Addressing the potential risks associated with ephedra use: a review of recent efforts

Schulman, Sara

doi:10.1016/s0033-3549(04)50284-4

Cited by 10 publications

(11 citation statements)

References 6 publications

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“…14, 101,235,297 As examples, Ginkgo biloba extracts contain several ginkgo-flavone glycosides, proanthrocyanin, numerous ginkgolides and alcohols and bilobalide, a terpenoid, while Ephedra has several alkaloids including ephedrine and norephedrine in addition to flavones, flavanols, bisfilavanols and numerous other potentially biologically active substances. 108,114,173,299 Until more is known about these factors, the identification of therapeutic and toxic doses of herbal products will prove elusive.…”

Section: Discussionmentioning

confidence: 99%

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

Woodward

2005

Hum Exp Toxicol

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The purpose of this paper is to explore the possibility that adverse reactions and drug interactions arising from the use of homeopathic and herbal medicines could lead to confusion when adverse reactions to conventional medicines are reported. An extensive literature review was conducted on the occurrence of adverse reactions and drug interactions following the use of homeopathic or herbal remedies, and the potential for these to confound adverse event reporting to conventional medicines considered. The survey demonstrates the potential for herbal remedies and homeopathic products, to produce adverse drug reactions or drug interactions, and shows the scope for potential for confusion with those arising from conventional medicines. There is a need for greater awareness that adverse reactions apparently due to a conventional medicine, might in reality be due to a herbal medicine or a drug interaction between a herbal medicine and a conventional drug, particularly when a health professional is unaware of the extent of a patient's selfmedication with alternative therapies.

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Section: Discussionmentioning

confidence: 99%

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

Woodward

2005

Hum Exp Toxicol

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“…The active compound ephedrine has stimulating and thermogenic effects, and is therefore also used in dietary supplements to stimulate weight loss and enhance athletic performance, and as a party drug due to the increased energy. However, ephedra has some serious side‐effects, including heart attacks, seizures, stroke and death . Zaacks et al.…”

Section: Cns Stimulants (Cocaine Amphetamines Khat and Ephedra)mentioning

confidence: 99%

Allergy to illicit drugs and narcotics

Swerts

Gasse

Leysen

et al. 2014

Clin Experimental Allergy

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Despite their frequent use, allergy to illicit drugs and narcotics is rarely reported in literature. We present a review of the different classes of drugs of abuse that might be involved in allergies: central nervous system (CNS) depressants (such as cannabis, opioids and kava), CNS stimulants (cocaine, amphetamines, khat and ephedra) and hallucinogens such as ketamine and nutmeg. Diagnosis of drug and narcotic allergy generally relies upon careful history taking, complemented with skin testing eventually along with quantification of sIgE. However, for various reasons, correct diagnosis of most of these drug allergies is not straightforward. For example, the native plant material applied for skin testing and sIgE antibody tests might harbour irrelevant IgE-binding structures that hamper correct diagnosis. Diagnosis might also be hampered due to uncertainties associated with the non-specific histamine releasing characteristics of some compounds and absence of validated sIgE tests. Whether the introduction of standardized allergen components and more functional tests, that is, basophil activation and degranulation assays, might be helpful to an improved diagnosis needs to be established. It is anticipated that due to the rare character of these allergies further validation is although necessary.

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“…According to Schulman (2003), from February 1993 through July 2003, FDA's adverse event reporting system documented 2 277 adverse events among -Ephedra‖ 34 users. The entirety of case reports was seen as a limited but the major source of safety information to draw inferences and to support the analysis of a causal relationship (Schulman, 2003). In addition, an investigation of a major manufacturer of products containing -Ephedra‖, found records of 14 684 reports of -Ephedra‖-related adverse events from May 1997 through July 2002.…”

Section: Case Reports Associated With Intake Of Dietary Supplements Cmentioning

confidence: 99%

Scientific Opinion on safety evaluation of Ephedra species for use in food

2013

EFS2

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The ANS Panel provides a scientific opinion evaluating the safety in use of Ephedra herb and its preparations originating from Ephedra species when used in food, e.g. in food supplements. Ephedra species contain alkaloids of biological relevance: ephedrine, pseudoephedrine, norephedrine, norpseudoephedrine (cathine), methylephedrine and methylpseudoephedrine. They have sympathomimetic activity and some of them are also used as active ingredients in medicinal products for which adverse effects are described. The use of Ephedra herb in food supplements is prohibited in several European countries, however food supplements containing Ephedra herb, also in combination with caffeine, are offered for sale via the internet. The Panel reviewed the available scientific data on a possible association between the intake of Ephedra herb, its preparations or its alkaloids and potential harmful effects on health. There is wide variation in the concentration of the individual ephedra alkaloids in different Ephedra species and in their preparations for use in food. No adequately specified individual preparations of Ephedra herb are known for which sufficient toxicological data for hazard characterisation exist. Due to the absence of adequate data on genotoxicity, short-term, long-term and reproductive and developmental toxicity the Panel could not provide advice on a daily intake of Ephedra herb and its preparations that do not give rise to concerns about harmful effects to health. Ephedra herb and its preparations in food supplements may result in exposure to total ephedra alkaloids or ephedrine which falls within or may exceed the therapeutic dose ranges for the individual ephedra alkaloids or ephedrine, respectively, in medicinal products. Such an exposure could lead to severe adverse effects, which may be enhanced by the combination with caffeine. The Panel concluded that Ephedra herb and its preparations containing ephedra alkaloids used as food supplements were of significant safety concern at the estimated use levels.

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Addressing the potential risks associated with ephedra use: a review of recent efforts

Cited by 10 publications

References 6 publications

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

The potential impact of the use of homeopathic and herbal remedies on monitoring the safety of prescription products

Allergy to illicit drugs and narcotics

Scientific Opinion on safety evaluation of Ephedra species for use in food

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