Ephedra - Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine Interaction
Herbal: Ephedra
Also Known As: Ephedra distachya, Belcho, Cao Mahuang, Desert Herb, Ephedra Sinisa, Herbal Ecstasy, Indian Jointfir, Joint Fir, Ma Huang, Popotillo, Raisin de Mer, Sea Grape, Teamster's Tea, Yellow Astringent, Yellow Horse, Zhong Mahuang
Drug: Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine
Brand names:
Anatuss
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
May 04, 2025
Interaction Details
Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine is classified as belonging to the following category: Cytochrome P450 1A2 (Cyp1A2) Substrates
Theoretically, ephedra might decrease levels of drugs metabolized by CYP1A2.
Some animal research suggests that ephedra induces CYP1A2 and increases the clearance of CYP1A2 substrates such as caffeine.
Interaction Rating
Likelihood of Occurrence
PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
References
- Tang J, Zhou X, Ji H, Zhu D, Wu L. Effects of ephedra water decoction and cough tablets containing ephedra and liquorice on CYP1A2 and the pharmacokinetics of theophylline in rats. Phytother Res. 2012;26(3):470-4.
Interaction Details
Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine is classified as belonging to the following category: Hepatotoxic Drugs
Theoretically, concomitant use might have additive adverse hepatotoxic effects.
There are numerous cases of liver toxicity from ephedra-containing supplements.
Interaction Rating
Likelihood of Occurrence
PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
References
- Nadir A, Agrawal S, King PD, Marshall JB. Acute hepatitis associated with the use of a Chinese herbal product, ma-huang. Am J Gastroenterol 1996;91:1436-8.
- Borum, M. L. Fulminant exacerbation of autoimmune hepatitis after the use of ma huang. Am J Gastroenterol. 2001;96(5):1654-1655.
- Vigano, M., Lampertico, P., and Colombo, M. Acute hepatitis following assumption of a herbal remedy. Eur.J.Gastroenterol.Hepatol. 2008;20(4):364-365.
- Neff, G. W., Reddy, K. R., Durazo, F. A., Meyer, D., Marrero, R., and Kaplowitz, N. Severe hepatotoxicity associated with the use of weight loss diet supplements containing ma huang or usnic acid. J Hepatol. 2004;41(6):1062-1064.
- Bajaj J, Knox JF, Komorowski R, Saeian K. The irony of herbal hepatitis: Ma-Huang-induced hepatotoxicity associated with compound heterozygosity for hereditary hemochromatosis. Dig Dis Sci. 2003;48(10):1925-8.
- Charalampopoulos A, Karatsourakis T, Tsiodra P. Acute hepatitis associated with the use of Ma-huang in a young adult. Eur J Intern Med. 2007;18(1):81.
- Skoulidis F, Alexander GJ, Davies SE. Ma huang associated acute liver failure requiring liver transplantation. Eur J Gastroenterol Hepatol. 2005;17(5):581-4.
- Drug record: Ma huang. U.S. National Library of Medicine: Livertox Database. https://livertox.nlm.nih.gov/Ephedra.htm. Updated October 16, 2017. Accessed November 1, 2017.
Interaction Details
Acetaminophen, Dextromethorphan, Guaifenesin, Phenylpropanolamine is classified as belonging to the following category: Stimulant Drugs
Theoretically, concomitant use might increase the risk for serious adverse effects.
Drugs with CNS stimulant properties might increase the risk of hypertension and the adverse cardiovascular effects of ephedra.
Interaction Rating
Likelihood of Occurrence
ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
References
- White LM, Gardner SF, Gurley BJ, et al. Pharmacokinetics and Cardiovascular Effects of Ma-Huang (Ephedra sinica) in Normotensive Adults. J Clin Pharmacol 1997;37:116-22.
- Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 2000;343:1833-8.
- Kernan, W. N., Viscoli, C. M., Brass, L. M., Broderick, J. P., Brott, T., Feldmann, E., Morgenstern, L. B., Wilterdink, J. L., and Horwitz, R. I. Phenylpropanolamine and the risk of hemorrhagic stroke. N.Engl.J Med 12-21-2000;343(25):1826-1832.
Ephedra Overview
Ephedra, also known as ma huang, is a plant species in the family Ephedraceae, which is native to Asia and parts of North America. It has been used traditionally in herbal medicine for centuries to treat a variety of conditions, including respiratory problems, allergies, and obesity.
Ephedra contains a number of active compounds, including ephedrine and pseudoephedrine, which are stimulants that affect the central nervous system. The stimulant compounds in ephedra compounds have been used in a number of over-the-counter and prescription medications, including decongestants and weight loss supplements.
While ephedra and related stimulant compounds are still available in a number of over-the-counter medications, such as the inhaler Primatene Mist, and Bronkaid Caplets, it is banned for use in dietary supplements.
Ephedra was once an extremely popular ingredient in dietary supplements for weight loss, but it was linked to a number of serious adverse effects, including increased blood pressure, heart palpitations, stroke, and even death. As a result, the use of ephedra and ephedra-containing products were banned or restricted in many countries.
Ephedra - More Interactions
Ephedra interacts with 801 drugs
Interaction Rating Key
These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.
| Major | The combined use of these agents is strongly discouraged as serious side effects or other negative outcomes could occur. |
| Moderate | Use cautiously under the care of a healthcare professional or avoid this combination. A significant interaction or negative outcome could occur. |
| Minor | Be aware that there is a chance of an interaction. Watch for warning signs of a potential interaction. |
| Unknown | No interactions have been reported or no interaction data is currently available. |
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Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Drug descriptions are provided by MedlinePlus.
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In addition to being a clinical pharmacist specializing in pharmacotherapy, Dr. Brian Staiger is a registered herbalist through the American Herbalist Guild. He has combined his passion for pharmacy practice with the study of medical ethnobotany to improve patient care. Feel free to reach out about any of your herbal or medication questions!
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