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Ma Huang and the Ephedra Alkaloids

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Toxicology and Clinical Pharmacology of Herbal Products

Part of the book series: Forensic Science and Medicine ((FSM))

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Abstract

Ephedra (ephérdre du valais in French and Walliser meerträubchen in German) is a small perennial shrub with thin stems. It rarely grows to more than a foot in height, and at first glance, the plant looks very much like a small broom. Different, closely related, species are found in western Europe, southeastern Europe, Asia, and even the New World. Some of the better known species include Ephedra sinica and E. equisentina (collectively known as ma haung) from China, as well as E. geriardiana, E. intermedia, and E. major which grow in India and Pakistan, and countless other members of the family Ephedraceae that grow in Europe and the United States (E. distachya, E. vulgaris). The various species are collectively known as ma huang, even though that name should really be confined to the species grown in China (Namba et al., 1976).

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References

  • Al-Khalil S, Alkofahi A, et al. Transtorine, a new quinoline alkaloid from Ephedra transitoria. J Nat Prod 1998; 61: 262–3.

    Article  CAS  PubMed  Google Scholar 

  • Anonymous. Adverse events associated with ephedrine-containing products—Texas, December 1993–September 1995. MMWR Morb Mortal Wkly Rep 1996a; 45: 689–93.

    Google Scholar 

  • Anonymous. Dietary supplements containing ephedrine alkaloids; proposed rule. 21 CFR 111. Fed Register 1997; 62 (107): 30677–724.

    Google Scholar 

  • Anonymous. From the Centers for Disease Control and Prevention. Adverse events associated with ephedrine-containing products—Texas, December 1993–September 1995. JAMA 1996b; 276: 1711–2.

    Article  Google Scholar 

  • Astrup A, Lundsgaard C. What do pharmacological approaches to obesity management offer? Linking pharmacological mechanisms of obesity management agents to clinical practice. Exp Clin Endocrinol Diabetes 1998; 106 (Suppl 2): 29–34.

    Article  CAS  PubMed  Google Scholar 

  • Backer R, Tautman D, et al. Fatal ephedrine intoxication. J Forensic Sci 1997; 42: 157–9.

    CAS  PubMed  Google Scholar 

  • Baselt R, Cravey B. Disposition of toxic drugs and chemicals in man. 3rd edit., Chicago, London: Year Book Medical Publishers, 1989.

    Google Scholar 

  • Blau JJ. Ephedrine nephrolithiasis associated with chronic ephedrine abuse. J Urol 1998; 160 (3 Pt 1): 825.

    CAS  PubMed  Google Scholar 

  • Blumenthal M. (ed.) Complete German Commission E monographs, therapeutic guide to herbal medicines. Austin, TX, American Botanical Council, 1998.

    Google Scholar 

  • Bories H. [Kidney stones]. Infirm Fr 1976; 179: 13–8.

    PubMed  Google Scholar 

  • Brater DC, Kaojarern S, et al. Renal excretion of pseudoephedrine. Clin Pharmacol Ther 1980; 28: 690

    Article  CAS  PubMed  Google Scholar 

  • Bruno A, Nolte KB, et al. Stroke associated with ephedrine use. Neurology 1993; 43: 1313–6.

    Article  CAS  PubMed  Google Scholar 

  • Chen K, Schmidt C. Ephedrine and related substances. Medicine 1930; 9: 1–94.

    Article  CAS  Google Scholar 

  • Chicharro M, Zapardiel A, et al. Direct determination of ephedrine and norephedrine in human urine by capillary zone electrophoresis. J Chromatogr 1993;8, 622: 103–108.

    Google Scholar 

  • Chung YT, Hung DZ et al. Intracerebral hemorrhage in a young woman with arteriovenous malformation after taking diet control pills containing phenylpropanolamine: a case report. Chung Hua I Hsueh Tsa Chih (Taipei) 1998; 61: 432–5.

    CAS  Google Scholar 

  • Clarkson P, Thompson H. Drugs and sport. Research findings and limitations. Sports Med 1997; 24: 366–84.

    Article  CAS  PubMed  Google Scholar 

  • Dawson J, Earnshaw S, et al. Dangerous monoamine oxidase inhibitor interactions are still occurring in the 1990s. J. Accid Emerg Med 1995; 12: 49–51.

    Article  CAS  PubMed  Google Scholar 

  • Deverall R. Red China’s dirty drug war. The story of opium, heroin, morphine, and philopon traffic, 3rd edit., New York, American Federation of Labor, 1954.

    Google Scholar 

  • Doyle H, Kargin M. Herbal stimulant containing ephedrine has also caused psychosis. Br Med J 1996; 312: 1441.

    Google Scholar 

  • ElSohly M, Jones A. Drug testing in the workplace: could a positive test for one of the mandated drugs be for reasons other than illicit use of the drug? J Analyt Toxicol 1995; 19: 450–458.

    CAS  Google Scholar 

  • Flurer CL, Lin LA, et al. Determination of ephedrine compounds in nutritional supplements by cyclodextrin-modified capillary electrophoresis. J Chromatogr B Biomed Appl 1995; 669: 133–9.

    Article  CAS  PubMed  Google Scholar 

  • Forman HP, Levin S, et al. Cerebral vasculitis and hemorrhage in an adolescent taking diet pills containing phenylpropanolamine: case report and review of literature. Pediatrics 1989; 83: 737–41.

    CAS  PubMed  Google Scholar 

  • Garriott JC, Simmons LM, et al. Five cases of fatal overdose from caffeine-containing “look-alike” drugs. J Analyt Toxicol 1985; 9: 141–3.

    CAS  Google Scholar 

  • Gaultieri J. Cardiomyopathy in a heavy ephedrine abuser. J Toxicol Clin Toxicol 1996; 34: 581–582.

    Google Scholar 

  • Glick R, Hoying J, et al. Phenylpropanolamine: an over-the-counter drug causing central nervous system vasculitis and intracerebral hemorrhage. Case report and review. Neurosurgery 1987; 20: 969–74.

    Article  CAS  PubMed  Google Scholar 

  • Glidden RS, DiBona FJ. Urinary retention associated with ephedrine. J Pediatr 1977; 90: 1013–4.

    Article  CAS  PubMed  Google Scholar 

  • Grinspoon L, Hedblom P. The speed culture: amphetamine use and abuse in America. Cambridge, MA, and London, England: Harvard University Press, 1995.

    Google Scholar 

  • Gruber A, Pope JH. Ephedrine abuse among 36 female weight lifters. Am J Addict 1998; 7: 40.

    Google Scholar 

  • Hamasaki Y, Kobayashi I, et al. The Chinese herbal medicine, shinpi-to, inhibits IgEmediated leukotriene synthesis in rat basophilic leukemia-2H3 cells. J Ethnopharmacol 1997; 56: 123–31.

    Article  CAS  PubMed  Google Scholar 

  • Hanzlick R. National Association of Medical Examiners Pediatric Toxicology (PedTox) Registry Report 3. Case submission summary and data for acetaminophen, benzene, carboxyhemoglobin, dextromethorphan, ethanol, phenobarbital, and pseudoephedrine. Am J Forensic Med Pathol 1995; 16: 270–7.

    Article  PubMed  Google Scholar 

  • Herridge CF, Brook MF. Ephedrine psychosis. Br Med J 1968; 2: 160.

    Article  CAS  PubMed  Google Scholar 

  • Holmstedt, B. Historical perspective and future of ethnopharmacology. J Ethnopharmacol 1991; 32: 7–24.

    Article  CAS  PubMed  Google Scholar 

  • Hurlbut J, Can J, et al. Solid-phase extraction cleanup and liquid chromatography with ultraviolet detection of ephedrine alkaloids in herbal products. JAOAC Int 1998; 81: 1121–7.

    CAS  Google Scholar 

  • Irvine G, Chen L. The environmental impact and adverse health effects of clandestine manufacture of methamphetamine. In NIDA Research Monograph 115, Miller, M. and Kozel, N. (eds.) pp 33–47, 1991.

    Google Scholar 

  • Ishigooka J, Yoshida Y, et al. Abuse of `BRON“: a Japanese OTC cough suppressant solution containing methylephedrine, codeine, caffeine and chlorpheniramine. Prog Neuropsychopharmacol Biol Psychiatry 1991; 15: 513–21.

    Article  CAS  PubMed  Google Scholar 

  • Jackson C, Hart A, et al. Fatal intracranial hemorrhage associated with phenylpropanolamine, pentazocine, and tripelenamine overdose. J Emerg Med 1985; 3: 127–32.

    Article  CAS  PubMed  Google Scholar 

  • Jawad SS, Eccles R. Effect of pseudoephedrine on nasal airflow in patients with nasal congestion associated with common cold. Rhinology 1998; 36: 73–6.

    CAS  PubMed  Google Scholar 

  • Johnson DA, Etter HS, et al. Stroke and phenylpropanolamine use [letter]. Lancet 1983; 2: 970.

    Article  CAS  PubMed  Google Scholar 

  • Jovanovic Z. [Risk factors for stroke in young people]. Srp Arh Celok Lek 1996; 124: 232–5.

    CAS  PubMed  Google Scholar 

  • Kalix P. The pharmacology of psychoactive alkaloids from ephedra and catha. J Ethnopharmacol 1991; 32: 201–8.

    Article  CAS  PubMed  Google Scholar 

  • Kanfer I, Dowse R, et al. Pharmacokinetics of oral decongestants. Pharmacotherapy 1993; 13 (6 Pt 2): 116S–128S;

    CAS  PubMed  Google Scholar 

  • Karch S. The pathology of drug abuse, 2nd edit., Boca Raton, Florida: CRC Press, 1996.

    Google Scholar 

  • Karch S. Comments on “ma haung toxicity” letter by Dr. Theoharides. J Clin Psychol Pharmacol 1999; 19: 196–199.

    CAS  Google Scholar 

  • Karch S, Green G, et al. Myocardial hypertrophy and coronary artery disease in male cocaine users. J Forensic Sci 1995; 40: 591–595.

    CAS  PubMed  Google Scholar 

  • Kunsman GW, Jones R, et al. Methylephedrine concentrations in blood and urine specimens. J Analyt Toxicol 1998; 22: 310–3.

    CAS  Google Scholar 

  • Lake C, Rosenberg D, et al. Phenylpropanolamine increases plasma caffeine levels. Clin Pharmacol Ther 1990a; 47: 675–85.

    Article  CAS  PubMed  Google Scholar 

  • Lake CR, Gallant S, et al. Adverse drug effects attributed to phenylpropanolamine: a review of 142 case reports. Am J Med 1990b; 89: 195–208.

    Article  CAS  PubMed  Google Scholar 

  • Lefebvre RA, Surmont F, Bouckaert J, Moerman E. Urinary excretion of ephedrine after nasal application in healthy volunteers. J Pharm Pharmacol 1992; 44: 672–5.

    Article  CAS  PubMed  Google Scholar 

  • Lermann B, Sten K, et al. Catecholamine facilitated reentrant ventricular tachycardia: uncoupling of adenosine’ s antiadreneregic effects. J Cardiovasc Electrophysiol 1999; 10: 17–26.

    Article  Google Scholar 

  • Levine B, Jones R, et al. An intoxication involving BRON and verapamil. J Analyt Toxicol 1993; 17: 381–3.

    CAS  Google Scholar 

  • Lietava J. Medicinal plants in a Middle Paleolithic grave Shanidar IV. J Ethnopharmacol 1992; 35: 263–6.

    Article  CAS  PubMed  Google Scholar 

  • Lindberg AW. [Urinary retention caused by Elsinore pills]. Ugeskr Laeger 1988; 150: 2086–7.

    CAS  PubMed  Google Scholar 

  • Ling M, Piddlesden SJ, et al. A component of the medicinal herb ephedra blocks activation in the classical and alternative pathways of complement. Clin Exp Immunol 1995; 102: 582–8.

    Article  CAS  PubMed  Google Scholar 

  • Liu YL, Toubro S, et al. Contribution of beta 3—adrenoceptor activation to ephedrineinduced thermogenesis in humans. Int J Obes Relat Metab Disord 1995; 19: 678–85.

    CAS  PubMed  Google Scholar 

  • Loizou L, Hamilton J, et al. Intracranial hemorrhage in association with pseudoephedrine overdose. J Neurol Neurosurg Psychiatry 1982; 45: 471–2.

    Article  CAS  PubMed  Google Scholar 

  • Lyon CC, Turney JH. Pseudoephedrine toxicity in renal failure. Br J Clin Pract 1996; 50: 396–7.

    CAS  PubMed  Google Scholar 

  • Mariani PJ. Pseudoephedrine-induced hypertensive emergency: treatment with labetalol. Am J Emerg Med 1986; 4: 141–2.

    Article  CAS  PubMed  Google Scholar 

  • Martin W, Sloan J, et al. Physiologic, subjective and behavioral effects of amphetamine, methamphetamine, ephedrine, phenemetrazine and methylphenidate in man. Clin Pharmacol Ther 1971; 12: 245–8.

    CAS  PubMed  Google Scholar 

  • Max B. This and that: the ethnopharmacology of simple phenethylamines, and the question of cocaine and the human heart. Trends Pharm Sci 1991; 12: 329–33.

    Article  CAS  PubMed  Google Scholar 

  • Nadeau SE. Intracerebral hemorrhage and vasculitis related to ephedrine abuse [letter]. Ann Neurol 1984; 15: 114–5.

    Article  CAS  PubMed  Google Scholar 

  • Nakahara Y, Kikura R. Hair analysis for drugs of abuse. XIX. Determination of ephedrine and its homologs in rat hair and human hair. J Chromatogr B Biomed Sci Appl 1997; 700: 83–91.

    Article  CAS  PubMed  Google Scholar 

  • Namba T, Kubo M, et al. Pharmacognostical studies of ephedra plants part I — the comparative histological studies on ephedra rhizomes from Pakistan and Afghanistan and Chinese crude drugs “Ma-Hung-Gen.” Planta Med 1976; 29: 216–25.

    CAS  PubMed  Google Scholar 

  • Neve KA, Molinoff PB. Effects of chronic administration of agonists and antagonists on the density of beta-adrenergic receptors. Am J Cardiol 1986; 57: 17F–22F.

    Article  CAS  PubMed  Google Scholar 

  • Pomerantz B, O’Rourke R. The Stokes–Adams syndrome. Am J Med 1969; 46: 941–60.

    Article  CAS  PubMed  Google Scholar 

  • Powell T, Hsu FF, et al. Ma-huang strikes again: ephedrine nephrolithiasis. Am J Kidney Dis 1998; 32: 153–9.

    Article  CAS  PubMed  Google Scholar 

  • Ramsey JJ, Colman RJ, et al. Energy expenditure, body composition, and glucose metabolism in lean and obese rhesus monkeys treated with ephedrine and caffeine. Am J Clin Nutr 1998; 68: 42–51.

    CAS  PubMed  Google Scholar 

  • Rosene JM, Rosene JA, et al. Decongestant effects on hemodynamics at rest, exercise, and recovery from exercise during 6 degrees of head down tilt. Aviat Space Environ Med 1999; 70: 15–21.

    CAS  PubMed  Google Scholar 

  • Roxanas MG, Spalding J. Ephedrine abuse psychosis. Med J Aust 1977; 2: 639–40.

    CAS  PubMed  Google Scholar 

  • Rutstein H. Ingestion of pseudoephedrine. Hypertension and unconsciousness following: report of a case. Arch Otolaryngol 1963; 77: 145–6.

    Article  Google Scholar 

  • Ryu SJ, Lin SK. Cerebral arteritis associated with oral use of phenylpropanolamine: report of a case. J Formos Med Assoc 1995; 94: 53–55.

    CAS  PubMed  Google Scholar 

  • Sagara K, Oshima T, et al. A simultaneous determination of norephedrine, pseudoephedrine, ephedrine and methylephedrine in Ephedrae herba and oriental pharmaceutical preparations by ion-pair high-performance liquid chromatography. Chem Pharmacol Bull (Tokyo)1983; 31: 2359–65.

    Google Scholar 

  • Schafers M, Dutka D, et al. Myocardial presynaptic and postsynaptic autonomic dysfunction in hypertrophic cardiomyopathy. Circ Res 1998; 82: 57–62.

    Article  CAS  PubMed  Google Scholar 

  • Schrauwen P, Walder K, et al. Human uncoupling proteins and obesity. Obes Res 1999; 7: 97–1105.

    CAS  PubMed  Google Scholar 

  • Schweisheimer W. [Kidney stones]. Krankenpflege (Frankf) 1976; 30: 194–5.

    CAS  Google Scholar 

  • Shufman NE, Witztum E, et al. [Ephedrine psychosis]. Harefuah 1994;127: 166–8, 215.

    Google Scholar 

  • Sidney K, Lefcoe NM. The effects of ephedrine on the physiological and psychological responses to submaximal and maximal exercise in man. Med Sci Sports 1977; 9: 95–99.

    Article  CAS  PubMed  Google Scholar 

  • Smith D, Perry P. The efficacy of ergogenic agents in athletic competition. Part II: Other performance-enhancing agents. Ann Pharmacother 1992; 26: 653–9.

    CAS  PubMed  Google Scholar 

  • Stoessl AJ, Young GB, et al. Intracerebral haemorrhage and angiographic beading following ingestion of catecholaminergics. Stroke 1985; 16: 734–6.

    Article  CAS  PubMed  Google Scholar 

  • Strand OA, Lund-Tonnesen S, et al. [Cerebral hemorrhage associated with phenylpropanolamine]. Tidsskr Nor Laegeforen 1991; 111: 1490–2.

    CAS  PubMed  Google Scholar 

  • Suwanwela C, Poshyachinda V. Drug abuse in Asia. Bull Narc 1986; 38: 41–53.

    CAS  PubMed  Google Scholar 

  • Sweeney S, Kelly R, et al. Amphetamines in hair by enzyme-linked immunosorbent assay. J Analyt Toxicol. 1998; 22: 418–24.

    CAS  Google Scholar 

  • Takahashi T, Minakami H, et al. Hyperamylasemia in response to ritodrine or ephedrine administered to pregnant women. J Am Coll Surg 1997; 184: 31–6.

    CAS  PubMed  Google Scholar 

  • Takayasu T, Ohshima T, et al. False identification of urinary ephedrine as methamphetamine by gas chromatography/mass spectrometry with a DB-17 column. Nippon Hoigaku Zasshi 1997; 51: 235–40.

    CAS  PubMed  Google Scholar 

  • Tapia J. [Cerebral hemorrhage associated with the use of phenylpropanolamine. Clinical cases]. Rev Med Chil 1996; 124: 1499–503.

    CAS  PubMed  Google Scholar 

  • Taylor E, Oertli E, et al. Accuracy of five on-site immunoassay drugs-of-abuse testing devices. J Analyt Toxicol 1999; 23: 119–24.

    CAS  Google Scholar 

  • Tekol Y, Tercan E, et al. Ephedrine enhances analgesic effect of morphine. Acta Anaesthesiol Scand 1994; 38: 396–7.

    Article  CAS  PubMed  Google Scholar 

  • Theoharides T. Reply to Comments by Dr. Karch. J Clin Psychol Pharmacol 1999; 19: 198–9.

    Google Scholar 

  • Thomas SH, Clark KL, et al. A comparison of the cardiovascular effects of phenylpropanolamine and phenylephrine containing proprietary cold remedies. Br J Clin Pharmacol 1991; 32: 705–11.

    Article  CAS  PubMed  Google Scholar 

  • To L, Sangster J, et al. Ephedrine-induced cardiomyopathy. Med J Aust 1980; 2: 35–6.

    CAS  PubMed  Google Scholar 

  • Tokunaga I, Takeichi S, et al. Electroencephalographical analysis of acute drug intoxication—SS Bron solution-W. Arukoru Kenkyuto Yakubutsu Ison 1989; 24: 471–9.

    CAS  PubMed  Google Scholar 

  • Upton R. Pharmacokinetic interactions between theophylline and other medication (Part I). Clin Pharmacokinet 1991; 20: 66–80.

    Article  CAS  PubMed  Google Scholar 

  • Vanakoski J, Seppala T. Heat exposure and drugs. A review of the effects of hyperthermia on pharmacokinetics. Clin Pharmacokinet 1998; 34: 311–22.

    Article  CAS  PubMed  Google Scholar 

  • Waluga M, Janusz M, et al. Cardiovascular effects of ephedrine, caffeine, and yohimbine measured by thoracic electrical bioimpedance in obese women. Clin Physiol 1998; 18: 69–76.

    Article  CAS  PubMed  Google Scholar 

  • Webb AA, Shipton EA. Re-evaluation of i.m. ephedrine as prophylaxis against hypotension associated with spinal anaesthesia for Caesarean section. Can J Anaesth 1998; 45: 367–9.

    Article  CAS  PubMed  Google Scholar 

  • Weesner K, Denison M, et al. Cardiac arrhythmias in an adolescent following ingestion of an over-the-counter stimulant. Clin Pediatr 1982; 21: 700–1.

    Article  CAS  Google Scholar 

  • Weiner I, Tilkian A, et al. Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion. Cath Cardiovas Diag 1990; 20: 51–3.

    Article  Google Scholar 

  • White LM, Gardner SF, et al. Pharmacokinetics and cardiovascular effects of ma-huang (Ephedra sinica) in normotensive adults. J Clin Pharmacol 1997; 37: 116–22.

    CAS  PubMed  Google Scholar 

  • Whitehouse AM, Duncan JM. Ephedrine psychosis rediscovered. Br J Psychiatry 1987; 50: 258–61.

    Article  Google Scholar 

  • Wilkinson G, Beckett A. Absorption, metabolism, and excretion of the ephedrines in man. II. Pharmacokinetics. J Pharm Sci 1968; 57: 1933–8.

    Article  CAS  PubMed  Google Scholar 

  • Wooten MR, Khangure MS, et al. Intracerebral hemorrhage and vasculitis related to ephedrine abuse. Ann Neurol 1983; 13: 337–40.

    Article  CAS  PubMed  Google Scholar 

  • Yap JC, Critchley LA, et al. A comparison of three fluid-vasopressor regimens used to prevent hypotension during subarachnoid anaesthesia in the elderly. Anaesth Intensive Care 1998; 26: 497–502.

    CAS  PubMed  Google Scholar 

  • Yin PA. Ephedrine-induced intracerebral hemorrhage and central nervous system vasculitis. Stroke 1990; 21: 1641.

    CAS  PubMed  Google Scholar 

  • Zhang J, Tian Z, et al. [Quality evaluation of twelve species of Chinese Ephedra]. Yao Hsueh Hsueh Pao 1989; 24: 865–871.

    CAS  PubMed  Google Scholar 

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  1. Steven B. Karch MD
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  1. WV Drug Information Center, Robert C. Byrd Health Sciences, West Virginia University School of Pharmacy, Morgantown, WV, USA

    Melanie Johns Cupp PharmD, BCPS

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Karch, S.B. (2000). Ma Huang and the Ephedra Alkaloids . In: Cupp, M.J. (eds) Toxicology and Clinical Pharmacology of Herbal Products. Forensic Science and Medicine. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-020-9_2

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  • DOI: https://doi.org/10.1007/978-1-59259-020-9_2

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