Ephedra
Common name
Chinese ephedra
ID
HD0025
Scientific name of the plant
Ephedra sinica
Anatomical part for use
stem, leaf
Human use
Cough and cold
Summary
Ephedra is a medicinal preparation from the plant Ephedra sinica. Several additional species belonging to the genus Ephedra have traditionally been used for a variety of medicinal purposes, and are a possible candidate for the soma plant of Indo-Iranian religion. It has been used in traditional Chinese medicine for more than 2,000 years. Native Americans and Mormon pioneers drank a tea brewed from other Ephedra species, called "Mormon tea" and "Indian tea".
Dietary supplements containing ephedra alkaloids have been found to be unsafe, with reports of serious side effects and ephedra-related deaths. In response to accumulating evidence of adverse effects and deaths related to ephedra, the U.S. Food and Drug Administration (FDA) banned the sale of supplements containing ephedrine alkaloids in 2004. The ban was challenged in court by ephedra manufacturers, but ultimately upheld in 2006 by the U.S. Court of Appeals for the Tenth Circuit. Ephedra extracts not containing ephedrine have not been banned by the FDA and are still sold legally. (Source: Wiki)
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Severe hepatotoxicity associated with the use of weight loss diet supplements containing ma huang or usnic acid : (Source)
- Ma huang associated acute liver failure requiring liver transplantation : (Source)
- Acute hepatitis associated with the use of Ma-huang in a young adult : (Source)
- Acute hepatitis associated with the use of a Chinese herbal product, ma-huang : (Source)
Hepatotoxicity Description
Despite its apparent safe use for centuries in Chinese traditional medicine, Ma Huang was linked to many serious and potential fatal side effects since its widescale use in Western countries for weight loss. The major reported serious adverse events were cardiovascular, including hypertension, palpitations, myocardial infarction, seizures, transient ischemic attacks, cerebrovascular accidents and sudden death. Ephedra preparations have also been implicated in more than a dozen instances of clinically apparent, acute liver injury. The time to onset ranged from a few weeks to more than 6 months, but averaged 12 weeks, presenting with symptoms of fatigue, nausea and abdominal discomfort followed by jaundice. The serum enzyme elevations were typically hepatocellular and the clinical syndrome resembled acute viral hepatitis. Immunoallergic features (rash, fever and eosinophilia) were uncommon as were autoantibodies. Recovery occurred within 1 to 6 months of stopping the ephedra preparation, but instances with acute liver failure and death or need for emergency liver transplantation have been reported. As with most herbal products, it is difficult to say whether the liver injury is due to ephedra itself as opposed to a contaminant or another undisclosed hepatotoxin in the herbal supplement. While cases of ephedra-associated liver injury are now rare in the United States, they continue to be reported from Asia, largely as a result of use of traditional Asian and Chinese medicines. (Source: LiverTox)
Common name
Chinese ephedra
ID
HD0025
Scientific name of the plant
Ephedra sinica
Anatomical part for use
stem, leaf
Human use
Cough and cold
Summary
Ephedra is a medicinal preparation from the plant Ephedra sinica. Several additional species belonging to the genus Ephedra have traditionally been used for a variety of medicinal purposes, and are a possible candidate for the soma plant of Indo-Iranian religion. It has been used in traditional Chinese medicine for more than 2,000 years. Native Americans and Mormon pioneers drank a tea brewed from other Ephedra species, called "Mormon tea" and "Indian tea". Dietary supplements containing ephedra alkaloids have been found to be unsafe, with reports of serious side effects and ephedra-related deaths. In response to accumulating evidence of adverse effects and deaths related to ephedra, the U.S. Food and Drug Administration (FDA) banned the sale of supplements containing ephedrine alkaloids in 2004. The ban was challenged in court by ephedra manufacturers, but ultimately upheld in 2006 by the U.S. Court of Appeals for the Tenth Circuit. Ephedra extracts not containing ephedrine have not been banned by the FDA and are still sold legally. (Source: Wiki)
Evidence Level
Level 4 (Individual reports repeated observed over 5 years among different countries)
Hepatotoxicity reports in literature
- Severe hepatotoxicity associated with the use of weight loss diet supplements containing ma huang or usnic acid : (Source)
- Ma huang associated acute liver failure requiring liver transplantation : (Source)
- Acute hepatitis associated with the use of Ma-huang in a young adult : (Source)
- Acute hepatitis associated with the use of a Chinese herbal product, ma-huang : (Source)
Hepatotoxicity Description
Despite its apparent safe use for centuries in Chinese traditional medicine, Ma Huang was linked to many serious and potential fatal side effects since its widescale use in Western countries for weight loss. The major reported serious adverse events were cardiovascular, including hypertension, palpitations, myocardial infarction, seizures, transient ischemic attacks, cerebrovascular accidents and sudden death. Ephedra preparations have also been implicated in more than a dozen instances of clinically apparent, acute liver injury. The time to onset ranged from a few weeks to more than 6 months, but averaged 12 weeks, presenting with symptoms of fatigue, nausea and abdominal discomfort followed by jaundice. The serum enzyme elevations were typically hepatocellular and the clinical syndrome resembled acute viral hepatitis. Immunoallergic features (rash, fever and eosinophilia) were uncommon as were autoantibodies. Recovery occurred within 1 to 6 months of stopping the ephedra preparation, but instances with acute liver failure and death or need for emergency liver transplantation have been reported. As with most herbal products, it is difficult to say whether the liver injury is due to ephedra itself as opposed to a contaminant or another undisclosed hepatotoxin in the herbal supplement. While cases of ephedra-associated liver injury are now rare in the United States, they continue to be reported from Asia, largely as a result of use of traditional Asian and Chinese medicines. (Source: LiverTox)