Commission E Monograph: Ephedra

Name of drug: Ephedrae herba, ephedra, ma huang

Composition of drug: Ephedra consists of the dried, young branchlets, harvested in the fall, of Ephedra sinica Stapf, E. shennungiana Tang [Fam. Ephedraceae], or other equivalent Ephedra species, as well as their equivalent preparations in effective dosage. The herb contains alkaloids; main alkaloids are ephedrine and pseudoephedrine.

Uses: Diseases of the respiratory tract with mild bronchospasms in adults and children over the age of six.

Contraindications: Anxiety and restlessness, high blood pressure, glaucoma, impaired circulation of the cerebrum, adenoma of prostate with residual urine accumulation, pheochromocytoma, thyrotoxicosis.

Side effects: Insomnia, motor restlessness, irritability, headaches, nausea, vomiting, disturbances of urination, tachycardia. In higher dosages: drastic increase in blood pressure, cardiac arrhythmia, development of dependency.

Interactions with other drugs: In combination with: cardiac glycosides or halothane causes disturbance of heart rhythm; with guanethidine, enhances the sympathomimetic effect. MAO-inhibitors: greatly raises the sympathomimetic action of ephedrine; secale alkaloid derivatives or oxytocin causes development of hypertension.

Dosage: Unless otherwise prescribed, single dosage for adults: herb preparations corresponding to 15—30 mg total alkaloid, calculated as ephedrine. Children: herb preparations corresponding to 0.5 mg total alkaloid per kg of body weight.

Maximum daily dosage: Adults: herb preparations corresponding to 300 mg total alkaloid, calculated as ephedrine. Children: 2 mg total alkaloid per kg of body weight.

Mode of administration: Comminuted [pulverized] herb, as well as other galenical preparations [extracts] for internal use.

Duration of administration: Ephedra preparations should only be used on a short-term duration because of tachyphylaxis and danger of addiction. Note: Ephedrine-containing preparations are listed as addictive by the International Olympic Committee and the German Sports Association.

Actions: In animal experiments: antitussive; ephedrine acts by indirectly stimulating the sympathomimetic and central nervous system; bacteriostatic.

Reprinted with permission from The Complete German Commission E Monographs—Therapeutic Guide to Herbal Medicines, a 700-page guide featuring 380 monographs. The guide is published by the American Botanical Council, Austin, Texas, 1998.