Hydrocortisone and Ma Huang: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Hydrocortisone
Ma Huang
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Decreased effectiveness of corticosteroids
Interaction Deep Dive
Ma huang (ephedra) is a natural source of ephedrine and pseudoephedrine2. Ma huang contains 0.5% to 2.5% of ephedra alkaloids. Ephedrine is the dominant alkaloid, comprising 30% to 90% of the total ephedra alkaloid content, depending on growing conditions 3. Ephedrine increased the half-life and metabolic clearance rate of dexamethasone in asthmatic patients 1. This may result in lower blood levels of corticosteroids and thereby increase the dose requirement in asthmatic patients or other patients requiring corticosteroids for immunosuppression.
Why it happens (mechanism)
Increased hepatic blood flow, resulting in greater hepatic clearance of corticosteroids, or induced hepatic microsomal enzymes, increasing hepatic metabolism
Literature reports
1 report — tap to read
a) Ephedrine increased the half-life and metabolic clearance rate of dexamethasone in asthmatic patients in a randomized, placebo-controlled study of 16 asthmatics and 5 healthy subjects. All medications were discontinued 3 weeks prior to the study, except for 3 patients with more severe disease were continued on their previous dose of prednisone. Ephedrine 100 mg was administered orally each day to 9 asthmatic patients, oxitriphylline (choline salt of theophylline) 800 mg daily was administered to 7 asthmatic patients, and placebo was administered to 5 healthy control patients for 3 weeks. After 3 weeks, labeled dexamethasone 1.5 mg was administered intravenously. In ephedrine-treated patients, half-life of dexamethasone decreased 36% (p less than 0.025), while metabolic clearance rate increased 42% (p less than 0.001). The rate of urine radioactivity recovery increased 47% (p less than 0.05) after ephedrine therapy. In contrast, no significant changes were found after theophylline therapy 1.
Common questions
Can I take Hydrocortisone and Ma Huang together?
Decreased effectiveness of corticosteroids Always confirm with your pharmacist or prescriber before making any change.
How serious is the Hydrocortisone and Ma Huang interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Hydrocortisone or Ma Huang need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (3)
- Brooks SM, Sholiton LJ, Werk EE, et al: The effects of ephedrine and theophylline on dexamethasone metabolism in bronchial asthma. J Clin Pharmacol 1977; 17(5-6):308-318. PubMed
- White LM, Gardner SF, & Gurley BJ: Pharmacokinetics and cardiovascular effects of Ma-Huang (ephedra sinica) in normotensive adults. J Clin Pharmacol 1997; 37:116-122.
- Blumenthal M & King P: Ma huang: ancient herb, modern medicine, regulatory dilemma. Herbalgram 1995; 34:22-26, 43, 56-57.
Keep reading about Hydrocortisone
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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