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Risks of Ephedra and Ephedrine

These agents do aid weight loss, but at what cost?

Ephedra and ephedrine are used for weight reduction and enhancement of athletic performance. Recent high-profile adverse events associated with these agents have received widespread attention. In response to a request for a synthesis of available evidence from the U.S. Department of Health and Human Services, these investigators reviewed 52 controlled trials of ephedra or ephedrine and 65 case reports of adverse events associated with these agents. Only weight-loss studies lasting 6 months or less were available for analysis. Data from 8 published controlled trials of ephedrine were insufficient to evaluate potential effects on athletic performance.

Ephedra or ephedrine, used alone or in combination with herbs or caffeine, produced an average weight loss 0.9 kg per month greater than that achieved with placebo. Compared with placebo, ephedra or ephedrine was associated with 2 to 3 times the risk for adverse events, including psychiatric symptoms (odds ratio, 3.64), autonomic hyperactivity (OR, 3.37), heart palpitations (OR, 2.29), hypertension (OR, 2.19), and upper gastrointestinal symptoms (OR, 2.15). Psychiatric symptoms included euphoria, neurotic behavior, agitation, depression, giddiness, irritability, and anxiety; autonomic hyperactivity symptoms included tremor, twitching, jitteriness, insomnia, and increased perspiration. Case reports described 5 deaths, 5 myocardial infarctions, and 11 cerebrovascular accidents associated with ephedra or ephedrine.

Comment: Although ephedra and ephedrine may lead to short-term weight loss, the benefit does not appear to be worth the risks. We need to warn teenagers about the significant risks and modest or unproven efficacy of these agents. These study results may lead to warning labels on products containing ephedra or ephedrine and emphasize the need for regulation of dietary supplements.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 28, 2003

Citation(s):

Shekelle PG et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: A meta-analysis. JAMA 2003 Mar 26; 289:1537-45.

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