Herb & supplement monograph

Ephedra Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS ·Updated July 2026

What is this page for?

First and foremost: how Ephedra interacts with medications. The heart of this page is the interaction list — every drug Ephedra is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Ephedra is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Ephedra Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the overall risk of a clinically significant Ephedra drug interaction is high, and this supplement can be dangerous with many common medications. Hundreds of the listed interactions are rated major and the rest moderate, with none considered minor.

Interactions deserving the most attention

The most serious concerns involve stimulants, including caffeine and related drugs like theophylline, which when combined with ephedra have been linked to life-threatening problems such as very high blood pressure, heart attack, and stroke. Ephedra can also affect heart rhythm even at recommended doses, so combining it with QT-prolonging medications raises the risk of dangerous irregular heartbeats. Combining it with MAOIs may trigger severe reactions including blood pressure swings, high fever, and seizures, and human research suggests it can raise blood sugar and work against diabetes medications.

What the rest of the list means

The sheer size of the list does not mean every pairing has been proven harmful, since some interactions are theoretical or based on animal studies, such as possible effects on an enzyme the body uses to clear certain medications. Still, the heart and blood pressure risks with ephedra are backed by human evidence, which sets it apart from most supplements.

Check your medications against Ephedra

Based on HelloPharmacist’s Ephedra interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Ephedra

834 medications have a known interaction with Ephedra, graded by severity. Select any drug for the full evidence-based detail.

337 major interactions. These combinations can be clinically significant — best avoided, or used only with close professional supervision. Always check with your pharmacist before combining them with Ephedra.

Don’t want to scroll the list? Just ask.

Tell us the medications you take and we’ll check each one against Ephedra using our pharmacist-reviewed interaction data.

AI summaries are generated from our Ephedra interaction data for education only — always confirm with your pharmacist. How we use AI

2,830 drugs

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
Probable. Interaction 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.
Possible. Interaction 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
Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
Each drug listed above links to the full report for that exact Ephedra combination — clinical detail, likelihood, evidence level, and citations.
Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

The big picture

The kinds of drugs Ephedra affects

Every type of medication (drug category) Ephedra is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 11 drug categories Ephedra interacts with

MethylxanthinesQt Interval-prolonging DrugsStimulant DrugsAnticonvulsantsAntidiabetes DrugsBeta-adrenergic AgonistsCytochrome P450 1a2 (cyp1a2) SubstratesDexamethasone (decadron)Ergot DerivativesHepatotoxic DrugsMonoamine Oxidase Inhibitors (maois)

Methylxanthines

Concomitant use might increase the risk of serious adverse effects.
Use of ephedra with caffeine or other methylxanthines such as theophylline might increase the risk of stimulatory adverse effects. There is also some evidence that using ephedra with caffeine might increase the risk of serious life-threatening or debilitating adverse effects such as hypertension, myocardial infarction (MI), stroke, seizures, and death.

Likelihood Probable Evidence D

Qt Interval-Prolonging Drugs

Theoretically, ephedra might have an additive effect with drugs that prolong the QT interval.
Even in healthy volunteers, EKG changes including prolonged QT interval and premature atrial contractions have been reported with ingestion of recommended doses of ephedra. Ephedra may have an additive effect with drugs that prolong the QT interval. This may increase the risk of ventricular arrhythmias.

Likelihood Probable Evidence B

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.

Likelihood Probable Evidence D

Anticonvulsants

Theoretically, ephedra may reduce the effects of anticonvulsants.
Ephedra has been associated with reports of seizure.

Likelihood Possible Evidence D

Antidiabetes Drugs

Theoretically, taking ephedra with antidiabetes drugs might interfere with blood glucose control.
One study in animals shows that some components of ephedra may lower blood glucose levels. However, most human research suggests that ephedra and ephedrine, a component of ephedra, can raise blood glucose levels and might decrease the effectiveness of drug therapy. Monitor blood glucose concentrations closely.

Likelihood Probable Evidence B

Beta-Adrenergic Agonists

Theoretically, large amounts of ephedra might increase the cardiac inotropic effects of beta-agonists.

Likelihood Probable Evidence D

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.

Likelihood Possible Evidence D

Dexamethasone (Decadron)

Theoretically, concomitant use might reduce the levels and clinical effects of dexamethasone.
Ephedra contains ephedrine. Ephedrine increases the clearance rate of dexamethasone.

Likelihood Possible Evidence B

Ergot Derivatives

Theoretically, concomitant use might increase the risk of hypertension.
The ephedrine contained in ephedra might cause excessive vasoconstriction and hypertension when used in combination with ergot derivatives.

Likelihood Probable Evidence B

Hepatotoxic Drugs

Theoretically, concomitant use might have additive adverse hepatotoxic effects.
There are numerous cases of liver toxicity from ephedra-containing supplements.

Likelihood Possible Evidence D

Monoamine Oxidase Inhibitors (Maois)

Theoretically, concomitant use might increase the risk of serious adverse effects.
Concomitant use of ephedra with MAOIs might increase the risk of hypertension or hypotension, hyperpyrexia, hallucinations, convulsions, rhabdomyolysis, and urinary problems.

Likelihood Probable Evidence B

Monograph

Ephedra: Uses, Safety & Side Effects

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Reviewed July 2026 ·

The bottom line

Ephedra (ma huang) contains powerful stimulants like ephedrine that affect the heart and nervous system. Because it has been linked to serious harms including high blood pressure, stroke, and death, it is banned for use in dietary supplements in the U.S. and many other countries. We do not recommend using ephedra-containing supplements; talk to your pharmacist or doctor about safer, approved options.

Scientific name: Ephedra sinica
Family: Ephedraceae
Part used: Dried stems and branches (aerial parts)
Common forms: Historically: capsules, tablets, teas, and tinctures (now banned in dietary supplements in many countries)

People commonly use it for

Weight loss
Nasal and sinus congestion
Asthma and breathing problems
Boosting energy and athletic performance
Allergies

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance

OverallBest avoided

Banned in dietary supplements in the U.S. due to serious cardiovascular risks, including death.

PregnancyLikely Unsafe

When used orally. Ephedra has been linked to several cases of severe side effects.

Read the full pregnancy detail

BreastfeedingLikely Unsafe

When used orally. Ephedra has been linked to several cases of severe side effects.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

Jump to a section

Overview

Ephedra is a shrubby plant often called ma huang. The most studied species is Ephedra sinica, which grows in parts of Asia. Other species grow in dry regions of Asia, Europe, and North America. The dried stems have been used in traditional Chinese medicine for thousands of years.

The plant contains natural stimulant chemicals, mainly ephedrine and pseudoephedrine. These same compounds (in purified, regulated forms) are used in some approved medicines for congestion and asthma. As a supplement, ephedra was once heavily marketed for weight loss and energy, but it was linked to serious harm and is now banned for use in dietary supplements in the United States and many other countries.

How it works

The main active compounds in ephedra are ephedrine and pseudoephedrine. These are stimulants that act on the body's "fight or flight" (sympathetic nervous) system.

They can speed up the heart, raise blood pressure, open the airways, and slightly increase how many calories the body burns. They may also reduce appetite. These effects explain why ephedra was used for breathing problems and weight loss—but the same stimulation of the heart and blood vessels is what makes it dangerous.

Effectiveness

Does Ephedra work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by Dr. Brian Staiger, PharmD.

Evidence overview · 4 uses evaluated

1 Possibly effective 1 Leans ineffective 2 Insufficient evidence

How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.

2Likely EffectiveGood evidence, though not yet conclusive.

3Possibly EffectiveSome evidence suggests a benefit.

4Possibly IneffectiveSome evidence it may not help.

5Likely IneffectiveFairly strong evidence it doesn’t help.

6IneffectiveStrong evidence it doesn’t work.

7Insufficient Reliable Evidence to RateToo little research to say either way.

Possibly Effective Obesity

Rating & evidence shown verbatim from Natural Medicines

Oral ephedra seems to improve weight loss by approximately 0.9 kg per month for up to 6 months. However, it is unclear if this benefit is sustained long-term. Also, the use of ephedra for this purpose has been associated with significant adverse effects.

Possibly Ineffective Athletic performance

Rating & evidence shown verbatim from Natural Medicines

Oral ephedra does not seem to improve athletic performance.

Also studied for 2 conditions — evidence insufficient to rate

Insufficient Reliable Evidence To Rate Attention

Rating & evidence shown verbatim from Natural Medicines

Although there is interest in using oral ephedra to improve attention, there is insufficient reliable information about the clinical effects of ephedra for this use.

Insufficient Reliable Evidence To Rate Hypotension

Rating & evidence shown verbatim from Natural Medicines

Although there is interest in using oral ephedra to increase blood pressure, there is insufficient reliable information about the clinical effects of ephedra for this use.

Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.

Safety & precautions

Ephedra has been linked to serious and sometimes fatal harm, including very high blood pressure, irregular heartbeat, heart attack, stroke, and seizures. Because of these risks, the U.S. FDA banned ephedra (ephedrine alkaloids) in dietary supplements, and many other countries restrict it.

People with heart disease, high blood pressure, an irregular heartbeat, diabetes, thyroid problems, anxiety, glaucoma, an enlarged prostate, or a history of seizures are at especially high risk and should not use it. Combining ephedra with caffeine or other stimulants raises the danger further.

Pregnancy and breastfeeding: Ephedra should be avoided. Its stimulant effects and lack of safety data make it unsafe during pregnancy, and the active compounds can pass into breast milk and may harm a nursing baby.

Always talk to a pharmacist or doctor before using any product that may contain ephedra or ephedrine, and be cautious of unregulated supplements sold online that may still include it.

Side effects

Common side effects of ephedra and ephedrine include fast or pounding heartbeat, raised blood pressure, restlessness, anxiety, trouble sleeping, headache, dizziness, nausea, and tremor.

Rare but serious effects include dangerous heart rhythm problems, heart attack, stroke, seizures, psychiatric symptoms, and death. These serious events have occurred even in young, otherwise healthy people, sometimes at typical supplement doses.

Ephedra: Reported Adverse Effects

Documented safety reports on Ephedra from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.

Orally, ephedra is frequently associated with adverse reactions and is banned in the US. In some cases, adverse effects can be severe or life-threatening. Large studies looking at the safety of ephedra have not been performed. Since most of the adverse effect data are from case reports, it is impossible to determine the overall incidence of these adverse effects. It is also difficult to determine which patient groups might be most likely to experience an adverse event.

Most Common Adverse Effects:

Orally: Anorexia, anxiety, difficulty concentrating, difficulty urinating, dizziness, dry mouth, flushing, headache, heartburn, hyperthermia, hypertension, insomnia, irritability, nausea, personality changes, polydipsia, restlessness, tachycardia, tingling, and vomiting.

Serious Adverse Effects (Rare):

Orally: Cardiac arrest, cardiac arrhythmia, cardiomyopathy, heart failure, hepatotoxicity, myocardial infarction, myopathies, psychosis, seizure, stroke, and sudden death.

Reports by condition

Anorexia Gastrointestinal

The use of ephedra causes a 2.2- to 3.6-fold increase in the risk of developing psychiatric, autonomic, or gastrointestinal (GI) symptoms and cardiac palpitations. Orally and intravenously, ephedra and ephedrine most commonly cause dry mouth, anorexia, nausea, vomiting, heartburn, abdominal discomfort, and changes in stool consistency. One case of ischemic colitis and symptoms of abdominal pain and bloody diarrhea associated with the use of a weight loss supplement containing ephedra has been reported.

Anxiety Psychiatric

The use of ephedra causes a 2.2- to 3.6-fold increase in the risk of developing psychiatric, autonomic, or gastrointestinal (GI) symptoms and cardiac palpitations. Ephedra most commonly causes anxiety, irritability, personality changes, difficulty concentrating, and insomnia.

Cases of ephedrine-induced psychiatric complications include mania, psychosis, and hallucinations. In some cases psychosis can be prolonged for several months after discontinuation. A case of a suicide attempt and mood disorder associated with the use of a diet pill containing ephedra has also been reported.

Long-term use of ephedra or use in high doses has been associated with dependence and tolerance.

Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003;289:1537-45..
Shekelle P, Morton, S, Maglione, M, and et al. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects. Evidence Report/Technology Assessment No. 76 (Prepared by Southern California Evidence-based Pr
Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. BMJ 1996;313:756.
Boozer CN, Nasser JA, Heymsfield SB, et al. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord 2001;25:316-24.
Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 2000;57:963-9.
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.
Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002;26:593-604.
Kalman D, Incledon T, Gaunaurd I, et al. An acute clinical trial evaluating the cardiovascular effects of an herbal ephedra-caffeine weight loss product in healthy overweight adults. Int J Obes 2002;26:1363-66..
Yates KM, O'Connor A, Horsley CA. "Herbal Ecstasy": a case series of adverse reactions. N Z Med J 2000;113:315-7..
Jacobs KM, Hirsch KA. Psychiatric complications of Ma-huang. Psychosomatics 2000;41:58-62.
Capwell, R. R. Ephedrine-induced mania from an herbal diet supplement. Am J Psychiatry 1995;152(4):647.
Walton R, Manos GH. Psychosis related to ephedra-containing herbal supplement use. South Med J 2003;96:718-20..
Tormey, W. P. and Bruzzi, A. Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol. Med Sci Law 2001;41(4):331-336.
Herridge, C. F. and a'Brook, M. F. Ephedrine psychosis. Br Med J 4-20-1968;2(598):160.
Roxanas, M. G. and Spalding, J. Ephedrine abuse psychosis. Med J Aust. 11-5-1977;2(19):639-640.
Shufman, N. E., Witztum, E., and Vass, A. [Ephedrine psychosis]. Harefuah 1994;127(5-6):166-8, 215.
Traboulsi, A. S., Viswanathan, R., and Coplan, J. Suicide attempt after use of herbal diet pill. Am J Psychiatry 2002;159(2):318-319.
FDA Takes Aim at Ephedra. The Washington Post. Available at: http://www.washingtonpost.com/archive/politics/2000/03/19/fda-takes-aim-at-ephedra/4ce534a7-d291-44ec-88a8-38e97ff27e3b/ (Accessed 19 March 2000).

Anxiety Neurologic/CNS

The use of ephedra causes a 2.2- to 3.6-fold increase in the risk of developing psychiatric, autonomic, or gastrointestinal (GI) symptoms and cardiac palpitations. Ephedra most commonly causes dizziness, restlessness, anxiety, irritability, personality changes, difficulty concentrating, insomnia, and headache.

Ephedra can cause seizures in otherwise healthy people, as well as in people with underlying seizure disorders. Of 33 seizures linked to dietary supplement use that were reported to the FDA over 7 years, 27 involved ephedra. Other adverse events reported with ephedra use include sudden hearing loss, stroke, transient ischemic attack, cerebral hemorrhage, and loss of consciousness. In one case-control study, doses of ephedra above 32 mg daily have been associated with an increased risk for hemorrhagic stroke. A case of encephalopathy syndrome with multi-organ failure and transient cortical blindness after ingestion of a performance-enhancing ephedra supplement has been reported. Symptoms were resolved after blood pressure was corrected.

Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003;289:1537-45..
Shekelle P, Morton, S, Maglione, M, and et al. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects. Evidence Report/Technology Assessment No. 76 (Prepared by Southern California Evidence-based Pr
Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. BMJ 1996;313:756.
Boozer CN, Nasser JA, Heymsfield SB, et al. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord 2001;25:316-24.
Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 2000;57:963-9.
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.
Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002;26:593-604.
Kalman D, Incledon T, Gaunaurd I, et al. An acute clinical trial evaluating the cardiovascular effects of an herbal ephedra-caffeine weight loss product in healthy overweight adults. Int J Obes 2002;26:1363-66..
Yates KM, O'Connor A, Horsley CA. "Herbal Ecstasy": a case series of adverse reactions. N Z Med J 2000;113:315-7..
Kockler DR, McCarthy MW, Lawson CL. Seizure activity and unresponsiveness after hydroxycut ingestion. Pharmacotherapy 2001;21:647-51..
Perrotta DM. From the Centers for Disease Control and Prevention. Adverse events associated with ephedrine-containing products--Texas, December 1993- September 1995. JAMA 12-4-1996;276(21):1711-1712.
Haller CA, Meier KH, Olson KR. Seizures reported in association with use of dietary supplements. Clin Toxicol (Phila) 2005;43:23-30.
Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3.
FDA Takes Aim at Ephedra. The Washington Post. Available at: http://www.washingtonpost.com/archive/politics/2000/03/19/fda-takes-aim-at-ephedra/4ce534a7-d291-44ec-88a8-38e97ff27e3b/ (Accessed 19 March 2000).
FDA. Proposed rule: dietary supplements containing ephedrine alkaloids. Available at: www.verity.fda.gov (Accessed 25 January 2000).
Samenuk D, Link MS, Homoud MK, et al. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clin Proc 2002;77:12-6.
Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 2003;60:132-5. .
Schweinfurth J, Pribitkin E. Sudden hearing loss associated with ephedra use. Am J Health Syst Pharm 2003;60:375-7.
du, Boisgueheneuc F., Lannuzel, A., Caparros-Lefebvre, D., and De Broucker, T. [Cerebral infarction in a patient consuming MaHuang extract and guarana]. Presse Med 2-3-2001;30(4):166-167.
Bruno, A., Nolte, K. B., and Chapin, J. Stroke associated with ephedrine use. Neurology 1993;43(7):1313-1316.
Moawad, F. J., Hartzell, J. D., Biega, T. J., and Lettieri, C. J. Transient blindness due to posterior reversible encephalopathy syndrome following ephedra overdose. South Med J 2006;99(5):511-514.

Arrhythmia Cardiovascular

The use of ephedra causes a 2.2- to 3.6-fold increase in the risk of developing psychiatric, autonomic, or gastrointestinal (GI) symptoms and cardiac palpitations. Orally, ephedra use has been associated with cardiomyopathy, hypersensitivity myocarditis, chest tightness, myocardial infarction, cardiac arrest and sudden death, hypertension, tachycardia, and cardiac arrhythmias. Ephedrine abuse has led to heart failure. Even in healthy volunteers, EKG changes including prolonged QT interval and premature atrial contractions can occur with ingestion of recommended doses of ephedra containing products. In a review of 926 cases reported to the FDA of possible adverse effects of ephedra, 37 patients had serious or fatal adverse reactions. Ephedra use was temporally related to 16 strokes, 10 myocardial infarctions, and 11 sudden deaths. These effects occurred in people aged 30-56 years. There is some evidence that people who take doses greater than 32 mg daily might have more than triple the risk of hemorrhagic stroke, including subarachnoid hemorrhage and intracerebral hemorrhage, when compared with those taking doses of less than 32 mg daily.

Ephedrine, the primary active ingredient in ephedra, has been associated with coronary artery spasm, myocardial injury with pulmonary edema, and cardiovascular collapse. However, several clinical trials evaluating ephedrine-caffeine combinations for weight loss reported no differences in mean heart rate or blood pressure when compared to placebo. Other preliminary clinical research showed that ephedrine and caffeine use by prescription did not result in increased risk of adverse cardiovascular outcomes.

Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003;289:1537-45..
Shekelle P, Morton, S, Maglione, M, and et al. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects. Evidence Report/Technology Assessment No. 76 (Prepared by Southern California Evidence-based Pr
Okada S, Rohan PJ, Miller FW, et al. Myopathies following ingestion of special nutritional products. Arthritis Rheum 1996;39:349.
Singh, A., Rajeev, A. G., and Dohrmann, M. L. Cardiomyopathy associated with ephedra-containing nutritional supplements. Congest.Heart Fail. 2008;14(2):89-90.
Zaacks SM, Klein L, Tan CD, et al. Hypersensitivity myocarditis associated with ephedra use. J Toxicol Clin Toxicol 1999;37:485-9.
Leikin JB, Klein L. Ephedra causes myocarditis. Clin Toxicol 2000;38:353-4.
Kurt, T. L. Hypersensitivity myocarditis with ephedra use. J Toxicol.Clin Toxicol. 2000;38(3):351.
Leikin, J. B. and Klein, L. Ephedra causes myocarditis. J Toxicol.Clin Toxicol. 2000;38(3):353-354.
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.
Theoharides TC. Sudden death of a healthy college student related to ephedrine toxicity from a ma-huang containing drink. J Clin Psychopharmacol 1997;17:437-9.
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.
Samenuk D, Link MS, Homoud MK, et al. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clin Proc 2002;77:12-6.
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Perrotta DM. From the Centers for Disease Control and Prevention. Adverse events associated with ephedrine-containing products--Texas, December 1993- September 1995. JAMA 12-4-1996;276(21):1711-1712.
Cockings, J. G. and Brown, M. Ephedrine abuse causing acute myocardial infarction. Med J Aust 8-18-1997;167(4):199-200.
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Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 2003;60:132-5. .
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Hirabayashi, Y., Saitoh, K., Fukuda, H., Mitsuhata, H., and Shimizu, R. Coronary artery spasm after ephedrine in a patient with high spinal anesthesia. Anesthesiology 1996;84(1):221-224.
Chen-Scarabelli, C., Hughes, S. E., Landon, G., Rowley, P., Allebban, Z., Lawson, N., Saravolatz, L., Gardin, J., Latchman, D., and Scarabelli, T. M. A case of fatal ephedra intake associated with lipofuscin accumulation, caspase activation and cleavage
Astrup, A., Breum, L., Toubro, S., Hein, P., and Quaade, F. The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. Int.J.Obes.Relat Metab D
Caron, M. F., Dore, D. D., Min, B., Kluger, J., Boguk, I., and White, C. M. Electrocardiographic and blood pressure effects of the ephedra-containing TrimSpa thermogenic herbal compound in healthy volunteers. Pharmacotherapy 2006;26(9):1241-1246.
Daly, P. A., Krieger, D. R., Dulloo, A. G., Young, J. B., and Landsberg, L. Ephedrine, caffeine and aspirin: safety and efficacy for treatment of human obesity. Int J Obes.Relat Metab Disord. 1993;17 Suppl 1:S73-S78.
Martinet A, Hostettmann K, and Schutz Y. Thermogenic effects of commercially available phytotherapy compounds aimed at treating human obesity. Phytomedicine 1999;6(4):S174.
Hallas, J., Bjerrum, L., Stovring, H., and Andersen, M. Use of a prescribed ephedrine/caffeine combination and the risk of serious cardiovascular events: a registry-based case-crossover study. Am J Epidemiol. 10-15-2008;168(8):966-973.

Cirrhosis Hepatic

Cases of hepatotoxicity such as acute hepatitis and liver failure from ephedra-containing supplements have been reported. Some cases of hepatotoxicity resolved after discontinuation of ephedra, while others required liver transplantation. In obese patients using ephedra for weight loss, it is possible that ephedra exacerbated pre-existing liver disease. Onset of liver injury seems to occur an average of 3 months after ephedra ingestion, suggesting an idiosyncratic mechanism of liver injury. Previously, it was thought that the cause of ephedra hepatotoxicity was an immune reaction or a contamination. However, since the majority of evidence suggests that hepatotoxicity is idiosyncratic, these prior postulations have since been dismissed.

Hearing loss Ocular/Otic

A case of encephalopathy syndrome with transient cortical blindness after ingestion of an ephedra supplement has been reported. Symptoms were resolved after blood pressure was corrected. A case of sudden hearing loss following the use of ephedra has also been reported.

Kidney stones (nephrolithiasis) Renal

Orally, ephedra has been reported to cause nephrolithiasis, diuresis, urinary retention, and dysuria.

Muscle breakdown Musculoskeletal

Orally, ephedra has been reported to cause myopathies, including myalgia, rhabdomyolysis, and eosinophilia-myalgia syndrome.

Okada S, Rohan PJ, Miller FW, et al. Myopathies following ingestion of special nutritional products. Arthritis Rheum 1996;39:349.
Burke J, Seda G, Allen D, Knee TS. A case of severe exercise-induced rhabdomyolysis associated with a weight loss dietary supplement. Mil Med 2007;172:656-8.
Stahl, C. E., Borlongan, C. V., Szerlip, M., and Szerlip, H. No pain, no gain--exercise-induced rhabdomyolysis associated with the performance enhancer herbal supplement ephedra. Med Sci Monit. 2006;12(9):CS81-CS84.

DISCLAIMER: This tool is intended for informational purposes only, and should not be interpreted as specific medical advice. Patients should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Adverse-effects data: Natural Medicines, Therapeutic Research Center

Dosing

There is no safe, recommended supplement dose for ephedra. It is banned in dietary supplements in the U.S. and many other countries, so we cannot and do not provide a dose.

Some regulated, FDA-approved over-the-counter medicines (for example certain asthma products) contain ephedrine in carefully controlled amounts and come with specific label directions. If you need a product for congestion, asthma, or weight management, follow the package label exactly and speak with your pharmacist or doctor to choose a safer, approved option.

Pregnancy & Breastfeeding

Ephedra & Pregnancy

Likely Unsafe

When used orally. Ephedra has been linked to several cases of severe side effects.

Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. BMJ 1996;313:756.
FDA. Proposed rule: dietary supplements containing ephedrine alkaloids. Available at: www.verity.fda.gov (Accessed 25 January 2000).
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.
Jacobs KM, Hirsch KA. Psychiatric complications of Ma-huang. Psychosomatics 2000;41:58-62.
Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 2003;60:132-5. .
Walton R, Manos GH. Psychosis related to ephedra-containing herbal supplement use. South Med J 2003;96:718-20..

Ephedra & Breastfeeding

Likely Unsafe

When used orally. Ephedra has been linked to several cases of severe side effects.

Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. BMJ 1996;313:756.
FDA. Proposed rule: dietary supplements containing ephedrine alkaloids. Available at: www.verity.fda.gov (Accessed 25 January 2000).
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.
Jacobs KM, Hirsch KA. Psychiatric complications of Ma-huang. Psychosomatics 2000;41:58-62.
Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 2003;60:132-5. .
Walton R, Manos GH. Psychosis related to ephedra-containing herbal supplement use. South Med J 2003;96:718-20..

Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center

References & further reading

The 87 references that drive our Ephedra monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.

Okada S, Rohan PJ, Miller FW, et al. Myopathies following ingestion of special nutritional products. Arthritis Rheum 1996;39:349.
Zaacks SM, Klein L, Tan CD, et al. Hypersensitivity myocarditis associated with ephedra use. J Toxicol Clin Toxicol 1999;37:485-9. PubMed
Powell T, Hsu FF, Turk J, Hruska K. Ma-huang strikes again: ephedrine nephrolithiasis. Am J Kidney Dis 1998;32:153-9. PubMed
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.
Theoharides TC. Sudden death of a healthy college student related to ephedrine toxicity from a ma-huang containing drink. J Clin Psychopharmacol 1997;17:437-9. PubMed
Vahedi K, Domingo V, Amarenco P, Bousser MG. Ischemic stroke in a sportsman who consumed MaHuang extract and creatine monohydrate for bodybuilding. J Neurol Neurosurg Psychiatr 2000;68:112-3.
Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. BMJ 1996;313:756. PubMed
FDA Takes Aim at Ephedra. The Washington Post. Available at: http://www.washingtonpost.com/archive/politics/2000/03/19/fda-takes-aim-at-ephedra/4ce534a7-d291-44ec-88a8-38e97ff27e3b/ (Accessed 19 March 2000).
FDA. Proposed rule: dietary supplements containing ephedrine alkaloids. Available at: www.verity.fda.gov (Accessed 25 January 2000).
Boozer CN, Nasser JA, Heymsfield SB, et al. An herbal supplement containing Ma Huang-Guarana for weight loss: a randomized, double-blind trial. Int J Obes Relat Metab Disord 2001;25:316-24. PubMed
Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 2000;57:963-9. PubMed
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. PubMed
Leikin JB, Klein L. Ephedra causes myocarditis. Clin Toxicol 2000;38:353-4.
Jacobs KM, Hirsch KA. Psychiatric complications of Ma-huang. Psychosomatics 2000;41:58-62. PubMed
Dulloo AG. Herbal simulation of ephedrine and caffeine in treatment of obesity. Int J Obes Relat Metab Disord 2002;26:590-2. PubMed
Samenuk D, Link MS, Homoud MK, et al. Adverse cardiovascular events temporally associated with ma huang, an herbal source of ephedrine. Mayo Clin Proc 2002;77:12-6. PubMed
Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial. Int J Obes Relat Metab Disord 2002;26:593-604. PubMed
Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 2003;60:132-5. .
Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003;289:1537-45.. PubMed
Kalman D, Incledon T, Gaunaurd I, et al. An acute clinical trial evaluating the cardiovascular effects of an herbal ephedra-caffeine weight loss product in healthy overweight adults. Int J Obes 2002;26:1363-66.. PubMed
Schweinfurth J, Pribitkin E. Sudden hearing loss associated with ephedra use. Am J Health Syst Pharm 2003;60:375-7. PubMed
Kockler DR, McCarthy MW, Lawson CL. Seizure activity and unresponsiveness after hydroxycut ingestion. Pharmacotherapy 2001;21:647-51.. PubMed
Yates KM, O'Connor A, Horsley CA. "Herbal Ecstasy": a case series of adverse reactions. N Z Med J 2000;113:315-7..
Walton R, Manos GH. Psychosis related to ephedra-containing herbal supplement use. South Med J 2003;96:718-20.. PubMed
Jenkins DJ, Wesson V, Wolever TM, et al. Wholemeal versus wholegrain breads: proportion of whole or cracked grain and the glycaemic response. BMJ 1988;297:958-60. PubMed
McBride BF, Karapanos AK, Krudysz A, et al. Electrocardiographic and hemodynamic effects of a multicomponent dietary supplement containing ephedra and caffeine: a randomized controlled trial. JAMA 2004;291:216-21. PubMed
Brooks SM, Sholiton LJ, Werk EE Jr, Altenau P. The effects of ephedrine and theophylline on dexamethasone metabolism in bronchial asthma. J Clin Pharmacol 1977;17:308-18. PubMed
Gardner SF, Franks AM, Gurley BJ, et al. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Cardiol 2003;91:1510-3, A9. PubMed
Haller CA, Jacob P 3rd, Benowitz NL. Enhanced stimulant and metabolic effects of combined ephedrine and caffeine. Clin Pharmacol Ther 2004;75:259-73.
Haller CA, Meier KH, Olson KR. Seizures reported in association with use of dietary supplements. Clin Toxicol (Phila) 2005;43:23-30. PubMed
Burke J, Seda G, Allen D, Knee TS. A case of severe exercise-induced rhabdomyolysis associated with a weight loss dietary supplement. Mil Med 2007;172:656-8. PubMed
Dawson, J. K., Earnshaw, S. M., and Graham, C. S. Dangerous monoamine oxidase inhibitor interactions are still occurring in the 1990s. J Accid.Emerg.Med 1995;12(1):49-51. PubMed
Weinberger M and Bronsky E. Interaction of ephedrine and theophylline. Clin Pharmacol Ther 1974;15(2):223. PubMed
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. PubMed
Jubiz, W. and Meikle, A. W. Alterations of glucocorticoid actions by other drugs and disease states. Drugs 1979;18(2):113-121. PubMed
Thomas, J. E., Munir, J. A., McIntyre, P. Z., and Ferguson, M. A. STEMI in a 24-year-old man after use of a synephrine-containing dietary supplement: a case report and review of the literature. Tex.Heart Inst.J 2009;36(6):586-590.
Cohen, P. A. and Ernst, E. Safety of herbal supplements: a guide for cardiologists. Cardiovasc.Ther 2010;28(4):246-253. PubMed
Astrup, A., Breum, L., Toubro, S., Hein, P., and Quaade, F. The effect and safety of an ephedrine/caffeine compound compared to ephedrine, caffeine and placebo in obese subjects on an energy restricted diet. A double blind trial. Int.J.Obes.Relat Metab D
Hackman, R. M., Havel, P. J., Schwartz, H. J., Rutledge, J. C., Watnik, M. R., Noceti, E. M., Stohs, S. J., Stern, J. S., and Keen, C. L. Multinutrient supplement containing ephedra and caffeine causes weight loss and improves metabolic risk factors in o
Hasani-Ranjbar, S., Nayebi, N., Larijani, B., and Abdollahi, M. A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J Gastroenterol. 7-7-2009;15(25):3073-3085. PubMed
Lovstad, R. Z., Granhus, G., and Hetland, S. Bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases. Acta Anaesthesiol.Scand 2000;44(1):48-52. PubMed
Ngan Kee, W. D., Khaw, K. S., Lee, B. B., Lau, T. K., and Gin, T. A dose-response study of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Anesth.Analg. 2000;90(6):1390-1395. PubMed
Kurt, T. L. Hypersensitivity myocarditis with ephedra use. J Toxicol.Clin Toxicol. 2000;38(3):351.
Leikin, J. B. and Klein, L. Ephedra causes myocarditis. J Toxicol.Clin Toxicol. 2000;38(3):353-354.
du, Boisgueheneuc F., Lannuzel, A., Caparros-Lefebvre, D., and De Broucker, T. [Cerebral infarction in a patient consuming MaHuang extract and guarana]. Presse Med 2-3-2001;30(4):166-167.
Borum, M. L. Fulminant exacerbation of autoimmune hepatitis after the use of ma huang. Am J Gastroenterol. 2001;96(5):1654-1655. PubMed
Tormey, W. P. and Bruzzi, A. Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol. Med Sci Law 2001;41(4):331-336. PubMed
Traboulsi, A. S., Viswanathan, R., and Coplan, J. Suicide attempt after use of herbal diet pill. Am J Psychiatry 2002;159(2):318-319. PubMed
Schweinfurth, J. and Pribitkin, E. Sudden hearing loss associated with ephedra use. Am J Health Syst Pharm 2-15-2003;60(4):375-377. PubMed
Gardner, S. F., Franks, A. M., Gurley, B. J., Haller, C. A., Singh, B. K., and Mehta, J. L. Effect of a multicomponent, ephedra-containing dietary supplement (Metabolife 356) on Holter monitoring and hemostatic parameters in healthy volunteers. Am J Card PubMed
Karch, S. B. Use of Ephedra-containing products and risk for hemorrhagic stroke. Neurology 9-9-2003;61(5):724-725. PubMed
Chen-Scarabelli, C., Hughes, S. E., Landon, G., Rowley, P., Allebban, Z., Lawson, N., Saravolatz, L., Gardin, J., Latchman, D., and Scarabelli, T. M. A case of fatal ephedra intake associated with lipofuscin accumulation, caspase activation and cleavage
Moawad, F. J., Hartzell, J. D., Biega, T. J., and Lettieri, C. J. Transient blindness due to posterior reversible encephalopathy syndrome following ephedra overdose. South Med J 2006;99(5):511-514. PubMed
Stahl, C. E., Borlongan, C. V., Szerlip, M., and Szerlip, H. No pain, no gain--exercise-induced rhabdomyolysis associated with the performance enhancer herbal supplement ephedra. Med Sci Monit. 2006;12(9):CS81-CS84.
Caron, M. F., Dore, D. D., Min, B., Kluger, J., Boguk, I., and White, C. M. Electrocardiographic and blood pressure effects of the ephedra-containing TrimSpa thermogenic herbal compound in healthy volunteers. Pharmacotherapy 2006;26(9):1241-1246. PubMed
Vigano, M., Lampertico, P., and Colombo, M. Acute hepatitis following assumption of a herbal remedy. Eur.J.Gastroenterol.Hepatol. 2008;20(4):364-365. PubMed
Singh, A., Rajeev, A. G., and Dohrmann, M. L. Cardiomyopathy associated with ephedra-containing nutritional supplements. Congest.Heart Fail. 2008;14(2):89-90. PubMed
Song, H. J., Shim, K. N., Ryu, K. H., Kim, T. H., Jung, S. A., and Yoo, K. A case of ischemic colitis associated with the herbal food supplement ma huang. Yonsei Med.J. 6-30-2008;49(3):496-499. PubMed
Flanagan, C. M., Kaesberg, J. L., Mitchell, E. S., Ferguson, M. A., and Haigney, M. C. Coronary artery aneurysm and thrombosis following chronic ephedra use. Int.J.Cardiol. 2-18-2010;139(1):e11-e13. PubMed
Hallas, J., Bjerrum, L., Stovring, H., and Andersen, M. Use of a prescribed ephedrine/caffeine combination and the risk of serious cardiovascular events: a registry-based case-crossover study. Am J Epidemiol. 10-15-2008;168(8):966-973. PubMed
Astrup, A., Toubro, S., Cannon, S., Hein, P., and Madsen, J. Thermogenic synergism between ephedrine and caffeine in healthy volunteers: a double-blind, placebo-controlled study. Metabolism 1991;40(3):323-329. PubMed
Martinez-Quintana, E., Rodriguez-Gonzalez, F., and Cuba-Herrera, J. [Myocardial necrosis and severe biventricular dysfunction in the context of chronic ephedrine abuse]. Adicciones. 2010;22(1):25-28.
Kim, H. J., Park, J. M., Kim, J. A., and Ko, B. P. Effect of herbal Ephedra sinica and Evodia rutaecarpa on body composition and resting metabolic rate: a randomized, double-blind clinical trial in Korean premenopausal women. J.Acupunct.Meridian.Stud. 20 PubMed
Konno, C., Mizuno, T., and Hikino, H. Isolation and hypoglycemic activity of ephedrans A, B, C, D and E, glycans of Ephedra distachya herbs. Planta Med 1985;(2):162-163.
Weinberger, M. M. and Bronsky, E. A. Evaluation of oral bronchodilator therapy in asthmatic children. Bronchodilators in asthmatic children. J Pediatr 1974;84(3):421-427. PubMed
Herridge, C. F. and a'Brook, M. F. Ephedrine psychosis. Br Med J 4-20-1968;2(598):160.
Roxanas, M. G. and Spalding, J. Ephedrine abuse psychosis. Med J Aust. 11-5-1977;2(19):639-640. PubMed
McLaughlin, E. T., Bethea, L. H., and Wittig, H. J. Comparison of the bronchodilator effect of oral fenoterol and ephedrine in asthmatic children. Ann Allergy 1982;49(4):191-195.
Capwell, R. R. Ephedrine-induced mania from an herbal diet supplement. Am J Psychiatry 1995;152(4):647. PubMed
Shufman, N. E., Witztum, E., and Vass, A. [Ephedrine psychosis]. Harefuah 1994;127(5-6):166-8, 215.
Bruno, A., Nolte, K. B., and Chapin, J. Stroke associated with ephedrine use. Neurology 1993;43(7):1313-1316. PubMed
Daly, P. A., Krieger, D. R., Dulloo, A. G., Young, J. B., and Landsberg, L. Ephedrine, caffeine and aspirin: safety and efficacy for treatment of human obesity. Int J Obes.Relat Metab Disord. 1993;17 Suppl 1:S73-S78.
Hirabayashi, Y., Saitoh, K., Fukuda, H., Mitsuhata, H., and Shimizu, R. Coronary artery spasm after ephedrine in a patient with high spinal anesthesia. Anesthesiology 1996;84(1):221-224. PubMed
Perrotta DM. From the Centers for Disease Control and Prevention. Adverse events associated with ephedrine-containing products--Texas, December 1993- September 1995. JAMA 12-4-1996;276(21):1711-1712.
Cockings, J. G. and Brown, M. Ephedrine abuse causing acute myocardial infarction. Med J Aust 8-18-1997;167(4):199-200. PubMed
Blau, J. J. Ephedrine nephrolithiasis associated with chronic ephedrine abuse. J Urol. 1998;160(3 Pt 1):825. PubMed
Shekelle P, Morton, S, Maglione, M, and et al. Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects. Evidence Report/Technology Assessment No. 76 (Prepared by Southern California Evidence-based Pr
Martinet A, Hostettmann K, and Schutz Y. Thermogenic effects of commercially available phytotherapy compounds aimed at treating human obesity. Phytomedicine 1999;6(4):S174.
Ryall JE. Caffeine and ephedrine fatality. Bull Int Assoc Forensic Toxicol 1984;17:13.
Rejent T, Michalek R, and Krajewski M. Caffeine fatality with coincident ephedrine. Bull Int Assoc Forensic Toxicol 1981;16:18-19.
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. PubMed
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. PubMed
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. PubMed
Skoulidis F, Alexander GJ, Davies SE. Ma huang associated acute liver failure requiring liver transplantation. Eur J Gastroenterol Hepatol. 2005;17(5):581-4. PubMed
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.

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.

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.

Brand directory

Brands that make products with Ephedra

20 brands in our database make a supplement containing Ephedra.

Accelerated Sport Nutraceuticals 2 products Aviva Nutrition 3 products BS Supplements 1 product Chaotic-Labz 37 products Cloma Pharma Laboratories 2 products Douglas Laboratories 3,067 products First Choice Supplements 1 product Hard Rock Supplements 14 products Hi-Tech Pharmaceuticals 106 products HTP Hi-Tech Pharmaceuticals 15 products IDL 1 product Innovative Bio-Labs 2 products Innovative Diet Labs (IDL) 1 product Innovative Laboratories 5 products Kempo Nutrition 5 products Plum Flower 573 products R.E.D. Labs 1 product Schwartz Laboratories 2 products Swoll Mafia 16 products Warrior Labz 13 products

Product directory

Supplement products with Ephedra

37 products in our database contain Ephedra. Open any to see its full ingredient list and every drug interaction we check.

Pharmacist Counseling Corner

Ephedra: Common Questions

What is Ephedra used for, and does it work?

People use Ephedra for many reasons, but the evidence varies by use. According to the Natural Medicines database, there is at least some clinical evidence supporting Ephedra for Obesity. For most other uses it has been studied for, the evidence is currently insufficient to rate. See the graded list on this page, and always confirm with your pharmacist or doctor.

Does Ephedra interact with prescription medications?

Yes. We list 834 medications with a known interaction with Ephedra, including 337 rated major. Use the checker above to see how Ephedra interacts with a specific drug.

How are Ephedra interactions rated?

Each interaction is graded major, moderate, or minor based on how clinically significant it is and the strength of the evidence behind it. Major interactions are the most serious and are best avoided, or used only under close professional supervision.

Is it safe to take Ephedra with my medications?

It depends on the specific medication. Some combinations are fine, while others call for monitoring, timing changes, or should be avoided. Check your exact drug above and confirm with your pharmacist or doctor before starting, stopping, or changing anything.

Where does this Ephedra interaction information come from?

Our interaction data is built on the Natural Medicines database — an evidence-graded reference for vitamins, herbs, and supplements — and is reviewed by licensed HelloPharmacist pharmacists, who may add clinical context.

Is Ephedra legal to buy as a supplement?

No. Ephedra (ephedrine alkaloids) is banned for use in dietary supplements in the United States and is restricted in many other countries because of its link to serious harm. Be wary of online products that may still contain it.

Did Ephedra really help people lose weight?

Ephedrine, the active drug in Ephedra, can cause modest short-term weight loss, but the amount is small and the risk of dangerous side effects is high. Health authorities decided the risks outweigh the benefits.

Why is Ephedra considered dangerous?

It contains powerful stimulants that can raise blood pressure and heart rate. This has been linked to heart attacks, strokes, seizures, and deaths—even in young, healthy people.

Can I take Ephedra while pregnant or breastfeeding?

No. Ephedra should be avoided during pregnancy and breastfeeding because of its strong stimulant effects, lack of safety data, and the fact that its compounds can pass into breast milk.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

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Products that contain Ephedra

A rotating sample of real supplements in our database that list Ephedra — open any to see its full ingredients and every drug interaction we check.

See all 37 products with Ephedra →

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Ephedra Drug Interactions, Uses, Effectiveness, Safety & More

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Ephedra Drug Interactions: The Bottom Line

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What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

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Where This Data Comes From

The kinds of drugs Ephedra affects

Ephedra: Uses, Safety & Side Effects

Overview

How it works

Does Ephedra work?

Safety & precautions

Side effects

Ephedra: Reported Adverse Effects

Dosing

Ephedra & Pregnancy

Ephedra & Breastfeeding

References & further reading

Brands that make products with Ephedra

Supplement products with Ephedra

Ephedra: Common Questions

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