Skip to main content


Scientific Name(s): Ephedra equisetina Bge., Ephedra intermedia Schrenk et Meyer, Ephedra sinica Stapf.
Common Name(s): Ephedra, Ma huang, Pinellia, Yellow astringent, Yellow horse

Medically reviewed by Last updated on Jul 14, 2023.

Clinical Overview


The whole Ephedra sinica plant has traditionally been used to treat symptoms of bronchial asthma, colds, influenza, allergies, and hives in teas or tinctures. Because of adverse events and lack of efficacy, use is not recommended for weight loss or increased athletic performance. Ephedra-containing supplements are banned for sale in the United States.


Ephedra-containing dietary supplements are currently banned in the United States. Dosages of ephedra more than 32 mg/day have resulted in adverse reactions.


Cardiovascular and cerebrovascular adverse events have been documented in case reports.


Documented adverse reactions. Avoid use.


Interactions are likely to be similar to those established for synthetic ephedrine and include monoamine oxidase inhibitors (MAOIs), the anesthetic propofol, cholinergic agents such as tricyclic antidepressants, caffeine, theophylline, and steroids such as dexamethasone.

Adverse Reactions

Reported adverse reactions include arrhythmia and sudden death, myocardial infarction, stroke, psychiatric symptoms, autonomic hyperactivity, seizures, and ischemic colitis and gastric mucosal injury.


Toxicological data are limited. Periconceptional use of ephedra-containing products has been associated with an increased adjusted odds ratio for anencephaly.

Scientific Family


Ephedra species grow as low, shrubby plants with small leaves on jointed, ribbed green stems. They are dioecious (ie, male and female flowers are usually found on separate plants). The 3-source species are native to China, where the aboveground parts are collected in the fall and dried for use. Ephedras are gymnosperms and are most closely related to conifers, although many aspects of their botany are different. About 45 Ephedra species exist, varying in their alkaloid content. American, Chilean, and European species are considered to be relatively low in alkaloid content, while Chinese and Indian varieties contain larger amounts of active alkaloids.

The root of E. sinica or E. intermedia, known as "ma huang gen," is considered by Chinese traditional practitioners to be a distinct drug product from the aboveground parts. A chapter on ephedra has been included in the Flora of China, a collaborative plant project.Lee 2011, USDA 2007, Chaw 2000, Bowe 2000, Fu 2000


Ma huang is one of the earliest and best known drugs of Chinese traditional medicine. It is mentioned in the Shen Nong Ben Cao Jing, one of the premodern classics of Chinese medicine written around 100 AD. Ma huang was used to induce perspiration and treat the symptoms of bronchial asthma, colds, and influenza; it is still in traditional use today.

The earliest scientific work on ephedra, and consequently on ephedrine, is attributed to the Japanese organic chemist and pharmacologist Nagayoshi Nagai (1844 to 1929), followed by his colleague Kinnosuke Miura (1864 to 1950), who identified the potential toxicity of the alkaloids. As a weight loss agent, ephedra has been commonly combined with caffeine; however, more recently the ephedra component has been replaced with bitter orange in US dietary supplements.Lee 2011, Fu 2000


Chemical investigations of ephedra in the early 20th century resulted in the isolation of the alkaloids ephedrine and pseudoephedrine, which were identified as the major pharmacologically active compounds in the aboveground portions of the plant. The ephedra alkaloids possess 2 adjacent chiral atoms that could generate 4 possible isomers for every planar structure; however, the plant produces only 2 of the possible isomers.Freudenberg 1932 Synthetic ephedrine and pseudoephedrine are usually produced as a racemate, and therefore contain all of the possible isomers. A total of 6 major alkaloids of this type are found in the 3 species known as Ephedrae herba; the major alkaloid of all species is ephedrine, with pseudoephedrine the next most abundant, and norephedrine, norpseudoephedrine, methylephedrine, and methylpseudoephedrine making up the balance.Jian 1988 The proportion of single alkaloids and total alkaloid content of the aboveground portions can vary widely, from 0.5% to 2.5%, with the highest concentration of alkaloids found in the fall. Biosynthesis of ephedra alkaloids has been studied; ephedrine is formed from pyruvate and benzoic acid.Grue-Srensen 1988, Grue-Srensen 1994 The supercritical fluid extraction of ephedrine from E. sinica has been studied using a mixture of carbon dioxide, diethylamine, and methanol.Choi 1999

A large number of analytical methods for ephedra alkaloids have been devised. Gas chromatography has been used, as well as chiral gas chromatography and gas chromatography-mass spectrometry of both plant material and urine specimens.Cui 1991, Betz 1997, Li 2001, Spyridaki 2001 Numerous high-performance liquid chromatography (HPLC) methods have been developedJian 1988, Moriyasu 1984, Gurley 1998, Hurlbut 1998, Li 2002, Hong 2011 including analysis of urine samplesGmeiner 2002 and a liquid chromatography-mass spectrometry method for dietary supplements.Gay 2001 Capillary electrophoresis and isotachophoresis also have been applied, with some methods using cyclodextrin as a matrix to resolve optically isomeric alkaloids.Kasahara 1985, Snopek 1988, Liu 1992, Liu 1993, Flurer 1995, Belder 2011 Carbon-13 nuclear magnetic resonance also has been used to qualitatively and quantitatively analyze ephedra alkaloids.Yamasaki 1979

Several systematic studies of alkaloid content in commercial ephedra samples have been conducted. One study used capillary electrophoresis to analyze 22 samples from Taiwan herbal markets and found that E. sinica samples were generally higher in alkaloid content than E. intermedia samples (1.6% vs 1.2%, respectively). The relative amounts of specific alkaloids in aboveground parts correlated well with the species studied, while root samples had no detectable alkaloids.Liu 1993 Because crude ephedra can be used as a starting substance for the synthesis of amphetamines, the profile of impurities was used to determine the origin of illicit amphetamine in Japan.Makino 2002 Another study examined 20 different dietary supplements from the United States market by HPLC and found that some products had no ephedra alkaloids, some had only ephedrine (suggesting the use of synthetic material), and others were properly labeled and contained the specified amount of alkaloid.Gurley 2000 American species of ephedra have been found to be devoid of or have very low amounts of alkaloids. Thus, species such as Ephedra nevadensis (Mormon tea) are not appropriate substitutes.Terry 1927

Other types of compounds also have been isolated from ma huang. Tetramethylpyrazine has been identified as a pharmacologically active constituent of stems, and analytical methods have been developed.Spyridaki 2001, Lv 2000, Zhao 2009 In the roots, which do not contain appreciable amounts of ephedrine alkaloids, feruloylhistamineHikino 1984 and ephedradines A-DHikino 1983, Tamada 1979 were isolated. The flavonoid derivative ephedrannin A was also isolated from the root.Hikino 1982 The polysaccharide ephedrans A-E have been isolated from ephedra stems.Konno 1985 The roots of ephedra have yielded a variety of hypotensive compounds, including the flavonoid ephedrannin AHikino 1982 feruloylhistamineHikino 1984 and the spermine alkaloids ephedradines A-DHikino 1983 which were not found in the aboveground parts.

Uses and Pharmacology

The US Food and Drug Administration (FDA) first banned the sale of all dietary supplements containing ephedra in April 2004 based on a lack of evidence to support efficacy claims and more than 16,000 reported cases of adverse reactions. The ban was later overturned by a federal judge in April 2005 for products containing ephedra 10 mg or less. However, in May 2007, the ban was upheld by the US Supreme Court based on a final FDA regulation declaring dietary supplements containing adulterated ephedrine alkaloids as presenting an unreasonable risk of illness or injury under conditions of use recommended or suggested in the labeling, or if no conditions of use are suggested or recommended, under ordinary conditions of use.FDA 2012, Greenway 2001

Athletic performance

Animal data

Ephedra-containing dietary supplements are banned by the FDA, making data from animal studies of their use as a performance enhancer irrelevant.

Clinical data

The use of ephedra-containing products in sports has been reported.Tokish 2004, Avois 2006, Dhar 2005 Few trials evaluating the ergogenic efficacy of ephedrine alone exist, and results suggest slight effects on performance.Tokish 2004, Shekelle 2003 However, combinations of ephedrine and caffeine have been reported to increase endurance in running and cycling experiments.Dhar 2005, Shekelle 2003 Most studies have been conducted by one groupBell 2001, Bell 2002 and because of the different types of exercise studied (endurance and power), the results cannot be pooled for analysis.Shekelle 2003 Because most classes of amphetamines are banned by the International Olympic Committee (except for medical use of ephedrine) and ephedra-containing supplements are banned by the FDA, further trials evaluating their efficacy are unlikely.Tokish 2004, Avois 2006

Weight loss

Animal data

Ephedra-containing supplements are banned by the FDA, making data from animal studies for use as a weight-loss aid irrelevant.

Clinical data

A combination of ephedrine with a caffeine-containing supplement, such as guarana or cola nut, has been most frequently used for weight loss.Greenway 2001 A meta-analysis evaluating the efficacy of ephedra in weight loss published in 2003 found few published high-quality trials. Of those trials included, the pooled data favored ephedra and ephedrine over placebo in the short-term (less than 6 months), with about 0.9 kg/month weight loss compared with placebo but with wide confidence limits.Shekelle 2003 Other reviews found similar results.Pittler 2005, Joyal 2004, Dwyer 2005, Dulloo 2002 The few trials that have been published since the 2004 ban on ephedra products came to similar conclusions, with enhanced thermogenesis proposed as the mechanism of action.Greenway 2001, Vukovich 2005 Whereas a variety of herbals (including ephedra) were shown to effectively decrease appetite and food intake in a 2009 systematic review of herbals used for management of obesity, significant adverse effects were reported only in studies using supplements containing ephedra and caffeine.Hasani-Ranjbar 2009 A more recent study in 7 volunteers attributed the weight loss activity of ephedra correlated to the changes in gut microbiota induced by ephedra consumption.Kim 2014

Other effects


Activity against a limited range of viruses has been shown in some, but not all, in vitro studies.Soltan 2009, Murakami 2008, Lee 2010 Antimicrobial activity has been demonstrated in vitro by other Ephedra species (Ephedra strobiliacea, Ephedra procera, and Ephedra pachyclada spp.).Parsaeimehr 2010


Ephedra extracts have shown anti-inflammatory and immune effects in experiments in rodents and in vitro studies. Complement activation was inhibited and E. sinica showed protective effects against sequelae of spinal cord injury in one experiment.Li 2009 Chemical constituents ephedrannin A and B suppressed the transcription of tumor necrosis factor-alpha and interleukin-1 beta in macrophages and in induced hepatic failure in mice.Kim 2010, Yamada 2008 Ephedra constricted isolated rabbit urethra tissue, possibly via arachidonic acid pathways, and alpha-adrenoreceptor stimulation in another laboratory experiment.Ayajiki 2008


There is a ban on the sale of all ephedra-containing dietary supplements in the United States. Doses of ephedra greater than 32 mg/day have resulted in adverse reactions.Andraws 2005

The pharmacokinetics of ephedra in humans have been studied, with ephedrine in crude herb requiring twice as long to reach the peak plasma concentration as pure ephedrine dosage forms.White 1997 Similarly, the combination of a single dose of ephedra and caffeine has been studied; ephedrine and pseudoephedrine had similar peak concentrations at 140 to 150 minutes, while caffeine blood levels peaked at 90 minutes. Overall results were similar to those of individual compounds in pure form.Haller 2002

Pregnancy / Lactation

Documented adverse reactions. Avoid use.Ernst 2002, Fleming 2008 It may increase blood pressure and heart rate, cause CNS activity, and stimulate uterine muscle. Periconceptional use of ephedra-containing products has been associated with an increased adjusted odds ratio for anencephaly.Bitsko 2008


Although natural forms of ephedra may contain different chemical constituents than those of ephedrine, in general, interactions are likely to be similar to those established for the synthetic form of the latter and include MAOIs, the anesthetic propofol, cholinergic agents such as tricyclic antidepressants, caffeine, theophylline, and steroids such as dexamethasone.Ulbricht 2008, Scott 2002, Tang 2011

Alkalinizing agents: Alkalinizing agents may increase the serum concentration of alpha-/beta-agonists (indirect-acting). Monitor therapy.Brater 1980, Kuntzman 1971, Wilkinson 1968, Zimmerman 1988, Zimmerman 1990

Alpha-1 blockers: Alpha-1 blockers may diminish the vasoconstricting effect of alpha-/beta-agonists. Similarly, alpha-/beta-agonists may antagonize alpha-1 blocker vasodilation. Monitor therapy.Amadesi 2001, Auvi-Q September 2012, Beretta-Piccoli 1985,, Harada 1999, Schafers 1999

Antihypertensive agents: Herbs (hypertensive properties) may diminish the antihypertensive effect of antihypertensive agents. Monitor therapy.Jalilil 2013

Antipsychotic agents (phenothiazines): Alpha-/Beta-agonists may enhance the arrhythmogenic effect of antipsychotic agents (phenothiazines). Thioridazine is of most concern. Consider therapy modification.Chouinard 1978, Forster 1954, Giles 1968, Yagiela 1985

Atomoxetine: Atomoxetine may enhance the hypertensive effect of sympathomimetics. Atomoxetine may enhance the tachycardic effect of sympathomimetics. Monitor therapy.Cantilena 2012, Hammerness 2009, Kelly 2005, Michelson 2003, Sofuoglu 2009, Spencer 2002, Strettera 2017

Benzylpenicilloyl polylysine: Alpha-/Beta-agonists may diminish the diagnostic effect of benzylpenicilloyl polylysine. Consider therapy modification.Pre-Pen October 2009

Cannabinoid-containing products: Cannabinoid-containing products may enhance the tachycardic effect of sympathomimetics. Monitor therapy.Benowitz 1977, Foltin 1987, Foltin 1990, Foltin 1995, Gash 1978, Lukas 1994, Williamson 2000

Carbonic anhydrous inhibitors: Carbonic Anhydrase Inhibitors may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy.Brater 1980, Delbeke 19991, Kuntzman 1971, Wilkinson 1968, Zimmerman 1988, Zimmerman 1990

Chloroprocaine: Chloroprocaine may enhance the hypertensive effect of alpha-/beta-agonists. Monitor therapy.Clorotekal 2017, Nesacaine 2010

Clozapine: Clozapine may diminish the therapeutic effect of alpha-/beta-agonists. Monitor therapy.John 2010, Leung 2015

Cocaine (topical): Cocaine (topical) may enhance the hypertensive effect of sympathomimetics. Consider therapy modification.Ashchi 1995, Barnett 1998, Laffey 1999, Lormans 1992, McGovern 2015, Miller 1978, Nicholson 1995, Sundboll 2014

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of doxofylline. Monitor therapy.Doxofylline December 2015

Droxidopa: Ephedra may enhance the hypertensive effect of droxidopa. Monitor therapy.Northera February 2014

Ergot derivatives: Ergot derivatives may enhance the hypertensive effect of alpha-/beta-agonists. Ergot derivatives may enhance the vasoconstricting effect of alpha-/beta-agonists. Avoid combination.Cafergot March 2006, Chan 2011, DHE 45 July 2002, Ergonovine March 2009, Parlodal January 2012

Fentanyl: Alpha-/beta-agonists (indirect-acting) may decrease the serum concentration of fentanyl. Specifically, fentanyl nasal spray serum concentrations may decrease and onset of effect may be delayed. Monitor therapy. This interaction is only expected to occur with intranasally administered fentanyl.Lazanda June 2011

Guanethidine: Guanethidine may enhance the arrhythmogenic effect of sympathomimetics. Guanethidine may enhance the hypertensive effect of sympathomimetics. Monitor therapy.Deshmankar 1967, Gulati 1966, Ismelin July 2014, Laurence 1963, Muelheims 1965, Simonyi 1972

Hyaluronidase: Hyaluronidase may enhance the vasoconstricting effect of alpha-/beta-agonists. Consider therapy modification. Avoid the use of hyaluronidase to enhance dispersion or absorption of alpha-/beta-agonists. Use of hyaluronidase for other purposes in patients receiving alpha-/beta-agonists may be considered as clinically indicated.Hylenex August 2011

Inhalational anesthetics: Ephedra may enhance the arrhythmogenic effect of inhalational anesthetics. Avoid combination.Ephedrine sulfate February 2005, Hahm 2007, Takaori 1965, Tucker 1974

Iobenguane: Alpha-/Beta-agonists (indirect-acting) may diminish the therapeutic effect of iobenguane radiopharmaceutical products. Avoid combination.AdreView March 2013, Azedra July 2018

Linezolid: Linezolid may enhance the hypertensive effect of sympathomimetics. Consider therapy modification.Hendershot 2001, Zyvox June 2010,

Monoamine oxidase inhibitors: Monoamine wxidase inhibitors may enhance the hypertensive effect of alpha-/beta-agonists (indirect-acting). While linezolid is expected to interact via this mechanism, management recommendations differ from other monoamine oxidase inhibitors. Refer to linezolid specific monographs for details. Avoid combination.Dingemanse 1993,, Dingemanse 1996, Elis 1967, Harrison 1989, Jenkins 1965, Low-Beer 1963, Wright 1978

Serotonin/Norepinephrine reuptake inhibitors: Serotonin/Norepinephrine reuptake inhibitors may enhance the tachycardic effect of alpha-/beta-agonists. Serotonin/Norepinephrine reuptake inhibitors may enhance the vasopressor effect of alpha-/beta-agonists. Consider therapy modification.Anon 1978, Boakes 1973, Cymbalta August 2008, Effexor February 2008, Gershon 1962, Khurana 2003, Knoll-Kohler 1989, Meechan 2002, Mitchell 1970, Prestiq April 2008, Stevens 2008, Svedmyr 1968

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of solriamfetol. Monitor therapy.Sunosi March 2019

Spironolactone: Spironolactone may diminish the vasoconstricting effect of alpha-/beta-agonists. Monitor therapy.Aldactone January 2008

Sympathomimetics: Sympathomimetics may enhance the adverse/toxic effect of other sympathomimetics. Monitor therapy.Foradil September 2001, ProAmatine February 2017

Tedizolid: Tedizolid may enhance the hypertensive effect of sympathomimetics. Tedizolid may enhance the tachycardic effect of sympathomimetics. Monitor therapy.Flanagan 2013, Hendershot 2001, Sivextro June 2014, Zyvox September 2013

Urinary acidifying agents: Urinary acidifying agents may decrease the serum concentration of alpha-/beta-agonists (indirect-acting). Monitor therapy.Kuntzman 1971, Wilkinson 1968, Zimmerman 1988

Adverse Reactions

A clear temporal association for cardiovascular and cerebrovascular adverse reactions and psychiatric symptoms has been shown with ephedra use, but a direct causal relationship is difficult to establish.Dhar 2005, Shekelle 2003, Andraws 2005, Figueredo 2011, Maglione 2005 A 2- to 3-fold increased odds for risk of adverse psychiatric reactions and heart palpitations was found in one meta-analysis, with a trend toward an increase in risk for hypertension.Shekelle 2003 A review of case reports found a trend toward an increased risk for cardiovascular and cerebrovascular adverse reactions at doses lower than those used for weight loss (ephedra 32 mg/day vs 90 to 150 mg/day, respectively).Andraws 2005

A clinical trial in which 20 healthy adults were given ephedra 1 g dry extract (or placebo) daily for 14 days found increases in heart rate after taking ephedra.Chen 2010, Chen 2010

Case reports of adverse reactions continue to appear in the literature despite the FDA ban on ephedra products and include cardiomyopathies, arrhythmia and sudden death, myocardial infarction, coronary artery aneurysm, stroke, psychiatric symptoms, autonomic hyperactivity, and seizures.Dhar 2005, Shekelle 2003, Joyal 2004, Vukovich 2005, Andraws 2005, Fleming 2008, Maglione 2005, Haller 2005, Haller 2005, Flanagan 2010, Nazeri 2009, Singh 2008, Cohen 2010 Unfavorable effects on glucose and potassium homeostasis have also been demonstrated, and case reports of ischemic colitis and gastric mucosal injury also exist.Fleming 2008, Haller 2005, Lillegard 2010, Song 2008

A case of acute bilateral angle-closure glaucoma was reported in a 52-year-old female associated with ma-huang within 24 hours of first dose. She had no past medical history and presented in the emergency department with acute bilateral ocular pain, decreased visual acuity, headache, nausea, and vomiting.Ryu 2017

Data collected between 2004 and 2013 from 8 US centers in the Drug-induced Liver Injury Network revealed that 15.5% (130) of hepatotoxicity cases were caused by herbals and dietary supplements, whereas 85% (709) of cases were related to prescription medications. Of the 130 cases of liver injury related to supplements, 65% were from non-bodybuilding supplements and occurred most often in Hispanics/Latinos compared with non-Hispanic whites and non-Hispanic blacks. Liver transplant was also more frequent with toxicity from non-bodybuilding supplements (13%) than with conventional medications (3%) (P<0.001). Overall, the proportion of severe liver injury cases was significantly higher for supplements than for conventional medications (P=0.02). Of the 217 supplement products implicated in liver injury, 175 had identifiable ingredients, of which ephedra was among the 32 (18%) single-ingredient products.Navarro 2014 The European Association for the Study of the Liver (EASL) clinical practice guideline for drug-induced liver injury (2019) recommends physicians consider herbal and dietary supplements as potential causative agents associated with liver injury (Level 4; Grade C), including ephedra (Ma Huang).EASL 2019

In the 2016 Scientific Statement by the American Heart Association regarding drugs that may cause or exacerbate heart failure, ephedra (ma-huang) and ephedra-like products have been recognized as products with stimulant effects on blood pressure and heart rate as well as an increased risk of mortality and morbidity, and should be avoided. The guidance noted that naturoceuticals are not recommended for the management of heart failure symptoms or for the secondary prevention of cardiovascular events, and that nutritional supplements are not recommended for the treatment of heart failure [Low-quality; Limited].Page 2016


Toxicological data on ephedra are limited. While ephedra extracts are cytotoxic to cultivated cells, the cytotoxicity is not primarily caused by ephedrine.Joyal 2004, Lee 2000 N-nitrosamines of ephedrine and pseudoephedrine have been found to be formed under physiological conditions. N-nitrosoephedrine has been shown to be a carcinogen.Alwan 1986, Tricker 1987 Periconceptional use of ephedra-containing products has been associated with an increased adjusted odds ratio for anencephaly.Bitsko 2008



This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

AdreView (iobenguane I 123) [prescribing information]. Arlington Heights, IL: GE Healthcare; March 2013.
Aldactone (spironolactone) [prescribing information]. New York, NY: Pfizer Inc, January 2008.
Alwan SM, Al-Hindawi MK, Abdul-Rahman SK, Al-Sarraj S. Production of nitrosamines from ephedrine, pseudoephedrine and extracts of Ephedra foliata under physiological conditions. Cancer Lett. 1986;31(2):221-226.3697965
Amadesi S, Varani K, Spisani L, et al. Comparison of prazosin, terazosin and tamsulosin: functional and binding studies in isolated prostatic and vascular human tissues. Prostate. 2001;47(4):231-238.11398170
Andraws R, Chawla P, Brown DL. Cardiovascular effects of ephedra alkaloids: a comprehensive review. Prog Cardiovasc Dis. 2005;47(4):217-225.15991150
Anon, Adverse Drug Reactions Advisory Committee. Reaction to local anaesthetic. Med J Aust, 1978;1:553.
Ashchi M, Wiedemann HP, James KB. Cardiac complication from use of cocaine and phenylephrine in nasal septoplasty. Arch Otolaryngol Head Neck Surg. 1995;121(6):681-684.7772323
Auvi-Q (epinephrine) [prescribing information]. Bridgewater, NJ: Sanofi-Aventis U.S. LLC; September 2012.
Avois L, Robinson N, Saudan C, Baume N, Mangin P, Saugy M. Central nervous system stimulants and sport practice. Br J Sports Med. 2006;40(suppl 1):i16-i20.16799095
Ayajiki K, Kimura T, Yamamizu K, Okamura T. Mechanisms underlying mechanical responses to Ephedra herb of isolated rabbit urinary bladder and urethra, a possible stress urinary incontinence therapeutic. J Pharmacol Sci. 2008;107(2):175-180.18544894
Azedra (iobenguane I 131) [prescribing information]. New York, NY: Progenics Pharmaceuticals Inc; July 2018.
Barnett P. Cocaine toxicity following dermal application of adrenaline-cocaine preparation. Pediatr Emerg Care. 1998;14(4):280-281.9733253
Belder D, Tolba K, Nagl S. Rapid quantitative determination of ephedra alkaloids in tablet formulations and human urine by microchip electrophoresis. Electrophoresis. 2011;32(3-4):440-447.21254134
Bell DG, Jacobs I, Ellerington K. Effect of caffeine and ephedrine ingestion on anaerobic exercise performance. Med Sci Sports Exerc. 2001;33(8):1399-1403.11474345
Bell DG, McClellan TM, Sabiston CM. Effect of ingesting caffeine and ephedrine on 10-km run performance. Med Sci Sports Exerc. 2002;34(2):344-349.11828246
Benowitz NL, Jones RT. Prolonged delta-9-tetrahydrocannabinol ingestion. Effects of sympathomimetic amines and autonomic blockades. Clin Pharmacol Ther. 1977;21(3):336-342.837652
Beretta-Piccoli C, Ferrier C and Weidmann P. Cardiovascular effects of short-term selective alpha 1-adrenergic blockade with terazosin in patients with essential hypertension. J Hypertens Suppl,.1985;3(3):S231-S234.2908818
Betz JM, Gay ML, Mossoba MM, Adams S, Portz BS. Chiral gas chromatographic determination of ephedrine-type alkaloids in dietary supplements containing Má Huáng. J AOAC Int. 1997;80(2):303-315.9086588
Bitsko RH, Reefhuis J, Louik C, et al; National Birth Defects Prevention Study. Periconceptional use of weight loss products including ephedra and the association with birth defects. Birth Defects Res A Clin Mol Teratol. 2008;82(8):553-562.18553492
Boakes AJ, Laurence DR, Teoh PC, Barar FS, Benedikter LT, Prichard BN. Interactions between sympathomimetic amines and antidepressant agents in man. Br Med J. 1973;1(5849):311-315.4685619
Bowe LM, Coat G, dePamphilis CW. Phylogeny of seed plants based on all three genomic compartments: extant gymnosperms are monophyletic and Gnetales' closest relatives are conifers. Proc Natl Acad Sci USA. 2000;97(8):4092-4097.10760278
Brater DC, Kaojarern S, Benet LZ, et al. Renal excretion of pseudoephedrine. Clin Pharmacol Ther. 1980;28(5):690-694.7438686
Cafergot (ergotamine/caffeine) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; March 2006.
Cantilena L, Kahn R, Duncan CC, Li SH, Anderson A, Elkashef A. Safety of atomoxetine in combination with intravenous cocaine in cocaine-experienced participants. J Addict Med. 2012;6(4):265-273.22987022
Chan KY, Vermeersch S, de Hoon J, Villalón CM, Maassenvandenbrink A. Potential mechanisms of prospective antimigraine drugs: a focus on vascular (side) effects. Pharmacol Ther. 2011;129(3):332-35121130807
Chaw SM, Parkinson CL, Cheng Y, Vincent TM, Palmer JD. Seed plant phylogeny inferred from all three plant genomes: monophyly of extant gymnosperms and origin of Gnetales from conifers. Proc Natl Acad Sci USA. 2000;97(8):4086-4091.10760277
Chen WL, Tsai TH, Yang CC, Kuo TB. Acute effects of ephedra on autonomic nervous modulation in healthy young adults. Clin Pharmacol Ther. 2010;88(1):39-44.20520603
Chen WL, Tsai TH, Yang CC, Kuo TB. Effects of ephedra on autonomic nervous modulation in healthy young adults. J Ethnopharmacol. 2010;130(3):563-568.20573567
Chouinard G, Ghadirian AM, and Jones BD. Death attributed to ventricular arrhythmia induced by thioridazine in combination with a single Contac C capsule. Can Med Assoc J. 1978;119(7):729-731.709472
Choi YH, Kim J, Kim YC, Yoo KP. Selective extraction of ephedrine from Ephedra sinica using mixtures of CO2, diethylamine, and methanol. Chromatographia. 1999;50:673-679.
Clorotekal (chloroprocaine) [prescribing information]. Mendrisio, Switzerland: Sintetica SA; September 2017.
Cohen PA, Ernst E. Safety of herbal supplements: a guide for cardiologists. Cardiovasc Ther. 2010;28(4):246-253.20633025
Cui J, Zhou T, Zhang J, Lou ZC. Analysis of alkaloids in Chinese Ephedra species by gas chromatographic methods. Phytochem Anal. 1991;2:116-119.
Cymbalta (duloxetine) [prescribing information]. .Indianapolis, IN: Eli Lilly & Co., August, 2008
Delbeke FT, Debackere M. The influence of diuretics on the excretion and metabolism of doping agents: Part VI. Pseudoephedrine. Biopharm Drug Dispos. 1991;12(1):37-48.2039811
Deshmankar BS, Lewis JA. Ventricular tachycardia associated with the administration of methylphenidate during guanethidine therapy. Can Med Assoc J. 1967;97(19):1166-1167.6057135
Dhar R, Stout W, Link MS, Homoud MK, Weinstock J, Estes NA 3rd. Cardiovascular toxicities of performance-enhancing substances in sports. Mayo Clin Proc. 2005;80(10):1307-1315.16212144
DHE 45 (dihydroergotamine) [prescribing information]. Costa Mesa, CA: Valeant Pharmaceuticals North America; July 2002.
Dingemanse J. An update of recent moclobemide interaction data. Int Clin Psychopharmacol. 1993;7(3-4):167-180.8468439
Dingemanse J, Guentert T, Gieschke R, Stabl M, .Modification of the cardiovascular effects of ephedrine by the reversible monoamine oxidase a-inhibitor moclobemide. J Cardiovasc Pharmacol. 1996;28(6):856-861.8961085
Doxofylline tablets [KR prescribing information]. Available at: Accessed December 15, 2015.
Dulloo AG. Herbal simulation of ephedrine and caffeine in treatment of obesity. Int J Obes Relat Metab Disord. 2002;26(5):590-592.12032740
Dwyer JT, Allison DB, Coates PM. Dietary supplements in weight reduction. J Am Diet Assoc. 2005;105(5 suppl 1):S80-S86.15867902
Effexor XR (venlafaxine) [prescribing information]. Philadelphia, PA: Wyeth Pharmaceuticals Inc; February 2008.
Elis J, Laurence DR, Mattie H, Prichard BN. Modification by monoamine oxidase inhibitors of the effects of some sympathomimetics on blood pressure,. Br Med J. 1967;2(5544):75-78.6020852
Ephedra sinica Stapf. USDA, NRCS. 2007. The PLANTS Database (, August 2007). National Plant Data Team, Greensboro, NC 27401-4901 USA. Accessed August 2007.
Ephedrine sulfate [prescribing information]. West Columbia, SC: Parenta Pharmaceuticals, Inc; February 2005.
Ergonovine [prescribing information]. Toronto, ON: Alveda Pharmaceuticals Inc., March 2009.
Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG. 2002;109(3):227-235.11950176
European Association for the Study of the Liver. Electronic address:; Clinical Practice Guideline Panel: Chair:; Panel members; EASL Governing Board representative:. EASL Clinical Practice Guidelines: Drug-induced liver injury. J Hepatol. 2019;70(6):1222-1261.30926241
FDA issues regulation prohibiting sale of dietary supplements containing ephedrine alkaloids and reiterates its advice that consumers stop using these products. Accessed July 2, 2012. [article archived on FDA site]
Figueredo VM. Chemical cardiomyopathies: the negative effects of medications and nonprescribed drugs on the heart. Am J Med. 2011;124(6):480-488.21605722
Flanagan CM, Kaesberg JL, Mitchell ES, et al. Coronary artery aneurysm and thrombosis following chronic ephedra use. Int J Cardiol. 2010;139(1):e11-e13.23612197
Flanagan S, Bartizal K, Minassian SL, Fang E, Prokocimer P. In vitro, in vivo, and clinical studies of tedizolid to assess the potential for peripheral or central monoamine oxidase interactions. Antimicrob Agents Chemother. 2013;57(7):3060-3066.18718687
Fleming RM. Safety of ephedra and related anorexic medications. Expert Opin Drug Saf. 2008;7(6):749-759.18983221
Flurer CL, Lin LA, Satzger D, Wolnik KA. Determination of ephedrine compounds in nutritional supplements by cyclodextrin-modified capillary electrophoresis. J Chromatogr B Biomed Appl. 1995;669(1):133-139.7581877
Foltin RW, Fischman MW, Pedroso JJ, Pearlson GD. Marijuana and cocaine interactions in humans: cardiovascular consequences. Pharmacol Biochem Behav. 1987;28(4):459-464.2829241
Foltin RW, Fischman MW. The effects of combinations of intranasal cocaine, smoked marijuana, and task performance on heart rate and blood pressure. Pharmacol Biochem Behav, 1990;36(2):311-315.2162543
Foltin RW, Fischman MW,Levin FR. Cardiovascular effects of cocaine in humans: laboratory studies. Drug Alcohol Depend. 1995;37(3):193-210.7796714
Foradil (formoterol) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; September 2001.
Foster CA, O'mullane EJ, Gaskell P, Churchill-Davidson HC. Chlorpromazine: a study of its action on the circulation in man. Lancet. 1954;2(6839):614-61713202451
Freudenberg K, Schoeffel E, Braun E. Study on the configuration of ephedrine. J Am Chem Soc. 1932;54:234-236.
Fu L, Yu Y, Riedl H. Ephedraceae. In: Wu Z, Raven PH, eds. Flora of China. Beijing: Science Press; St. Louis, MO: 2000:97.
Gash A, Karliner JS, Janowsky D, Lake CR. Effects of smoking marihuana on left ventricular performance and plasma norepinephrine: studies in normal men. Ann Intern Med. 1978;89(4):448-452.697222
Gay ML, White KD, Obermeyer WR, Betz JM, Musser SM. Determination of ephedrine-type alkaloids in dietary supplements by LC/MS using a stable-isotope labeled internal standard. J AOAC Int. 2001;84(3):761-769.11417640
Gershon S, Holmberg G, Mattsson E, Mattson N, Marshall A. Imipramine hydrochloride. Its effects on clinical, autonomic, and psychological functions. Arch Gen Psychiatry. 1962;6:96-101.13898068
Giles TD, Modlin RK. Death associated with ventricular arrhythmia and thioridazine hydrochloride. JAMA. 1968;205(2):108-110.5694867
Gmeiner G, Geisendorfer T, Kainzbauer J, Nikolajevic M, Tausch H. Quantification of ephedrines in urine by column-switching high-performance liquid chromatography. J Chromatogr B Analyt Technol Biomed Life Sci. 2002;768(2):215-221.11888049
Greenway FL. The safety and efficacy of pharmaceutical and herbal caffeine and ephedrine use as a weight loss agent. Obes Rev. 2001;2(3):199-211.12120105
Grue-Srensen G, Spenser ID. Biosynthesis of ephedrine. J Am Chem Soc. 1988;110:3714-3715.
Grue-Srensen G, Spenser ID. Biosynthetic route to the Ephedra alkaloids. J Am Chem Soc. 1994;116:6195-6200.
Gulati OD, Dave BT, Gokhale SD, Shah KM. Antagonism of adrenergic neuron blockade in hypertensive subjects. Clin Pharmacol Ther. 1966;7(4):510-514.5939974
Gurley BJ, Gardner SF, Hubbard MA. Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm. 2000;57(10):963-969.10832496
Gurley BJ, Wang P, Gardner SF. Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (ma-huang) as determined by high performance liquid chromatography. J Pharm Sci. 1998;87(12):1547-1553.10189265
Hahm TS, Lee JJ, Yang MK, Kim JA. Risk factors for an intraoperative arrhythmia during esophagectomy. Yonsei Med J. 2007;48(3):474-479.17594156
Haller CA, Jacob P, Benowitz NL. Short-term metabolic and hemodynamic effects of ephedra and guarana combinations. Clin Pharmacol Ther. 2005;77(6):560-571.15961987
Haller CA, Jacob P III, Benowitz NL. Pharmacology of ephedra alkaloids and caffeine after single-dose dietary supplement use. Clin Pharmacol Ther. 2002;71(6):421-432.12087345
Haller CA, Meier KH, Olson KR. Seizures reported in association with use of dietary supplements. Clin Toxicol. 2005;43(1):23-30.15732443
Hammerness P, Georgiopoulos A, Doyle RL, et al. An open study of adjunct OROS-methylphenidate in children who are atomoxetine partial responders: II. Tolerability and pharmacokinetics. J Child Adolesc Psychopharmacol. 2009;19(5):493-499.19877973
Harada K, Ohmori M, Kitoh Y, Sugimoto K, Fujimura A. A comparison of the antagonistic activities of tamsulosin and terazosin against human vascular alpha1-adrenoceptors. Jpn J Pharmacol. 1999;80(3):209-215.10461765
Harrison WM, McGrath PJ, Stewart JW, Quitkin F. MAOIs and hypertensive crises: the role of OTC drugs. J Clin Psychiatry. 1989;50(2):64-65.2464583
Hasani-Ranjbar S, Nayebi N, Larijani B, Abdollahi M. A systematic review of the efficacy and safety of herbal medicines used in the treatment of obesity. World J Gastroenterol. 2009;15(25):3073-3085.19575486
Hendershot PE, Antal EJ, Welshman IR, Batts DH, Hopkins NK. Linezolid: pharmacokinetic and pharmacodynamic evaluation of coadministration with pseudoephedrine HCl, phenylpropanolamine HCl, and dextromethorpan HBr. J Clin Pharmacol. 2001;41(5):563-572.11361053
Hikino H, Kiso Y, Ogata M, et al. Pharmacological actions of analogues of feruloylhistamine, an imidazole alkaloid of Ephedra roots. Planta Med. 1984;50(6):478-480.6531409
Hikino H, Ogata K, Konno C,Sato S. Studies on the constituents of Ephedra. 12. Validity of the oriental medicines. Part 41. Hypotensive actions of ephedradines, macrocyclic spermine alkaloids of Ephedra roots. Planta Med. 1983;48:290-293.
Hikino H, Takahashi M, Konno C. Studies on the constituents of Ephedra. 10. The validity of oriental medicines. 33. Structure of ephedrannin A, a hypotensive principle of Ephedra roots. Tetrahedron Lett. 1982;23:673-676.
Hong H, Chen HB, Yang DH, et al. Comparison of contents of five ephedrine alkaloids in three official origins of Ephedra Herb in China by high-performance liquid chromatography. J Nat Med. 2011; 65(3-4):623-628.21465337
Hurlbut JA, Carr JR, Singleton ER, et al. Solid-phase extraction cleanup and liquid chromatography with ultraviolet detection of ephedrine alkaloids in herbal products. J AOAC Int. 1998;81(6):1121-1127.9850573
Hylenex (hyaluronidase) [prescribing information]. San Diego, CA: Halozyme Therapeutics, Inc., August 2011.
Ismelin (guanethidine) [summary of product characteristics]. Basildon, Essex, UK: Amdipharm UK Limited; July 2014.
Jalili J, Askeroglu U, Alleyne B, Guyuron B. Herbal products that may contribute to hypertension. Plast Reconstr Surg. 2013;131(1):168-173.23271526
Jenkins LC, Graves HB.. Potential hazards of psychoactive drugs in association with anaesthesia. Can Anaesth Soc J. 1965;12:121-128.14311657
Jian Z, Zhen T, Zhi-cen L. Simultaneous determination of six alkaloids in ephedrae herba by high-performance liquid chromatography. Planta Med. 1988;54(1):69-70.17265209
John A, Yeh C, Boyd J, Greilich PE. Treatment of refractory hypotension with low-dose vasopressin in a patient receiving clozapine. J Cardiothorac Vasc Anesth. 2010;24(3):467-468.19926306
Joyal SV. A perspective on the current strategies for the treatment of obesity. Curr Drug Targets CNS Neurol Disord. 2004;3(5):341-356.15544444
Kasahara Y, Hikino H, Hine T. Determination of ephedrine alkaloids by isotachophoresis. J Chromatogr. 1985;324:503-507.
Kelly RP, Yeo KP, Teng CH, et al. Hemodynamic effects of acute administration of atomoxetine and methylphenidate. J Clin Pharmacol. 2005;45:851-855.15951476
Khurana RN, Baudendistel TE. Hypertensive crisis associated with venlafaxine. Am J Med. 2003; 115(8): 676-677.
Kim IS, Park YJ, Yoon SJ, Lee HB. Ephedrannin A and B from roots of Ephedra sinica inhibit lipopolysaccharide-induced inflammatory mediators by suppressing nuclear factor-kB activation in RAW 264.7 macrophages. Int Immunopharmacol. 2010;10(12):1616-1625.20939997
Kim BS, Song MY, Kim H. The anti-obesity effect of Ephedra sinica through modulation of gut microbiota in obese Korean women. J Ethnopharmacol. 2014;152(3):532-539.24556223
Knoll-Kohler E, Frie A, Becker J, Ohlendorf D. Changes in plasma epinephrine concentration after dental infiltration anesthesia with different doses of epinephrine. J Dent Res. 1989;68(6):1098-1101.2808867
Konno C, Mizuno T, Hikino H. Isolation and hypoglycemic activity of ephedrans A, B, C, D and E, glycans of Ephedra distachya herbs. Planta Med. 1985;51(2):162-163.4034736
Kuntzman RG, Tsai I, Brand L, Mark LC. The influence of urinary pH on the plasma half-life of pseudoephedrine in man and dog and a sensitive assay for its determination in human plasma. Clin Pharmacol Ther. 1971;12(1):62-67.5541135
Laffey JG, Neligan P, Ormonde G. Prolonged perioperative myocardial ischemia in a young male: due to topical intranasal cocaine? J Clin Anesth. 1999;11(5):419-424.10526815
Laurence DR, Nagle RE. The effects of bretylium and guanethidine on the pressor responses to noradrenaline and angiotensin. Br J Pharmacol Chemother. 1963;21:403-413.14110739
Lazanda (fentanyl) [prescribing information]. Bedminster, NJ: Archimedes Pharma US Inc; June 2011.
Lee MK, Cheng BW, Che CT, Hsieh DP. Cytotoxicity assessment of ma-huang (Ephedra) under different conditions of preparation. Toxicol Sci. 2000;56(2):424-430.10911002
Lee MR. The history of Ephedra (ma-huang). J R Coll Physicians Edinb. 2011;41(1):78-84.21365072
Lee SA, Hong SK, Suh CI, et al. Anti-HIV-1 efficacy of extracts from medicinal plants. J Microbiol. 2010;48(2):249-252.20437159
Leung JG, Nelson S, Hocker S. Failure of induced hypertension for symptomatic vasospasm in the setting of clozapine therapy. Neurocrit Care. 2015;23(3):409-413.25792345
Li HX, Ding MY, Lv K, Yu JY. Separation and determination of ephedrine alkaloids and tetramethylpyrazine in Ephedra sinica Stapf. by gas chromatography-mass spectrometry [in Chinese]. J Chromatogr Sci. 2001;39(9):370-374.11565946
Li HX, Ding MY, Lv K, Yu JY. Simultaneous separation and determination of ephedrine alkaloids and tetramethylpyrazine in Ephedra sinica Stapf. by HPLC. J Liq Chrom Relat Technol. 2002;25:313-320.
Li L, Li J, Zhu Y, Fan G. Ephedra sinica inhibits complement activation and improves the motor functions after spinal cord injury in rats. Brain Res Bull. 2009;78(4-5):261-266.19000748
Lillegard JB, Porterfield Jr JR. Ephedra-induced gastric mucosal injury. Case Rep Gastroenterol. 2010;4(1):79-83.21103232
Liu YM, Sheu SJ. Determination of ephedrine alkaloids by capillary electrophoresis. J Chromatogr. 1992;600:370-372.
Liu YM, Sheu SJ. Determination of ephedrine and pseudoephedrine in Chinese herbal preparations by capillary electrophoresis. J Chromatogr. 1993;637:219-223.
Liu YM, Sheu SJ, Chiou SH, Chang HC, Chen YP. A comparative study on commercial samples of ephedrae herba. Planta Med. 1993;59(4):376-378.17235993
Lormans P, Gaumann D, Schwieger I, Tassonyi E. Ventricular fibrillation following local application of cocaine and epinephrine for nasal surgery. ORL J Otorhinolaryngol Relat Spec. 1992;54(3):160-162.17235993
Low-Beer GA, Tidmarsh D. Collapse after parstelin. Br Med J. 1963;2:683.14044878
Lukas SE, Sholar M, Kouri E, Fukuzako H, Mendelson JH. Marihuana smoking increases plasma cocaine levels and subjective reports of euphoria in male volunteers. Pharmacol Biochem Behav. 1994;48(3):715-721.7938127
Lv K, Li H, Ding M. Analysis of tetramethylpyrazine in Ephedrae herba by gas chromatography-mass spectrometry and high-performance liquid chromatography. J Chromatogr A. 2000;878(1):147-152.10843553
Maglione M, Miotto K, Iguchi M, Hilton L, Shekelle P. Psychiatric symptoms associated with ephedra use. Expert Opin Drug Saf. 2005;4(5):879-884.16111450
Makino Y, Urano Y, Nagano T. Impurity profiling of ephedrines in methamphetamine by high-performance liquid chromatography. J Chromatogr A. 2002;947(1):151-154.11873994
McGovern E, Moylett E, McMahon CJ. Myocardial ischaemia following cocaine and adrenaline exposure in a child during an ophthalmological procedure. Ir Med J. 2015;108(3):89-90.25876303
Meechan JG, Parry G, Rattray DT, Thomason JM. Effects of dental local anesthetics in cardiac transplant recipients. Br Dent J. 2002;192(3): 161-163.11863154
Michelson D, Adler L, Spencer T, et al. Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Biol Psychiatry. 2003;53:112-120.12547466
Miller SA, Mieler WF. Systemic reaction to subconjunctival phenylephrine. Can J Ophthalmol. 1978;13(4):290-293.743613
Mitchell JR, Cavanaugh JH, Arias L, Oates JA. Guanethidine and related agents. 3. Antagonism by drugs which inhibit the norepinephrine pump in man. J Clin Invest. 1970,49(8):1596-1604.5431666
Moriyasu M, et al. High-performance liquid chromatographic determination of organic substances by metal chelate derivatization. III. Analysis of Ephedra bases. Chem Pharm Bull. 1984;32:744-747.
Muelheims GH, Entrup RW, Paiewonsky D, Mierzwiak DS. Increased sensitivity of the heart to catecholamine-induced arrhythmias following guanethidine. Clin Pharmacol Ther. 1965;6(6):757-762.5846408
Murakami T, Harada H, Suico MA, et al. Ephedrae herba, a component of Japanese herbal medicine Mao-to, efficiently activates the replication of latent human immunodeficiency virus type 1 (HIV-1) in a monocytic cell line. Biol Pharm Bull. 2008;31(12):2334-2337.19043222
Navarro VJ, Barnhart H, Bonkovsky HL, et al. Liver injury from herbals and dietary supplements in the U.S. drug-induced liver injury network. Hepatology. 2014;60(4):1399-1408.25043597
Nazeri A, Massumi A, Wilson JM, et al. Arrhythmogenicity of weight-loss supplements marketed on the Internet. Heart Rhythm. 2009;6(5):658-662.19328040
Nesacaine. (chloroprocaine) [prescribing information]. Schaumburg, IL: APP Pharmaceuticals, LLC; February 2010.
Nicholson KE, Rogers JE. Cocaine and adrenaline paste: a fatal combination? BMJ. 1995;311(6999):250-251.7627047
Northera (droxidopa) [prescribing information]. Charlotte, NC: Chelsea Therapeutics, Inc; February 2014.
Page RL 2nd, O'Bryant CL, Cheng D, et al; American Heart Association Clinical Pharmacology and Heart Failure and Transplantation Committees of the Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular and Stroke Nursing; and Council on Quality of Care and Outcomes Research. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2016;134(6):e32-69.27400984
Parlodel (bromocriptine) [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corporation, January 2012.
Parsaeimehr A, Sargsyan E, Javidnia K. A comparative study of the antibacterial, antifungal and antioxidant activity and total content of phenolic compounds of cell cultures and wild plants of three endemic species of Ephedra. Molecules. 2010;15(3):1668-1678.20336006
Pittler MH, Ernst E. Complementary therapies for reducing body weight: a systematic review. Int J Obes. 2005;29(9):1030-1038.15925954
Pre-Pen (benzylpenicilloyl-polylysine) [prescribing information]. Round Rock, TX: ALK-Abello, Inc; October 2009.15925954
Pristiq (desvenlafaxine) [prescribing information]. Philadelphia, PA: Wyeth Pharmaceuticals Inc., April 2008.
ProAmatine (midodrine) [prescribing information]. Lexington, MA: Shire US Inc; February 2017.
Ryu SJ, Shin YU, Kang MH, Cho HY, Seong M. Bilateral acute myopia and angle closure glaucoma induced by ma-huang (ephedra). Medicine (Baltimore). 2017;96(50):e9257.29390365
Schafers RF, Fokuhl B, Wasmuth A, et al. Differential vascular alpha1-adrenoceptor antagonism by tamsulosin and terazosin. Br J Clin Pharmacol. 1999;47(1):67-74.10073742
Scott GN, Elmer GW. Update on natural product-drug interactions. Am J Health Syst Pharm. 2002;59(4):339-347.11885397
Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA. 2003;289(12):1537-1545.12672771
Simonyi J, Krassoi A, Decsy J, et al. Guanethidine (Sanotensin)-induced changes in alpha and beta receptor sensitivity. Ther Hung. 1972;20(1):47-55.5057665
Singh A, Rajeev AG, Dohrmann ML. Cardiomyopathy associated with ephedra-containing nutritional supplements. Congest Heart Fail. 2008;14(2):89-90.18401217
Sivextro (tedizolid phosphate) [prescribing information]. Lexington, MA: Cubist Pharmaceuticals US; June 2014.
Snopek J, Jelinek I, Smolkova-Keulemansova E. Use of cyclodextrins in isotachophoresis. IV. The influence of cyclodextrins on the chiral resolution of ephedrine alkaloid enantiomers. J Chromatogr. 1988;438:211-218.
Sofuoglu M, Poling J, Hill K, Kosten T. Atomoxetine attenuates dextroamphetamine effects in humans. Am J Drug Alcohol Abuse. 2009;35(6):412-416.20014909
Soltan MM, Zaki AK. Antiviral screening of forty-two Egyptian medicinal plants. J Ethnopharmacol. 2009;126(1):102-107.19666102
Song HJ, Shim KN, Ryu KH, Kim TH, Jung SA, Yoo K. A case of ischemic colitis associated with the herbal food supplement ma huang. Yonsei Med J. 2008;49(3):496-499.18581601
Spencer T, Heiligenstein JH, Biderman J, et al. Results from 2 proof-of-concept, placebo-controlled studies of atomoxetine in children with attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2002;63(12):1140-1147.12523874
Spyridaki MH, Tsitsimpikou CJ, Siskos PA, Georgakopoulos CG. Determination of ephedrines in urine by gas chromatography-mass spectrometry. J Chromatogr B Biomed Sci Appl. 2001;758(2):311-314.11486842
Stevens DL. Duloxetine-associated tachycardia. Ann Pharmacother 2008;42(10):1511-1513.18728105
Strattera (atomoxetine) [prescribing information]. Indianapolis, IN: Lilly USA, LLC; May 2017.
Sundboll J, Pareek M, Hogsbro M, Madsen EH. Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine. BMJ Case Rep. 2014;2014.18728105
Sunosi (solriamfetol) [prescribing information]. Palo Alto, CA: Jazz Pharmaceuticals, Inc.; March 2019.
Svedmyr N. The influence of a tricyclic antidepressive agent (protriptyline) on some circulatory effects of noradrenaline and adrenaline in man. Life Sci. 1968;7(1):77-84.5636628
Tamada M, Endo K, Hikino H, Kabuto C. Structure of ephedradine A, a hypotensive principle of Ephedra roots. Tetrahedron Lett. 1979;873-876.
Tang J, Zhou X, Ji H, Zhu D, Wu L. Effects of ephedra water decoction and cough tablets containing ephedra and liquorice on CYP1A2 and the pharmacokinetics of theophylline in rats. Phytother Res. 2012;26(3):470-474.21796703
Takaori M, Loehning RW. Ventricular arrhythmias during halothane anaesthesia: effect of isoproterenol, aminophylline, and ephedrine. Can Anaesth Soc J. 1965; 12:275-280.14294788
Terry RE. A study of Ephedra nevadensis. J Am Pharm Assoc. 1927;16:397.
Tokish JM, Kocher MS, Hawkins RJ. Ergogenic aids: a review of basic science, performance, side effects, and status in sports. Am J Sports Med. 2004;32(6):1543-1553.15310585
Tricker AR, Wacker CD, Preussmann R. Nitrosation products from the plant Ephedra altissima and their potential endogenous formation. Cancer Lett. 1987;35(2):199-206.3581050
Tucker WK, Rackstein AD, Munson ES. Comparison of arrhythmic doses of adrenaline, metaraminol, ephedrine and phenylephrine during isoflurane and halothant anaesthesia in dogs. Br J Anaesth. 1974;46(6):392-396.4458752
Ulbricht C, Chao W, Costa D, Rusie—Seamon E, Weissner W, Woods J. Clinical evidence of herb-drug interactions: a systematic review by the natural standard research collaboration. Curr Drug Metab. 2008;9(10):1063-1120.19075623
Vukovich MD, Schoorman R, Heilman C, Jacob P III, Benowitz NL. Caffeine-herbal ephedra combination increases resting energy expenditure, heart rate and blood pressure. Clin Exp Pharmacol Physiol. 2005;32(1-2):47-53.15730434
White LM, Gardner SF, Gurley BJ, Marx MA, Wang PL, Estes M. Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol. 1997;37(2):116-122.9055137
Wilkinson GR, Beckett AH. Absorption metabolism and excretion of the ephedrines in man. I. The influence of urinary pH and urinary volume output. J Pharmacol Exp Ther. 1968;162(1):139-147.5656593
Williamson EM, Evans FJ. Cannabinoids in clinical practice. Drugs. 2000;60(6):1303-1314.11152013
Wright SP. Hazards with monoamine oxidase inhibitors: a persistent problem. Lancet. 1978;1{8058):284-285.74715
Yagiela JA, Duffin SR, Hunt LM. Drug interaction and vasoconstrictors used in local anesthetic solutions. Oral Surg Oral Med Oral Pathol. 1985;59(6):565-571.3892411
Yamada I, Goto T, Takeuchi S, et al. Mao (Ephedra sinica Stapf) protects against D-galactosamine and lipopolysaccharide-induced hepatic failure. Cytokine. 2008;41(3):293-301.18218321
Yamasaki K, Fujita K. Qualitative and quantitative analysis of ephedra alkaloids in ephedrae herba by carbon-13 nuclear magnetic resonance. Chem Pharm Bull. 1979;27:43-47.
Zhao W, Deng AJ, Du GH, Zhang JL, Li ZH, Qin HL. Chemical constituents of the stems of Ephedra sinica. J Asian Nat Prod Res. 2009;11(2):168-171.19219730
Zimmerman CL. The effect of urinary pH modification on the disposition of phenylpropanolamine. Pharm Res. 1988;5(2):120-122.2854630
Zimmerman CL, O'Connell MB, Soria I. The effects of urine pH modification on the pharmacokinetics and pharmacodynamics of phenylpropanolamine. Pharm Res. 1990;7(1):96-102.2300545
Zyvox (linezolid) [prescribing information]. New York, NY: Pharmacia and Upjohn Company; June 2010.
Zyvox (linezolid) [prescribing information]. New York, NY: Pfizer Inc; September 2013.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.