Ephedra (Ma-Huang)

________________________________________________________________________

KEY POINTS

• This remedy has been used to treat several conditions. The FDA has ruled that ephedra is a health risk. Before using this remedy, you should talk with your healthcare provider.
• The US Food and Drug Administration (FDA) does not approve uses for natural remedies. The FDA does not inspect or regulate natural remedies the way they do prescription medicines. Natural remedies are not always safe.
• This remedy may cause severe and life-threatening side effects. Tell your healthcare provider if you have any side effects that are serious, continue, or get worse.
• This remedy affects your body and may interact with prescription medicines that you take. Tell all healthcare providers who treat you about all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take.

________________________________________________________________________

WARNING: The FDA has ruled that ephedra is a health risk. Severe side effects and drug interactions (some life-threatening) have been reported with the use of ephedra. ALWAYS check with a healthcare provider before taking any product that contains ephedra. Traditional Chinese natural remedies and natural teas are the only products in the US that may still contain ephedra. (The Chinese name for ephedra is ma-huang.)

What are other names for this remedy?

Type of medicine: natural remedy

Scientific and common names: Ephedra sinica, Ephedra gerardiana, Ephedra distachya, Ephedra equisetina, Ephedra shennungiana, Ephedra herba, Ephedra sinesis, Ephedra vulgaris, Ephedra intermedia, ephedra, ma-huang, desert herb, joint fir, popotillo, sea grape, teamster's tea

What is ephedra (ma-huang)?

Ephedra is a shrub. The dried young branches of the ephedra shrub are used medicinally.

What is it used for?

Ephedra has been suggested as a treatment for many conditions, but there is no safe use for ephedra. The active ingredient in ephedra is a stimulant of the heart, lungs, and central nervous system. Ephedra can increase risk of stroke, seizure, and heart attack and may result in death.

Ephedra use is banned by the National Collegiate Athletic Association, International Olympic Committee, and National Football League.

The US Food and Drug Administration (FDA) does not approve uses for natural remedies. The FDA does not inspect or regulate natural remedies the way they do prescription medicines.

How is it taken?

Ephedra may be taken as a tablet, capsule, or liquid. It can also be prepared as a tea to drink. Follow the directions printed on the product label or given by your healthcare provider.

What if I overdose?

If you or anyone else has intentionally taken too much of this remedy, call 911 or go to the emergency room right away. If you pass out, have seizures, weakness or confusion, or have trouble breathing, call 911. If you think that you or anyone else may have taken too much of this remedy, call the poison control center. Do this even if there are no signs of discomfort or poisoning. The poison control center number is 800-222-1222.

Symptoms of an acute overdose may include: tremors, fast or irregular heartbeat, restlessness, nervousness, confusion, diarrhea.

What should I watch out for?

Do not take ephedra if you have:

• Chest pain (angina)
• Diabetes
• Glaucoma
• Heart disease or irregular heartbeat
• High blood pressure
• Kidney stones
• A movement or muscle disorder
• Pheochromocytoma (tumor of the adrenal gland)
• Problems with anxiety
• Seizures
• Thyroid problems
• Trouble sleeping

Do not take this remedy if you are pregnant or breast-feeding. It may cause premature labor.

If you have diabetes: This medicine may affect your blood sugar level and change the amount of insulin or other diabetes medicines you may need. Talk to your healthcare provider about this.

If you need emergency care, surgery, lab tests, or dental work, tell the healthcare provider or dentist you are taking this medicine.

Talk to your healthcare provider or pharmacist about any natural remedy that you are using or thinking about using. If your provider does not tell you how to take it, follow the directions that come with the package. Do not take more or take it longer than recommended. Ask about anything you do not understand. Remember:

• Natural remedies are not always safe.
• You should not take them if you are pregnant or breast-feeding without your healthcare provider's approval. They should not be taken by infants, children, or older adults without your provider's approval.
• They affect your body and may interact with prescription medicines that you take.
• Natural remedies are not standardized and may have different strengths and effects. They may be contaminated.

What are the possible side effects?

Along with its desirable effects, this remedy may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the remedy. Tell your healthcare provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; trouble breathing; chest pain or tightness in your chest; swelling of your lips, tongue, and throat); sudden weakness, numbness, or tingling, especially on one side of your body; sudden or severe headache; sudden trouble with vision, speech, balance, or walking.

Serious (Report these to your healthcare provider right away.): Symptoms of hypoglycemia: shaking, anxiety, cold sweats, irritability, fast heartbeat, feeling faint, strong hunger, vision problems, headache, nausea, slurred speech, confusion, unusual mood changes, tingling in the lips or tongue, weakness; trouble urinating; nosebleeds; unexplained muscle pain; fast or irregular heartbeat; shortness of breath; seizures; fainting.

Other: Minor headache, irritability, confusion, nausea, restlessness, vomiting, trouble sleeping, loss of appetite, trouble concentrating, dry mouth, flushing, stomach pain.

What products might interact with this remedy?

When you take this remedy with other medicines, it can change the way the remedy or the medicines work. Vitamins and certain foods may also interact. Using these products together might cause harmful side effects. Do NOT take ephedra if you are also taking:

• Antipsychotic medicines such as asenapine (Saphris), chlorpromazine, haloperidol (Haldol), iloperidone (Fanapt), olanzapine (Zyprexa), paliperidone (Invega), pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine, trifluoperazine, and ziprasidone (Geodon)
• Antiseizure medicines such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), gabapentin (Neurontin), phenobarbital, phenytoin (Dilantin, Phenytek), primidone (Mysoline), and valproic acid (Depacon, Depakene, Depakote)
• Bromocriptine (Cycloset, Parlodel)
• Diabetes medicines such as acarbose (Precose), glipizide (Glucotrol), glyburide (DiaBeta, Glynase), insulin, metformin (Fortamet, Glucophage, Riomet), pioglitazone (Actos), repaglinide (Prandin), and rosiglitazone (Avandia)
• Heart medicines such as amiodarone (Cordarone, Pacerone), digoxin (Lanoxin), disopyramide (Norpace), dronedarone (Multaq), eplerenone (Inspra), isosorbide (Dilatrate, Isordil, Monoket), procainamide, propafenone (Rythmol), quinidine, and ranolazine (Ranexa)
• MAO inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• Medicines that contain phenylephrine (Neo-Synephrine, Sudafed PE), pseudoephedrine (Sudafed), ephedrine, or caffeine (such as allergy, cold, or cough medicines, pain medicines, or diet pills)
• Medicines to treat breathing or lung problems such as albuterol (ProAir, Proventil, Ventolin), aminophylline, budesonide (Entocort, Rhinocort, Uceris), fluticasone (Flonase, Flovent, Veramyst), fluticasone/salmeterol (Advair), mometasone (Asmanex, Nasonex), salmeterol (Serevent), theophylline, and umeclidinium/vilanterol (Anoro Ellipta)
• Migraine medicines such as dihydroergotamine (D.H.E. 45, Migranal) and ergotamine (Ergomar)
• Natural remedies such as ginger, guarana, kola nut, mate, and yohimbe
• Nausea medicines such as dolasetron (Anzemet) and ondansetron (Zofran)
• Stimulants such as dextroamphetamine (Dexedrine), diethylpropion (Tenuate), and methamphetamine (Desoxyn)

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

---

Keep all natural remedies and medicines out of the reach of children.

This advisory includes select information only. The information was obtained from scientific journals, study reports, and other documents. The author and publisher make no warranty, expressed or implied, as to the information. The advisory may not include all side effects associated with a remedy or interactions with other medicines. Nothing herein shall constitute a recommendation for the use of any remedy. Ask your healthcare provider or pharmacist for more information.