Ephedra interactions

Other conditions in which ephedra is contraindicated are anxiety disorders, angle-closure glaucoma, prostate adenoma with residual urine volume, pheochromocytoma, and thyrotoxicosis (Gruenwald et al. 1998). Known medications that may interact adversely with ephedrine include heart glycosides, halothane, guanethidine, MAO inhibitors, secale alkaloids, and oxytocin. 

Ephedra (Ephedra sinica)/Ma Huang Uses Stimulant, aid in wt loss, bronchial dilation Dose Not OK d/t reported deaths (>100 mg/d can be life-threatening). US sales banned by FDA in 2004 bitter orange w/ similar properties has replaced this compound in most wt loss supplements Caution Advise cardiac events, strokes, death SE Nervousness, HA, insomnia, palpitations, V, hypoglycemia Interactions Digoxin, antihypertensives, antidepressants, diabetic medications EMS Tinctures extracts contain EtOH may X glucose linked to several deaths behavioral mood changes... 

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 Ephedra was recently withdrawn from the market (64). 

A number of other types of compounds have been used as chiral catalysts in phase-transfer reactions. Many of these compounds embody the key structural component, a P-hydroxyam-monium salt-type structure, which has been shown to be crucial to the success of the above described cinchona-derived quats. Although they have not been as successful as the cinchona catalysts, the ephedra-alkaloid derived catalysts (see 20, 22, 23 and 25 in Charts 3 and 4) have been used effectively in several reactions. In general, quats with chirality derived only from a single chiral center, which cannot participate in a multipoint interaction with other reaction species, have not been effective catalysts [80]. 

Ephedra has negative interactions with cardiac heart glycosides, halothene, guanethidine, MAO inhibitors, and secale alkaloid derivatives or oxytocin. 

Unlike the situation with ephedra, in many cases we simply have no idea what the components do. The constituents of some herbal drugs seem to work synergistically and cannot be separated without loss of activity of the preparation. Herbal preparations are most often used as crude mixtures and are not standardized or analyzed for the content of the active principlc(s). Hence, the chemistry of medicinal herbs cannot be treated in the same way as that of. say. a pure antibiotic or a calcium channel blocker. The medicinal chemistry of the actions, interactions, and side effects of herbal products is complex and difficult to assess clinically and chemically. Frequently, some of the compounds present... 

Ephedra has been closely linked to methamphetamine production. There are movements In many localities to outlaw the herb. There are many drug interactions with Ma huang. )9-BI(K kcrs may enhance the sympathetic effect and cause hypertentiion. MAOIs may interact with ephedra to cause hypertensive cri.si.s. Phcnothiaz.ines might block the or effects of ephedra, causing hypotension and tachycardia. Simultaneous use of theophylline may cau.se GI and CNS effects. In pregnancy, ephedra is absolutely contraindicated (uterine stimulation). Persons with heart disease, hypertension, and diabetes should not take ephedra. 

Ephedra Kava PC-Specs St. John s wort Weight loss Stress relief Lowers blood pressure Antidepressant Through 2001, there were more than 13000 health complaints and 100 deaths Liver damage - 11 cases of liver failure as of March, 2002 Product contaminated with warfarin, leading to bleeding. Also use represents a drug claim Interacts with drugs such as indinavir... 

As with other sympathomimetic agents, theoretical drug interactions with ephedra alkaloids are possible. Despite this potential, only a handful of adverse drug interactions have been reported. This is especially pertinent when considering the extensive use of both ephedra-containing supplements and ephedrine- or pseudoephedrine-containing OTC products. The most notable interaction exists between nonselective monoamine oxidase inhibitors and ephedra- or ephedrine-containing products. 

The ephedra alkaloids are all sympathomimetic amines, which means that a host of drug interactions are theoretically possible. In fact, only a handful of adverse drug interactions have been reported in the peer-reviewed literature. The most important of these involve the monoamine oxidase inhibitors (MAOI). Irreversible, nonselective MAOIs have been reported to adversely interact with indirectly acting sympathomimetic amines present in many cough and cold medicine. In controlled trials with individuals taking moclobemide, ephedrine s effects on pulse and blood pressure were potentiated, but only at higher doses than those currently provided in health supplements (137). Ephe-drine-MAOI interaction may, on occasion, be severe enough to mimic pheo-... 

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. 

Clinically important, potentially hazardous interactions with ephedra, lithium, mivacurium... 

Clinically important, potentially hazardous interactions with amprenavir, clonidine, ephedra, epinephrine, eucalyptus, guanethidine, iobenguane, isocarboxazid, linezolid, MAO inhibitors, paroxetine, phenelzine, quinolones, sparfloxacin, St John s wort, tranylcypromine... 

Clinically important, potentially hazardous interactions with antihypertensives, dexamethasone, ephedra, furazolidone, guanethidine, guarana, MAO inhibitors, methyldopa, oxprenolol, phenelzine, phenylpropanolamine, selegiline, tranylcypromine, tricyclic antidepressants... 

Clinically important, potentially hazardous interactions with albuterol, alpha-blockers, amitriptyline, amoxapine, atenolol, beta-blockers, carteolol, chlorpromazine, clomipramine, cocaine, desipramine, doxepin, ephedra, ergotamine, furazolidone, halothane, imipramine, insulin detemir, MAO inhibitors, metoprolol, nadolol, nortriptyline, oxprenolol, penbutolol, phenelzine, phenoxybenzamine, phenylephrine, pindolol, prazosin, propranolol, protriptyline, sympathomimetics, terbutaline, thioridazine, timolol, tranylcypromine, tricyclic antidepressants, trimipramine, vasopressors... 

Clinically important, potentially hazardous interactions with amitriptyline, amoxapine, amphetamines, bupropion, citalopram, clomipramine, cyproheptadine, desipramine, dextroamphetamine, dextromethorphan, diethylpropion, dopamine, doxepin, entacapone, ephedra, ephedrine, epinephrine, fluoxetine, fluvoxamine, ginseng, imipramine, levodopa, mazindol, meperidine, methamphetamine, nefazodone, nortriptyline, paroxetine, phendimetrazine, phentermine, phenylephrine, pizotifen, propoxyphene, protriptyline, pseudoephedrine, rizatriptan, sertraline, sibutramine, sumatriptan, sympathomimetics, tramadol, tricyclic antidepressants, trimipramine, tryptophan, venlafaxine, zolmitriptan... 

Clinically important, potentially hazardous interactions with carbidopa, citalopram, doxepin, ephedra, ephedrine, escitalopram, fluoxetine, fluvoxamine, levodopa, meperidine, moclobemide, nefazodone, oral contraceptives, paroxetine, sertraline, venlafaxine... 

---