Ephedra Caffeine

Additive sympathetic stimulation (caffeine, ephedra, green tea, guarana)... 

Numerousherbai diureticsare available as over-the-counter (OTQ products. Most plants and herbal extracts available as OTCdiureticsare nontoxic. However, most are either ineffective or no more effective than caffeine. The following are selected herbals reported to possess diuretic activity cetery, chicory, sassafras juniper berries St. John s wort, foxglove, horsetail, licorice, dandelion, digital is purpurea, ephedra, hibiscus parsley, and elderberry. 

At one time, Coca-Cola actually contained a form of cocaine. These days, the primary stimulant in Coca-Cola and many other beverages is caffeine. Other stimulants are less obvious. Chocolate contains theobromine, a caffeinelike stimulant. Nondrowsy cold remedies contain pseudoephedrine, a relative of ephedra, another plant-alkaloid stimulant. 

Jacob P III, Haller CA, Duan M, Yu L, Peng M, et al. 2004. Determination of ephedra alkaloid and caffeine concentrations in dietary supplements and biological fluids. J Anal Toxicol 28 152. 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Ephedra (ma huang) is a popular botanical incorporated into a variety of formulations for weight loss, energy or performance enhancement, and symptomatic control of asthma. A pharmacodynamic interaction leading to a fatality has been reported with concurrent use of caffeine and ephedra (62), possibly as a result of additive adrenergic agonist effect of the ephedrine alkaloids and caffeine on the cardiovascular system and the CNS (63). Ephedra was recently withdrawn from the market (64). 

Other herbal stimulants include guarana or kola, which are natural sources of caffeine, just like the coffee bean. There are many such concoctions of caffeine or ephedra on the market, or recently taken off the market (Table 5.2). 

Some body builders tout the combination of caffeine with the herbal stimulant ephedra as harmless, and suggest the combination helps turn fat into muscle. A study published in 2001 does support the claim that caffeine and ephedrine can boost results in laboratory attempts to mimic the tasks of competing athletes. However, ephedra, the herbal drug containing the chemical ephedrine, has been linked to several deaths. 

The therapeutic treatment of obesity with caffeine is another controversial area of interest. Many over-the-counter diet aids contain caffeine, but it has not yet been determined whether there is a medically safe way to use caffeine as a fat fighter. A 2000 study showed that a combination of herbal ephedra and caffeine lowered participants body weight by both decreasing fat and decreasing the body mass index (BMI). Losses were 15 and 7 pounds for those taking the herbal supplement and a placebo, respectively. 

In the United States, ephedrine alkaloids are derived from the Ephedra sinica, or ma huang plant. Most ephedra supplements contain a standard extract of 6-8% ephedrine alkaloids. Other herbs and ingredients, including caffeine, may also be added to ephedra supplements. 

The molecular structure of ephedra resembles that of amphetamine, a stimulant. Dietary supplement product manufacturers often mixed caffeine with ephedra. Some experts believe that caffeine probably enhances or heightens ephedra s stimulant effects. Ephedra may also be combined with other herbs in supplements, depending on the desired effects. 

Ephedra supplements typically contain caffeine, and users may consume caffeine in carbonated beverages, coffee, or tea. Researchers suspect that caffeine may enhance ephedra s stimulant effects on cardiovascular and/or central nervous system responses. This may account for the types of adverse events that have been reported by ephedra users. 

A previously healthy 19-year-old man took tablets containing a total of 24 mg of Ephedra alkaloids and 100 mg of caffeine, and 15 minutes later developed severe chest pain radiating down the left arm. An electrocardiogram showed an inferolateral myocardial infarct, confirmed by creatine kinase and troponin I measurements. He made a full recovery, and coronary angiography showed only minimal atherosclerotic disease of the left anterior descending artery. 

Great stress, to ensure efficacy, is put on those products containing stimulants, such as caffeine or ephedra, to those on a diet, workout often, or under the age of 18. These products can cause long-term stress to the body if used for extensive amounts of time. Ephedra arises in the concern of the FDA because of the mechanism of ephedra in the human body. The adrenaline-like stimulant can cause dangerous effects to the nervous system and heart. Some of these effects include heart attack, seizure, stroke, and even death. There must be caution because the risk can increase with the dose, and with strenuous exercise. It specifies certain groups (such as women who are pregnant or breast feeding) who should never use these products and lists other conditions, such as diseases and the use of certain medications that rule out the use of ephedrine alkaloids. 

Additive stimulant effects of caffeine Caffeine is present in many products that contain ephedra alkaloids, and those who take these products might also be consuming considerable quantities of caffeine in coffee, tea, and soft drinks. Caffeine can enhance the undesirable effects of ephedrine on the heart, blood supply system, and brain function. 

Speed is the nomenclature used for a number of preparations that resemble and are often misrepresented as prescription amphetamines. They are used as substitutes for amphetamines. Speed is commonly composed of ephedrine, caffeine, synephrine, or a combination of these agents. Ephedrine is probably the most frequently encountered component of street speed. Elerbal weight loss products containing ephedra, which is made up a number of sympathomimetic alkaloids, were removed from the US market in 2003. Phenypropanolamine, previously marketed as a weight loss supplement and oral decongestant and abused as a look alike , was removed from the US market in 2002. 

Ephedra was also sold in combination with many other herbs in obscure combinations. Labels frequently listed 10 or 15 different herbs, but, analysis usually disclosed only the ephedra alkaloids and caffeine as present in sufficient quantities to be physiologically active. After several well-publicized accidental deaths, products clearly intended for abuse, such as herbal ecstasy, and other look-alike drugs (products usually containing ephedrine or phenylpropanolamine designed to look like illicit methamphetamine, but in concentrations higher than recommended by industry or the FDA) were withdrawn from the market. Labels on these products were frequently misleading. For example, one might suppose that a product called Ephedrine 60 contained 60 mg of ephedrine when, in fact, the actual ephedrine content was 25 mg. 

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(5) 593-604. 

Haller CA, Jacob P III, Benowitz NL. Pharmacology of ephedra alkaloids and caffeine after single-dose dietary supplement use. Clin Pharmacol Ther 2002 71(6) 421 132. 

Tormey WP, 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. 

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