Ephedrine toxicity

Theoharides TC. Sudden death of a healthy college student related to ephedrine toxicity from a ma huang containing drink. J Clin Psychopharmacol 1997 17 437-439. 

Very few fatalities have ever been reported (or studied), but it appears that the therapeutic index for ephedrine is very great. A 1997 case report described a 28-year-old woman with two prior suicide attempts, who died after ingesting amitriptyline and ephedrine. The blood ephedrine concentration was 11,000 ng/mL, and the liver concentration was twice that value (kidney, 14 mg/kg brain, 8.9 mg/kg). The amitriptyline concentration was 0.33 mg/kg in blood and 7.8 mg/kg in liver (131). Values in a second case report (where methylephedrine concentrations were nearly 6000 ng/mL) may or may not be relevant to the problem of ephedrine toxicity, as the individual in question took massive quantities of a calcium channel blocker, and it is not known whether methylephedrine exerts all the same effects as ephedrine (132). Baselt and Cravey mention the case of a young woman who died several hours after ingesting 2.1 g of ephedrine combined with 7.0 g of caffeine, but tissue findings were not described. Her blood ephedrine level was 5 mg/L, whereas the concentration in the liver was 15 mg/kg (133). 

According to Camus, hordenine is of low toxicity, but in large doses it causes death by arrest of respiration. It is less active than adrenaline but analogous in its action, resembling ephedrine rather than adrenaline. Barger and Dale found that the methiodide had a marked nicotine-... 

Additive sympathomimetic effects may develop when decongestants are administered with other sympathomimetic drug s (see Chap. 22). Use of the nasal decongestants with the MAOIs may cause hypertensive crisis. Use of a decongestant with beta-adrenergic blocking dragp may cause hypertension or bradycardia. When ephedrine is administered with theophylline, the patient is at increased risk for theophylline toxicity. 

Diuretic teas such as juniper berries and shave grass or horsetail are contraindicated. Juniper berries have been associated with renal damage, and horsetail contains severely toxic compounds Teas with ephedrine should be avoided, especially by individuals with hypertension. 

Ephedrine is an alkaloid that is present in various forms of the ephedrine family, and which is still extracted from Ephedra sinica and Ephedra equisetina. Because of the presence of two asymmetric atoms, there are four isomeric forms. Pseudoepinephrine (d-isoephrine) is a stereoisomer with pharmacological action that differs slightly from ephedrine. The pharmacological action of ephedrine is typical of noncatecholamine sympathomimetics of mixed action. It stimulates both a- and 8-adrenoreceptors, and simultaneously causes a release of norepinephrine from synaptic neurons. Its vasoconstrictive ability is approximately 100 times weaker than that of epinephrine however, the duration of action is approximately 10 times longer. It is much less toxic than epinephrine, which allows it to be used widely in medicine. 

Generally speaking, alkaloids are more toxic for vertebrates than for invertebrates. The coefficients of the selective toxicity show that alkaloids are very dominantly selective toxins to vertebrates (Table 26). Vertebrate very strong selectivity (<0.01) is observed in such alkaloids as ajmalicine, brucine, ephedrine, ergometrine, harmaline, lupanine, lupinine, scopolamine and... 

Pinellia temata (Thunb.) Breit. P. tuberifera Tenore Ban Xia (tuber) 1-ephedrine, choline, amino acids.33-144 This herb is toxic. Antiemetic, antitussive and antidote for strychnine intoxication. 

Ephedra distachya L. China 1-ephedrine, 1-methylephedrine, 1-norephedrine, methylephedrine, d-pseudoephedrinem, d-N-methy lpseudoephedrine. 30-3133 This herb is toxic. Treat asthma, sympathomimetic action, relieve headache, body ache, and coughing, lower fever by increasing perspiration. 

Ephedrine, a drug of low toxicity used for treating asthma... 

Local anesthetics block the sodium channels, are cardiac depressants, and bring about a ventricular conduction defect and block that may progress to cardiac and ventilatory arrest if toxic doses are given. In addition, these agents produce arteriolar dilation. Circulatory failure may be treated with vasopressors such as ephedrine, metaraminol (Aramine), or mephentermine (Wyamine). Artificial respiration and cardiac massage may also become necessary. Among the local anesthetics, only cocaine blocks the uptake of norepinephrine, causes vasoconstriction, and may precipitate cardiac arrhythmias. 

Because of high demand, ecstasy pills are frequently mixed with fillers and other active substances, most commonly amphetamines (speed), caffeine, and ephedrine (a natural amphetamine-like substance). Some pills have been found to contain DXM (dextromethorphan), a dissociative psychedelic found in some cough medicine, and PMA (paramethoxyamphetamine), a highly toxic hallucinogenic stimulant. 

Methamphetamine is a white, odorless, bitter-tasting powder that dissolves easily in water or alcohol. Methamphetamine production begins with a common chemical known as ephedrine. After using several toxic chemicals, including hydriodic acid, chemical solvents, and heavy metals such as mercury and lead, methamphetamine is produced. Chronic users often combine... 

Cardiovascular toxicity is also frequently encountered in poisoning. Hypotension may be due to depression of cardiac contractility hypovolemia resulting from vomiting, diarrhea, or fluid sequestration peripheral vascular collapse due to blockade of -adrenoceptor-mediated vascular tone or cardiac arrhythmias. Hypothermia or hyperthermia due to exposure as well as the temperature-dysregulating effects of many drugs can also produce hypotension. Lethal arrhythmias such as ventricular tachycardia and fibrillation can occur with overdoses of many cardioactive drugs such as ephedrine, amphetamines, cocaine, tricyclic antidepressants, digitalis, and theophylline. 

The severe form of erythema multiforme known as toxic epidermal necrolysis has been attributed to a mixture of dexamfetamine and ephedrine (77). 

In New Zealand, herbal ecstasy is a term used for many different herbal formulations, none of which contains ecstasy. Some of the names for these herbs (which can be sold in stores) include The Bomb , Reds , and Sublime . Analysis of The Bomb showed substantial amounts of ephedrine the Ministry of Health in New Zealand removed it from the market. Some symptoms associated with herbal ecstasy include headache, dizziness, palpitation, tachycardia, and raised blood pressure. Thus, in countries where the term herbal ecstasy is commonly used, it is important that those who see patients who have taken herbal ecstasy should not confuse it with ecstasy, as toxicity and medical management may be quite different (133). 

As can be seen from Table I a substantial number of alkaloids display significant insect toxicity, including nicotine, pipeline, lupine alkaloids, caffeine, gramine, strychnine, berberine, ephedrine, and steroidal alkaloids. Only the specialists can tolerate the respective alkaloids. The tobacco homworm (Manduca sexto), for example, can grow on a diet with more than 1% nicotine without any adverse effects. Most of the nicotine is either degraded or directly eliminated via the Malpighian tubules and in feces 182). Because nicotine binds to the acetylcholine (ACH) receptor, it is likely that in Manduca this receptor has been modified in such a way that ACH can still bind, but not nicotine (so-called target site modification). 

SYMPATHOMIMETICS ANTACIDS-SODIUM BICARBONATE Possibly t ephedrine/ pseudoephedrine levels Alkalinising urine 1 excretion of these sympathomimetics Watch for early features of toxicity... 

SAFETY PROFILE A poison by intra-peritoneal, subcutaneous, and intravenous routes. When heated to decomposition it emits very toxic fumes of HCl and NOx. See also EPHEDRINE. 

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