Ephedrine may cause serious illness

Dietary supplements containing ephedrine can pose severe health risks and even kill some people, researchers have found.

The US Food and Drug Administration (FDA) has warned that research is urgently needed to ascertain what level of ephedrine can safely be added to supplements, and which people are most at risk.

Scientists at the University of California, San Francisco (UCSF) who conducted the study, also say products that contain ephedrine should be more clearly labelled with standardised information.

Ephedrine is a stimulant, used for short-term energy boosts to enhance athletic performance and endurance, to help people exercise longer, feel more alert, and to dampen appetite.

Even though it is found in some cough and cold remedies, it is on the list of substances banned by international athletic federations.

The UCSF assessed 140 reports filed with the FDA about adverse effects from ephedrine-containing supplements.

The researchers found that just under a third (31%), or 43 of the people "definitely" or "probably" suffered an adverse effect from ephedrine in a dietary supplement.

Of these 43, three died, seven suffered permanent injury and four more required on-going medical treatment.

Serious effects among these people included:

• five heart attacks - two fatal and three resulting in permanent brain damage and disability
• four strokes
• ten cases of hypertension

The researchers then considered another 44 people whose physical symptoms were "possibly" related to ephedrine products.

They found that another seven deaths among this group.

Severe risks

The UCSF scientists said the claimed benefits of these products are questionable and unproven compared with potentially severe risks.

Lead researcher Dr Christine Haller said: "Although 140 serious ill effects may not seem like that many compared to the number of consumers of these products, adverse effects are widely believed to be underreported by ten-fold or more.

"We believe there are many more injuries than are represented by the FDA reports. And with ephedra, the potential risks are not accompanied by any clear benefits."

Studies indicate that any weight loss achieved by using ephedrine is only temporary.

In addition, the body develops tolerance to ephedrine, so users must take a progressively larger dose to gain the same effect.

Most of the stimulating supplements are derived from the herbal plant ma huang, and often also contain caffeine derived from guarana.

Ephedrine and caffeine in combination produce a much more intense effect.

Professor Neal Benowitz, of the UCSF-affiliated San Francisco General Hospital Medical Center, said: "People should use these supplements with caution and consider the risks, but we need to be more clear about who specifically is at risk."

The research is published in the New England Journal of Medicine.

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