Ephedra, Ma huang : Interactions

by MedlinePlus

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Interactions with Drugs

Many drugs can cause increased stimulation when used with ephedra or ephedrine. Examples include caffeine and theophylline. When combined with ephedra, these drugs may lead to difficulty sleeping, nervousness, or stomach upset. The combination of ephedrine and caffeine may be fatal. Many products contain both ephedrine and caffeine and should be used with caution, if at all.

Combined ingestion of caffeine and ephedrine has been observed to increase blood glucose and lactate concentrations. Ephedrine and dopamine concentrations are significantly increased. A case report exists of Ephedra use associated with the onset of psychosis and autonomic hyperactivity after administration of risperidone.

Bronchodilators used for asthma or the decongestant pseudoephedrine (Sudafed®) may have increased bronchodilating effects when used with ephedra.

If ephedra is taken with monoamine oxidase inhibitor antidepressants, such as isocarboxazid (Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®), severe side effects may develop, including dangerously high blood pressure, muscle damage, fever, and irregular heart rate. Other antidepressants and medications for psychiatric disorders (phenothiazines, tricyclics) may reduce the effects of ephedra and cause low blood pressure and rapid heartbeat.

Because ephedra affects blood pressure and heart rate, it may alter the effectiveness of medications given to control blood pressure or heart rhythm, including digoxin, alpha-blockers, beta-blockers, diuretics, calcium-channel blockers, or angiotensin converting enzyme (ACE) inhibitors. The side effects of ephedra may be worsened by guanethidine, ergot alkaloids (bromocriptine, dihydroergotamine, ergotamine), oxytocin (Ptosin®), diuretics, morphine, and anesthetic drugs (halothane, cyclopropane, propofol).

Ephedra products should be stopped 24 hours prior to surgery.

Ephedra may lower blood sugar levels, although ephedra-caffeine combinations may increase blood sugar. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

Ephedra may reduce the effects of steroids such as dexamethasone. Ephedra may increase serum levels of thyroid hormones and may alter thyroid hormone treatments. Medications that alter the acidity of urine may reduce the effectiveness of ephedra.

Effects of cholesterol lowering medications may be altered by ephedra, although this has not been proven. One study of Metabolife 356, a product containing ephedra and multiple other ingredients, was associated with heart rhythm abnormalities (arrhythmias, QT prolongation) and may therefore interact with other agents with similar side effects like haloperidol (Haldol®) and metoclopramide (Reglan®).

Phenylpropanolamine, previously removed from the US market, may lead to additive effects if taken with ephedra.

Interactions with Herbs and Dietary Supplements

The stimulant effects of ephedra may be increased when combined with herbs and supplements that have stimulant properties or with supplements that contain caffeine, such as guarana, cola nut, and yerba mate. Commercially available products may contain combinations of ephedrine and caffeine or guarana. Ephedra may alter thyroid hormones and should be used cautiously with other herbs or supplements that affect thyroid hormones, such as bladderwrack (seaweed, kelp).

Ephedra may decrease the effectiveness of cardiac glycosides, such as adonis, balloon cotton, black hellebore root/melampode, black Indian hemp, bushman's poison, Cactus grandifloris , convallaria, eyebright, figwort, foxglove/digitalis, frangipani, hedge mustard, hemp root/Canadian hemp root, king's crown, lily-of-the-valley, motherwort, oleander leaf, pheasant's eye plant, plantain leaf, pleurisy root, psyllium husks, redheaded cotton-bush, rhubarb root, rubber vine, sea-mango, senna fruit, squill, strophanthus, uzara, wallflower, wintersweet, yellow dock root, or yellow oleander.

Ephedra may raise blood pressure and may increase the blood pressure-raising effects of herbs such as American ginseng, arnica, bayberry, betel nut, blue cohosh, broom, cayenne, cola, coltsfoot, ginger, licorice, Polypodium vulgare , and yerba mate. Similarly, ephedra may lessen the effects of blood pressure-lowering herbs such as aconite/monkshood, arnica, baneberry, betel nut, bilberry, black cohosh, bryony, calendula, California poppy, coleus, curcumin, eucalyptol, eucalyptus oil, evening primrose oil, flaxseed, garlic, ginger, ginkgo, goldenseal, green hellebore, hawthorn, Indian tobacco, jaborandi, mistletoe, night blooming cereus, oleander, pasque flower, periwinkle, pleurisy root, shepherd's purse, Texas milkweed, turmeric, and wild cherry.

Ephedra may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment. Some examples include Aloe vera , American ginseng, bilberry, bitter melon, burdock, fenugreek, fish oil, gymnema, horse chestnut seed extract (HCSE), marshmallow, milk thistle, Panax ginseng, rosemary, Siberian ginseng, stinging nettle, and white horehound.

Ephedra may increase the diuretic effects of herbs such as artichoke, celery, corn silk, couchgrass, dandelion, elderflower, horsetail, juniper berry, kava, shepherd's purse, uva ursi, and yarrow.

Combining ephedra with herbs that have possible monoamine oxidase inhibitor (MAOI) antidepressant activity may cause severe side effects, including dangerously high blood pressure, muscle breakdown, fever, and irregular heartbeats. Herbs and supplements with possible MAOI effects include 5-HTP (5-hydroxytryptophan), California poppy, chromium, DHEA (dihydroepiandrosterone), DLPA (DL phenylalanine), evening primrose oil, fenugreek, Ginkgo biloba , hops, mace, St. John's wort, SAMe (S-adenosylmethionine), sepia, tyrosine, valerian, vitamin B6, and yohimbe bark extract.

Effects of cholesterol lowering herbs and supplements may be altered by ephedra, although this has not been proven. One study of Metabolife 356, a product containing ephedra, shows that it may cause heart rhythm abnormalities (arrythmias, QT prolongation) and may therefore interact with other agents with similar side effects.

Interactions with Foods

Ephedra and caffeine may curb appetite. Caffeine-containing foods in combination with ephedra may increase the risk of negative effects on the heart or the nervous system and may cause psychiatric changes. In several cases, the use of caffeine and ephedrine is reported to result in death.

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