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    Ephedrine review by RAND: Adverse Effects, Less Serious


    Posted by .(JavaScript must be enabled to view this email address)
    Tuesday, September 23, 2003 8:05 pm Email this article
    "Ephedrine and ephedra are associated with 2 to 3 times the risk of psychiatric symptoms, autonomic symptoms [hyperactivity], upper gastrointestinal symptoms, and heart palpitations," according to researchers from the RAND Corporation in a meta-analysis of ephedrine studies.

    “It is not possible to separate out the effect caffeine may contribute to these events,” they also noted.

    One-third of participants given the equivalent to 70 mg of ephedrine plus 350 mg of caffeine for a 154 pound person reported nausea and vomiting.

    This dose was 0.45 mg of ephedrine per pound of body weight plus 2.27 mg of caffeine per pound of body weight or 1 mg per kilogram of ephedrine plus 5 mg per kilogram of caffeine.

    No adverse effects were reported by patients given a lower dose equivalent to 56 mg of ephedrine plus 280 mg of caffeine in a 154 pound person.

    This is 0.36 mg of ephedrine per pound of body weight and 1.8 mg of caffeine per pound of body weight or 0.8 mg per kilogram of ephedrine and 4 mg per kilogram of caffeine.

    Psychiatric symptoms were 3.6 times as common in patients given ephedrine and caffeine.

    Psychiatric symptoms were described in the original studies as “euphoria”, “neurotic behavior”, “agitation”, “neuropsychiatric”, “depressed mood”, “giddiness”, “irritability”, and “anxiety”.

    Hyperactivity was 3.4 times as common in patients given ephedrine and caffeine.

    Hyperactivity symptoms included those described in the original studies as “tremor”, “twitching”, “jitteriness”, “insomnia”, “difficulty sleeping”, “increased sweating”, “increased perspiration”, and “sweating”.

    Heart palpitations were 2.3 times as common in patients given ephedrine and caffeine.

    Palpitations included symptoms described in the original studies as “palpitations”, “irregular heartbeat”, “loud heartbeat”, “heart pounding”, and “increased or stronger heartbeat”.

    Hypertension was 2.2 times as common in patients given ephedrine and caffeine.

    Hypertension included symptoms described in the original studies as “hypertension”, “increased systolic blood pressure”, and “increased diastolic blood pressure”.

    Gastrointestinal symptoms were 2.2 times as common in patients given ephedrine and caffeine.

    Upper gastrointestinal symptoms included those described in the original studies as “nausea”, “vomiting”, “abdominal pain”, “upset stomach”, “heartburn”, and “gastroesophageal reflux”.

    Headache was 1.6 times as common in patients given ephedrine and caffeine.

    Tachycardia was reported in 6 patients given ephedrine and caffeine compared to none given placebo.

    Tachycardia symptoms included those described in the original studies as “tachycardia” and “slightly elevated heart rate”.

    REFERENCE

    Shekelle P, Hardy M, Morton S, Maglione M, Mojica W, Suttorp M, Rhodes S, Jungvig L, Gagne J. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA. 2003 Mar 26, 289(12):1537-45.

    AUTHOR CONTACT:

    Paul G. Shekelle
    Southern California Evidence-based Practice Center-RAND
    Santa Monica, Calif 90407-2138
    USA
    .(JavaScript must be enabled to view this email address)

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