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JAMA Patient Page
March 26, 2003

Ephedra and Ephedrine

JAMA. 2003;289(12):1590. doi:10.1001/jama.289.12.1590

Ephedra is a plant-based substance from the herb Ephedra sinica. Ephedra is used in many over-the-counter weight loss products. It is also used by some athletes who believe it can improve their performance. It may be combined with herbs containing caffeine (such as guarana) or with other substances in these supplements. Ephedra, also known as ma huang, has also been used in traditional Chinese medicine to treat asthma or other lung problems. Because ephedra is marketed by companies as a supplement (not a drug to treat a disease), the US Food and Drug Administration (FDA) does not regulate its use. However, many serious adverse (bad) effects related to ephedra use have been reported. Recent research has shown that use of ephedra appears to be more risky than use of other herbal preparations.

The March 26,2003, issue of JAMA includes an article about the efficacy and safety of ephedra and ephedrine.


Ephedrine is a chemical contained in the ephedra herb. Ephedrine has medical uses, mostly in operating rooms and intensive care units. Its chemical properties raise blood pressure and heart rate and open up the large air passages in the lungs. Ephedrine is safe when used under the supervision of a doctor and with proper monitoring of the patient. Ephedrine has also been used as a weight loss product and by athletes who believe it makes them stronger or have more energy and endurance. However, this has not been proven and this type of unmonitored use for nonmedical reasons may not be safe.

Possible adverse effects of ephedra and ephedrine

  • �Elevated blood pressure

  • Palpitations

  • Headache

  • Nausea

  • Agitation or restlessness

  • Psychiatric disturbances

  • Heart attack

  • Stroke

  • Death

Individuals with very high risks for adverse effects include children younger than 18 years; women who are pregnant or nursing; individuals who have health conditions such as high blood pressure, heart disease, eizure disorder, depression, diabetes, thyroid or liver disorders; and those who are using prescription medicines.

For anyone, the risks of bad effects from ephedra or ephedrine products far outweigh the possible minimal benefits. Products that are natural or plant-based are not necessarily safe just because they come from plants. Plants produce chemicals that can be dangerous and may interact with other medications you are taking. Discuss with your doctor any herbal or plant-based products you use.

Reporting adverse events

If you believe you have experienced a harmful side effect from ephedra or ephedrine, you or your doctor should report it to the FDA. The FDA has a hotline called MEDWATCH (800/FDA-1088) for reporting problems connected with the use of supplements, drugs, or medical devices. Your identity will be kept confidential. You may also use the FDA Web site (see For More Information) to access MEDWATCH for online reporting.

For more information

Inform yourself

To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's Web site at http://www.jama.com. They are available in English and Spanish.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any other print or online reproduction is subject to AMA approval. To purchase bulk reprints, call 718/946-7424.

Sources: US Food and Drug Administration, US Department of Health and Human Services, National Center for Complementary and Alternative Medicine, National Institutes of Health