Herbal remedies, ephedrine

Ephedrine is the principal ingredient in Ma Huang, an herbal remedy originally used to treat asthma. The remedy is advertised as a "natural" way to enhance mood, reduce fatigue, and lose weight, but its stimulating effects on the heart can be fatal. 

Serious liver damage may ensue from taking other herbal remedies. Noteworthy are cases linked to Ma Huang with its ephedrine alkaloids. Predominant symptoms include jaundice and liver necrosis (Nadir et al.,... 

Demonstrating the abihty of CE to do analysis in complex matrices, Liu and Sheu [38] have reported the separation of 8 quaternary alkaloids from Coptidis rhizoma which are commonly found in Chinese herbal remedies (Figxire 6). These investigators also determined ephedrine and pseudophedrine in Chinese herbal preparations [39]. Stuppner, et al. demonstrated the separation of 6 oxindole alkaloids from the root bark of Unicaria tomentosa [40]. 

In addition to this serious diet-drug interaction, irreversible MAOIs also potentiate the effects of sympathomimetic drugs like ephedrine found in over-the-counter cold remedies and recreational stimulants like amphetamine. The MAOIs also interact with drugs that increase synaptic concentrations of 5-HT, such as the tricyclic antidepressant clomipramine and the herbal SSRI antidepressant St John s wort (Hypericum spp.). The resulting serotonin syndrome is characterised by hyperthermia and muscle rigidity. While devoid of these side effects the reversible MAO-A inhibitor moclobemide has yet to establish itself as a first-line alternative to the SSRIs. 

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