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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Ephedra Is Associated with More Adverse Effects than Other Herbs
18 March 2003 | Volume 138 Issue 6 | Page I-56
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full report titled "The Relative Safety of Ephedra Compared with Other Herbal Products." It is in the 18 March 2003 issue of Annals of Internal Medicine (volume 138, pages 468-471). The authors are S Bent, TN Tiedt, MC Odden, and MG Shlipak.
What is the problem and what is known about it so far?
Ephedra (ma huang) is an herb. It contains several substances called ephedra alkaloids, such as ephedrine and pseudoephedrine. Medicines that contain ephedra alkaloids were used to treat nasal congestion and asthma; however, use of the alkaloids for these purposes has declined because of frequent reported adverse effects and safer alternatives. More recently, ephedra has been an ingredient in dietary supplements to "promote weight loss and enhance energy." Adverse effects, including nervousness, insomnia, heart attack, and stroke, have been reported in patients taking products that contain ephedra or ephedra alkaloids. The actual frequency of adverse effects due to ephedra is unclear. Furthermore, whether adverse effects are more common with ephedra than with other herbal products is unknown.
Why did the researchers do this particular study?
To find out whether ephedra is associated with more adverse effects than other herbs.
What was studied?
Number of adverse effects reported to poison control centers in the United States in 2001.
How was the study done?
The researchers looked at adverse effects from herbal products that were reported to U.S. poison control centers. A poison control specialist determined whether the adverse effect could be attributed to "normal" or "recommended" use of the product. Reports of overdose or clear abuse of "recommended" use were not examined. The researchers also compared the numbers of different herbal products that were sold in the United States in 2001 with the numbers of reported adverse effects.
What did the researchers find?
Products containing ephedra accounted for 64% of all reported adverse effects from herbs even though they represented less than 1% of total herbal product sales. The risk for an adverse effect from ephedra compared with other commonly used herbal products was very high. For example, relative risks for adverse effects from ephedra were 100 times greater than from kava and as much as 700 times greater than from Ginkgo biloba. Types and severity of adverse effects were not described.
What were the limitations of the study?
The researchers studied adverse effects that were reported to poison control centers. However, many people don't report adverse effects to these centers. More people taking ephedra might have reported effects to the centers, and more people taking other products might have failed to report effects. The actual number of people who took ephedra was not known. Thus, the study does not show the actual frequency of adverse effects in patients taking ephedra.
What are the implications of the study?
Ephedra is associated with greatly increased risk for adverse effects compared with other commonly used herbal products.
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A. Dickinson The Relative Safety of Ephedra Compared with Other Herbal Products Ann Intern Med, September 2, 2003; 139(5_Part_1): 385 - 385. [Full Text] [PDF]
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S. E. Kimmel The Relative Safety of Ephedra Compared with Other Herbal Products Ann Intern Med, August 5, 2003; 139(3): 234 - 234. [Full Text] [PDF]
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Correction: The Relative Safety of Ephedra Compared with Other Herbal Products Ann Intern Med, August 5, 2003; 139(3): 235 - 235. [Full Text] [PDF]
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D. S. Kalman, J. Antonio, and R. B. Kreider The Relative Safety of Ephedra Compared with Other Herbal Products Ann Intern Med, June 17, 2003; 138(12): 1006 - 1006. [Full Text] [PDF]
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Correction: The Relative Safety of Ephedra Compared with Other Herbal Products Ann Intern Med, June 17, 2003; 138(12): 1012 - 1012. [Full Text] [PDF]
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