Ephedra Ban: Evidence of Harm

by Food and Drug Administration (FDA)

The Food and Drug Administration has banned the sale of dietary supplements containing ephedra (ephedrine alkaloids) due to concerns over their cardiovascular effects, including increased blood pressure and irregular heart rhythm. The final rule, published Feb. 6, 2004, becomes effective on April 12, 2004.

"This FDA rule reflects what the scientific evidence shows — that ephedra poses an unreasonable risk to those who use it," Health and Human Services Secretary Tommy G. Thompson said. "The regulations prohibit the sale of dietary supplements containing ephedra, and we intend to take swift action against anyone who puts consumers at risk by continuing to sell such products after the prohibition takes effect."

The action banning ephedra, often referred to as ma huang, marks the first time that the FDA is taking formal action to halt the sale of a dietary supplement ingredient since passage of the Dietary Supplement Health and Education Act (DSHEA) in 1994.

Ephedra is a naturally occurring substance found in plants. Its principal active ingredient is ephedrine, an amphetamine-like compound that potentially has powerful stimulant effects on the nervous system and heart. Like an amphetamine, ephedra increases both blood pressure and heart rate, decreases appetite, and makes the user feel energetic.

In synthetic form, ephedrine is regulated as a drug under the Federal Food, Drug and Cosmetic Act (FD&C Act), and is allowed as an ingredient in over-the-counter drugs to treat asthma, nasal congestion, and minor eye irritation. In recent years, however, dietary supplement products containing botanical ephedra, often in combination with caffeine, another type of stimulant, have been promoted to help people lose weight and enhance sports performance and energy. At the same time, ephedra has been suspected of causing unreasonable health risks or injuries.

Evidence of Harm

There is strong scientific evidence of harm associated with the use of ephedra products. The FDA has been reviewing information for many years about ephedra's effects in the body, its safety and effectiveness, and the adverse event reports associated with its use. The agency found that supplements containing ephedra show little evidence of effectiveness, except for short-term weight loss. The agency also found that the herbal substance raises blood pressure and stresses the circulatory system. These reactions have been linked to serious health problems, including heart ailments and strokes.

One review sponsored by the National Institutes of Health concluded that ephedra is associated with higher risks of mild-to-moderate heart palpitations, psychiatric and upper gastrointestinal effects, and symptoms of hyperactivity of the autonomic nervous system, such as tremor and insomnia, especially when taken with caffeine and other stimulants. Another review showed that, for people taking more than 32 milligrams daily, the rate of hemorrhagic (bleeding) strokes among ephedra users was significantly higher than that recorded for non-users. Some ephedra-containing dietary supplement labels recommend daily doses of up to 100 milligrams.

Additionally, a study of calls to poison control centers revealed a disproportionate rate of reactions to ephedra relative to other herbal products. In short, the evidence shows that ephedra is associated with an increased risk of alarming side effects, possibly even deaths.

The Dietary Supplement Law

A dietary supplement is a product taken by mouth that contains a dietary ingredient, such as a vitamin, mineral, herb, other botanical, or amino acid. Substances intended to supplement the diet, such as enzymes, organ tissues, glandulars, and metabolites, also fall in this category. Dietary supplements can be extracts or concentrates, and may be found in many forms, such as tablets, capsules, softgels, gelcaps, liquids, or powders. People take dietary supplements for many reasons, including weight loss, energy, disease prevention and management, and health maintenance.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.