Psychosis, ephedrine

Martin WR, Sloan JW, Sapira JD, et al Physiologic, subjective, and behavioral effects of amphetamine, methamphetamine, ephedrine, phenmetrazine, and methylphenidate in man. Clin Pharmacol Ther 12 245-258, 1971 McCormick TC Jr, McNeil TW Acute psychosis and Ritalin abuse. Tex State J Med... 

It is a synthetic compound with structural similarity to ephedrine and is available in racemic and dextro isomers. It increases the systolic and diastolic blood pressure. Amphetamine is a potent CNS stimulant and causes alertness, insomnia, increased concentration, euphoria or dysphoria and increased work capacity. Amphetamine produces wakefulness and improved physical performance. It contracts the sphincter of the bladder and relaxes the bronchial smooth muscle in large doses. Amphetamines are drugs of abuse and can produce behavioural abnormalities and can precipitate psychosis. It can produce psychological but no physical dependence. 

In another three cases (girls aged 10, 13, and 15 years) severe acute psychosis was associated with the use of an over-the-counter formulation containing ephedrine or pseudoephedrine and dextromethorphan combined with other compounds (225). The psychopathology included agitation, depressed mood, flat affect, pressure of speech, visual and auditory hallucinations, and paranoia. All three improved dramatically, with residual symptoms of irritability, 2-4 days after withdrawal of the mixture and treatment with risperidone 0.5-2.0 mg/day. 

In another three cases (girls aged 10, 13, and 15 years) severe acute psychosis was associated with the use of an over-the-counter formulation containing ephedrine or pseudoephedrine and dextromethorphan combined with... 

Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. BMJ 1996 313(7059) 756. 

Metab-O-Lite Metabolift Up Your Gas Truckers Luv It Yellow Jackets Methyl ephedrine Myocardial infarction Hepatitis Stroke Seizures Psychosis Death... 

Roxanas MG, Spalding J. Ephedrine abuse psychosis. Med J Aust... 

Shufman NE, Witztum E, Vass A. [Ephedrine psychosis]. Harefuah 1994 127(5-... 

Sometimes, especially in Japan and the Philippines, ephedrine is taken specifically as a psychostimulant. In Japan, BRON, the OTC cough medication containing methylephedrine, dihydrocodeine, caffeine, and chlorpheniramine is very widely abused and transient psychosis is not an uncommon result (Tokunaga et al., 1989 Ishigooka et al., 1991 Levine et al., 1993). 

More often than not, psychosis occurs in individuals taking ephedrinebased products for asthma and other respiratory conditions. Ephedrine s usefulness as a bronchodilator is somewhat limited by the fact that chronic use leads to a predictable, and fairly rapid, down regulation of 3-receptors and decreased bronchial responsiveness (Neve and Molinoff, 1986). As the medication becomes less and less effective, patients tend to increase the dose. If they take enough, psychosis can occur. Of course, ephedrine, and products containing ephedrine enantiomers, can also be taken specifically with the intent of becoming intoxicated. 

Ephedrine psychosis closely resembles psychosis induced by amphetamines paranoia with delusions of persecution and auditory and visual hallucinations, even though consciousness remains unclouded. Typically, patients with ephedrine psychosis will have ingested more than 1000 mg/d. Recovery is rapid after the drug is withdrawn (Shufman et al., 1994). The ephedrine content per serving of most food supplements is on the order of 10-20 mg, making it extremely unlikely that, in recommended doses, use of any of the products would lead to neurologic symptoms. 

Whitehouse AM, Duncan JM. Ephedrine psychosis rediscovered. Br J Psychiatry 1987 50 258-61. 

Ephedrine is used in the treatment of asthmatic conditions. It is of low toxicity, but its prolonged use may lead to toxic psychosis with auditory and visual hallucinations 224). 

Ma huang Ephedrine (various Ephedra spp.) Stimulant athletic performance enhancement appetite suppressant Insomnia hypertension, tachycardia psychosis, seizures (see Caffeine, p 142). 

Phenylpropanolamine can raise blood pressure and in some cases this may be further increased by caffeine. Combined use has resulted in hypertensive crises in a few individuals. Ephedrine may interact similarly. Phenylpropanolamine can markedly raise plasma caffeine levels, and isolated reports describe the development of acute psychosis when caffeine was given with phenylpropanolamine or ephedrine. 

If used for therapeutic purposes with dose control, ephedrine has no potential toxicity. However, the toxicity of this amine may be expressed in overdosages, which can lead to paranoid psychosis, delusimis, and hallucinations [20]. Large doses of ephedrine may cause hypeitensimi, headache, dizziness, palpitations, vomiting, nervousness, and insomnia [12]. 

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