Herbs and supplements containing ephedrine were once widely available from many Chinese traditional health stores. The abuse of ephedrine containing products over the past 3 decades has led the FDA to limit its use as a nasal decongestant.|
|Today, the use of ephedrine is limited to the Intensive Care Unit. Rarely the drug is used to treat narcolepsy or nocturnal enuresis. However, the availability of safer agents has led to its demise in most of clinical medicine.|
|Ephedrine is also a potent thermogenic agent and thus widely used by people who want to lose weight. Body builders and athletes who want a surge of energy and burn fat frequently use ephedrine containing products.|
Ephedrine is a classical sympathomimetic agent with both alpha and beta adrenergic effects; it generally causes relaxation of smooth muscle in the bronchus and uterus. It also can increase blood pressure and raise the heart rate. Because of its alpha effects it also has the ability to release norepinephrine from the sympathetic nerve endings. Its action on the brain are similar to amphetamine but less pronounced. Ephedrine also increases break down of glycogen in the liver, increases oxygen consumption and metabolic rate.
|Ephedrine is usually used in the ICU to treat patients who have low blood pressure. The low blood pressure may be due to any number of causes including surgery, anesthesia, trauma, blood loss, spinal anesthesia, shock, drug induced or sepsis. The drug is also very useful in the treatment of acute asthmatic attacks but has been replaced by better and safer drugs. In the hospital setting, it is frequently administered as an intravenous or subcutaneous injection.|
The dose at which it increases blood pressure is between 25-50 mg. In many cases repeat dosing is required. When administered by subcutaneous or intramuscular route, the absorption is slow. The fastest response is seen when the drug is administered intravenously. The maximum does of ephedrine is about 150-200 mg/day. Ephedrine is never taken orally as it is not absorbed from the stomach.
|Ephedrine is generally a safe drug when used at therapeutic doses. However excessive doses can cause the following side effects:|
In some individuals ephedrine can cause severe increases in blood pressure which can result in bleeding inside the brain. Those patients with a history of coronary artery disease can develop a heart attack. Further, when very high doses are administered, the blood flow to the kidneys can be reduced, resulting in renal failure. There are also reports that ephedrine can cause dependence-both physical and mental. Deaths from heart attacks, strokes and aortic dissections have also been reported.
Over dosage generally occurs outside the hospital setting. Some individuals may inject themselves with too much ephedrine or may inject it directly into a vein. Intravenous injection of ephedrine outside the hospital setting is like taking a fully loaded gun, pointing it at the head and pressing the trigger. This drug should never be injected in a vein directly without monitoring equipment. Rarely over dosage from ephedrine can occur and can result in paradoxical hypotension. Other individuals will also develop a very fast heart rate, chest pain and shortness of breath. In all cases of over dosage, the drug should be stopped and supportive therapy should be initiated.
Any patient with a history of closed angle glaucoma should refrain from using ephedrine. Ephedrine should also be used with extreme caution in individuals who have thyroid gland hyperactivity, are pregnant or have coronary artery disease. Individuals who take certain anti depressant medications should also avoid ephedrine containing products.
Ephedrine products were once routinely advertised in health food stores, spas and cyberspace as great weight-loss supplements, energy boosters and alternatives to substances like amphetamine. Many of these products were not labeled and even the exact content of chemicals was unknown. Many consumers were led to believe that because ephedrine is a medical product, its quantity and quality was regulated. However, in the nutrient and food industry the majority of products are unregulated. Many products are mislabeled, others have contaminants added to the product and yet others are entirely fake. In fact, there are countless reports of Oriental products which have been labeled as containing benign herbs, but when analyzed have been found to contain potent levels of ephedrine, caffeine and a variety of other real medicines.
Despite all these concerns about product quality, the use of ephedrine is widespread. There are some who use it to lose weight, others use it to remain awake and yet others think it can revitalize the body. Ephedrine is widely used by the younger age group. There are many isolated case reports from high school teenagers and college students that ephedrine helps them study more by allowing them to be awake.
Ephedrine can easily be converted into amphetamine and thus, is a highly sought after product. This is one major reason why the FDA has banned the availability of ephedrine in most cough mixtures and asthma medication. The FDA has a ban on all alkaloids that contain ephedrine, irrespective of the use- thus ephedra and related products are illegal to possess and sell. Ephedrine is still legal for use in hospitals but its use is strictly monitored. All pharmacies who sell ephedrine also have to maintain records and are regularly audited by the FDA.
Despite these restrictions, ephedrine is widely abused by many individuals. Many sites on the internet continue to promote the drug by marketing it under different names or combining it with different products. The majority of States have made the selling and distribution of ephedrine over the internet unlawful. However, the herbal market still remains unregulated and alkaloids of every type- some which resemble ephedra- can still be bought relatively easily. Unfortunately, there are many individuals who are hooked on to the ephedrine hype and continue to abuse it.
DeWald T, Khaodhiar L, Donahue MP, et al. Pharmacological and surgical treatments for obesity. Am Heart J 2006 Mar; 151(3):604-24.
Docherty JR. Pharmacology of stimulants prohibited by the World Anti-Doping Agency (WADA). Br J Pharmacol 2008 Jun; 154(3):606-22.
Dwyer JT, Allison DB, Coates PM. Dietary supplements in weight reduction. J Am Diet Assoc 2005 May; 105(5 Suppl 1):S80-6.
Eccles R. Substitution of phenylephrine for pseudoephedrine as a nasal decongeststant. An illogical way to control methamphetamine abuse. Br J Clin Pharmacol 2006 Nov 20.
Jones G. Caffeine and other sympathomimetic stimulants: modes of action and effects on sports performance. Essays Biochem 2008.109-24.
Maughan RJ. Contamination of dietary supplements and positive drug tests in sport. J Sports Sci 2005 Sep; 23(9):883-9.
Pittler MH, Ernst E. Complementary therapies for reducing body weight: a systematicreview. Int J Obes (Lond) 2005 Sep; 29(9):1030-8.
Powers ME. Ephedra and Its Application to Sport Performance: Another Concern for the Athletic Trainer? J Athl Train 2001 10; 36(4):420-424.
Pyle KR. FDA v. ephedra: is it time to lift the ban? Food Drug Law J 2006; 61(4):701-51.
Ricaurte GA, McCann UD. Recognition and management of complications of new recreational drug use. Lancet 2005 Jun 18-24; 365(9477):2137-45.
Thevis M, Schänzer W. Examples of doping control analysis by liquid chromatography-tandem mass spectrometry: ephedrines, beta-receptor blocking agents, diuretics, sympathomimetics, and cross-linked hemoglobins. J Chromatogr Sci 2005 Jan; 43(1):22-31.