Tremor ephedrine

Ephedrine stimulates CNS and produces restlessness, insorrmia, anxiety and tremors. Ephedrine produces mydriasis on local as well as systemic administration. 

SYMPATHOMIMETICS BICARBONATE Possibly t ephedrine/ pseudoephedrine levels Alkalinizing urine 1 the excretion of these sympathomimetics Watch for early features of toxicity (tremor, insomnia and tachycardia)... 

Ephedrine (t/ approx. 4 h) is a plant alkaloid with indirect sympathomimetic actions that resemble adrenaline peripherally. Centrally (in adults) it produces increased alertness, anxiety, insomnia, tremor and nausea children may be sleepy when taking it. In practice central effects limit its use as a sympathomimetic in asthma. 

Even low doses of caffeine can, in sensitive patients, cause tremor, insomnia, and anxiety, and such problems are much more marked if ephedrine is given together with caffeine, as it sometimes is for appetite control (SEDA-17,161). 

There are very few animal studies conducted investigating the toxic effects of ephedra. Studies using ephedrine in animals suggest that if it is given in excessive amounts, it produces symptoms of sympathetic stimulation, manifested by anxiety and restlessness. If the dosage is large, muscular tremors and even convulsions may occur. 

Alkalinisation of the urine (e.g. by sodium bicarbonate) causes retention of ephedrine and pseudoephedrine by the kidneys, leading to the possible development of toxicity (tremors, anxiety, insomnia, tachycardia). Acidification of the urine (e.g. with ammonium chloride) has the opposite effect. 

The interaction between ephedrine or pseudoephedrine and urinary alkalinisers are established but reports of adverse reactions in patients appear to be rare. Be aware that any increase in the adverse effects of these drugs (tremor, anxiety, insomnia, tachycardia, etc.) could be due to drug retention brought about by this interaction. Acetazolamide makes the urine alkaline and would be expected to interact with ephedrine and pseudoephedrine in the same way as sodium bicarbonate. 

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