9 Uses of Ephedrine + Side Effects, Dangers, Overdose

9 Uses of Ephedrine + Side Effects, Dangers, Overdose

9 Uses of Ephedrine + Side Effects, Dangers, Overdose

Ephedrine is a medication once widely used to increase blood pressure and relieve asthma symptoms. Some have also used it to promote weight loss and lower cholesterol levels. However, the health authorities banned it due to a high risk of abuse and adverse health effects. Read more to learn the uses, side effects, and dangers of ephedrine.

Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature. Please discuss your medications with your doctor.

As a matter of fact, we strongly advise against the use of banned and unapproved drugs or substances.

What is Ephedrine?

Ephedrine (commonly known as Akovaz) is a medication and stimulant commonly used to increase blood pressure and promote airflow to the lungs [1, 2].

Ephedrine is derived from the plant Ephedra, which has long been used by the Chinese for medicinal purposes. After its initial discovery in 1885, ephedrine became a popular and effective treatment for asthma [3].

It is now used as a recreational drug or nutritional supplement. Ephedrine is banned in many countriesincluding the United States, as it can be misused to make methamphetamine (crystal meth) [3, 4].

Additionally, the FDA prohibited the sale of all dietary supplements containing Ephedra alkaloids, including ephedrine, due to potential adverse effects on heart health [5].

While it is most known to increase blood pressure and treat asthma, people also use ephedrine for weight loss, fatigue, and narcolepsy [6, 7, 8].

Components

Ephedrine exists in 4 different molecular arrangements or isomers. The 4 isomers are classified as true ephedrine or pseudoephedrine, depending on the way their chemical structures are rotated around their centers [9].

Pseudoephedrine is a diastereomer of ephedrine. This means that while they are made of the same elements, the 2 molecules differ in the arrangement at 2 molecular centers [10].

The 2 types of ephedrine are called (+)-ephedrine or L-ephedrine, and (-)-ephedrine or D-ephedrine, depending on if the molecule is rotated clockwise or counterclockwise around their centers, respectively [1].

Mechanism of Action

Ephedrine mainly functions by increasing therelease and activity of adrenaline on its receptors. This action increases heart rate, narrows the blood vessels, opens the airways to the lungs, and stimulates the brain [11].

Ephedrine stimulates 3 main types of adrenaline receptors: alpha, beta-1, and beta-2. It specifically targets the beta-type adrenaline receptors and increases the production of the messenger molecule, cyclic AMP (cAMP). Ephedrine acts on alpha receptors by decreasing the production of cAMP. Decreasing cAMP decreases glycogen, sugar, and fat production [3, 4, 12].

It can also increase or decrease blood pressure the type of beta receptors it targets. By stimulating the beta-1 receptors in the heart, ephedrine can cause high blood pressure. On the other hand, ephedrine can lower blood pressure by activating beta-2 receptors, leading to fainting and flushing [4].

Ephedrine also acts as a mild brain stimulant. Because of its unique structure, it can easily dissolve through fats and act directly on the brain. This increases the activity of sections of the brain that control emotion (limbic system) [3].

It may also act by:

  • Blocking adrenaline transporters, which increases the activity of adrenaline by allowing it to remain active longer in the brain. This increases heart rate and blood pressure [4, 13].
  • Partially inhibiting monoamine oxidase (MAO), an enzyme that breaks down adrenaline. This causes adrenaline to stay active longer, resulting in irregular heartbeat and headaches [4].
  • Increasing the release and blocking the uptake of dopamine, which enhances physical activity [14, 15].
  • Increasing the release of acetylcholine at adrenaline nerves [16].
  • Increasing serotonin release, which promotes weight loss by suppressing appetite [17].

1) Low Blood Pressure

In a study of 204 pregnant female patients under spinal anesthesia, ephedrine was more effective in treating low blood pressure than phenylephrine [18].

However, in a review of 7 such studies (292 pregnant women), there was no difference in blood pressure increase between ephedrine and phenylephrine. In fact, phenylephrine was more ly to increase heart rate than ephedrine [19].

In a randomized study of 51 vein-surgery patients under long-term treatment for high blood pressure, ephedrine effectively increased blood pressure when it went below normal levels [20].

Ephedrine administered through the veins increased the rate at which the heart contracted in dogs, which can cause a rise in blood pressure [21].

In male rats, the (-)-ephedrine isomer contracted blood vessels more than a racemic mixture of ephedrine, which can result in higher blood pressure [1].

Ephedrine has a greater capacity to constrict veins than arteries, which increases blood pressure [22].

In one study of 32 adolescents, ephedrine did not significantly increase blood pressure and heart rate [23].

2) Asthma Symptoms

Ephedrine may relieve shortness of breath and airway spasms. In a study of 25 asthma patients, ⅔ of the group experienced relief from their symptoms [24].

In 12 patients with inflamed and spasming airways, gaseous ephedrine was 50% effective in reducing the symptoms. Oral ephedrine was not effective at all [25].

In a 2-week study of 8 asthma patients, ephedrine prevented lung function decline. However, after being treated with ephedrine 3 times per day in this 2-week period, a single dose of ephedrine had no additional effect in opening up the patients’ airways, which may indicate treatment tolerance [2].

In a trial of 20 asthma patients comparing the immediate effects of terbutaline (a bronchodilator) and ephedrine on the heart and bronchial tubes, ephedrine significantly widened the airways, but not as much as terbutaline [26].

While ephedrine is generally effective in treating asthma, there are some instances where it does not work. This may be because the dosage was too small to have any effect on the airway spasms [27].

3) Weight Loss

Many supplements are promoted to stimulate weight loss, but none of them has yet been supported by strong clinical evidence and approved by the health authorities. A healthy, calorie-controlled diet and increased physical activity remain the only proven strategies for weight control [28].

Particular caution is warranted when it comes to banned substances ephedrine with a high potential of abuse and adverse health effects.

A randomized trial conducted on 43 obese patients (41 women) found that the patients lost an average of 12.6 kg after taking a combination of ephedrine and caffeine 3 times a day for 8 weeks, coupled with a low-calorie diet [29].

In another 16-week study of 57 patients, a combination of ephedrine and caffeine reduced body fat by 6%, and triglycerides by 15.2 mg/dL. When combined with a drug used to treat type 2 diabetes, ephedrine reduced triglyceride levels by 41 mg/mL [30].

In a 6-month study of 167 patients, herbal ephedra and caffeine decreased body weight and body fat two times more efficiently than placebo [31].

In a study of 67 subjects, an herbal mixture of Ma Huang (ephedrine plant) and Guarana (caffeine plant) promoted short-term weight and fat loss [32].

In a study with a 1-year follow-up period of 225 heavy smokers, weight gain was significantly reduced when ephedrine and caffeine were taken during the first 12 weeks of the study [33].

In naturally obese mice, ephedrine reduced weight and suppressed appetite [34].

4) Cholesterol Levels

According to a clinical review, ephedrine helps breaks down a type of LDL cholesterol that blocks arteries. When combined with caffeine, it increases HDL cholesterol. This protects against artery blockage and may prevent cholesterol-related heart disease [35].

In a 6-month trial of 167 subjects, herbal ephedra and caffeine significantly decreased LDL cholesterol and increased HDL cholesterol levels [31].

A combination of 20 mg ephedrine and 200 mg caffeine reduced triglycerides and prevented a drop in HDL cholesterol levels in 32 obese women on a strict dietary regiment [36].

In a 16-week trial of 57 patients, a combination of ephedrine, caffeine, and a diabetes drug increased HDL cholesterol by 7.8 mg/dL [30].

Ephedrine reduced cholesterol levels in the blood of obese mice in one study [34].

Insufficient Evidence:

No valid clinical evidence supports the use of ephedrine for any of the conditions in this section. Below is a summary of up-to-date animal studies, cell-based research, or low-quality clinical trials which should spark further investigation. However, you shouldn’t interpret them as supportive of any health benefit.

5) Brain Protection

Ephedrine acts on and activates beta adrenaline receptors, which are involved in increasing memory [37, 38].

In a 2-week trial, ephedrine had mild effect in improving attention [39].

In rats, Ephedra plant extract treated blood-brain barrier breakage and an abnormal buildup of fluid in the brain after spinal cord and brain injury. This may be a protective factor against early brain injury caused by bleeding [40].

6) Narcolepsy Symptoms

In a trial conducted on 46 narcolepsy patients, 20 were completely relieved of their symptoms, and all but 2 had some form of improvement [41].

Some doctors reported preliminary success with ephedrine for narcolepsy in children. A 13-year-old male and two 9-year-old females were all cured of daytime sleepiness with ephedrine [8].

In 5 narcolepsy cases, the mid-sleep seizures stopped within 24 hours of taking ephedrine [42].

However, we can’t draw any conclusions from one small trial and individual case reports.

7) Athletic Performance

Ephedrine has been used by athletes and bodybuilders for its supposed ergogenic properties that stem from the effects on mood, energy, fat metabolism, and heart rate [43].

A comprehensive clinical review found moderate benefits of ephedrine only on short-term performance. The authors also emphasized low-quality clinical evidence as a major limitation. In one study, ephedrine was effective only in combination with caffeine [44].

Another review concluded that ergogenic (performance-enhancing) properties are being overplayed and that the risks outweigh the potential benefits [45].

8) Myasthenia Gravis

Ephedrine has been used to treat Myasthenia gravis, a disease that causes rapid weakness and fatigue of the muscles.

Four patients in a series of placebo-controlled studies took ephedrine as an add-on to their main treatment. This resulted in a small but consistent reduction of their symptoms and weakness [46].

In a separate follow-up study, 10/12 patients experienced greater strength and mobility after 6-8 months of ephedrine treatment, but this study lacked a control group [47].

9) Bladder Control

In a study of 37 patients with a loss of bladder control (urinary incontinence), ephedrine improved control in those with mild wetting problems, regardless of the cause [48].

Ephedrine: Uses, Dosage & Side Effects – Drugs.com

9 Uses of Ephedrine + Side Effects, Dangers, Overdose

Generic Name: ephedrine capsules and tablets (e-FED-rin

Medically reviewed by Drugs.com. Last updated on Mar 28, 2018.

What is ephedrine?

Ephedrine is used for temporary relief of shortness of breath, chest tightness, and wheezing due to bronchial asthma. Ephedrine may also be used for other conditions as determined by your doctor.

Ephedrine is a decongestant and bronchodilator. It works by reducing swelling and constricting blood vessels in the nasal passages and widening the lung airways, allowing you to breathe more easily.

Do not use ephedrine if:

  • you are allergic to this medication.
  • you do not have a diagnosis of asthma
  • you have a diagnosis of asthma but use prescription asthma medications
  • if you have ever been hospitalized for asthma
  • you are taking a monoamine oxidase (MAO) inhibitor (eg, phenelzine) now or have taken an MAO inhibitor in the last 14 days. If you do not know if your prescription drug contains an MAO inhibitor, ask your health care provider before taking this product.
  • you have high blood pressure, heart disease, an irregular heartbeat, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland or other severe heart problems

Contact your doctor or health care provider before using ephedrine if any of these apply to you.

Before using ephedrine:

Some medical conditions may interact with ephedrine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have a history of heart problems, diabetes, glaucoma, an enlarged prostate or other prostate problems, adrenal gland problems, high blood pressure, seizures, stroke, blood vessel problems, an overactive thyroid, or severe asthma

Some medicines may interact with ephedrine. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Beta-blockers (eg, propranolol), cocaine, indomethacin, methyldopa, MAO inhibitors (eg, phenelzine), linezolid, oxytocic medicines (eg, oxytocin), rauwolfia derivatives (eg, reserpine), or tricyclic antidepressants (eg, amitriptyline), or ergot alkaloids (eg, dihydroergotamine) because the actions and side effects of ephedrine may be increased
  • Bromocriptine, catechol-O-methyltransferase (COMT) inhibitors (eg, entacapone), or digoxin because the actions and side effects of these medicines may be increased
  • Guanadrel, guanethidine, mecamylamine, methyldopa, or reserpine because its effectiveness may be decreased by ephedrine

This may not be a complete list of all interactions that may occur. Ask your health care provider if ephedrine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use ephedrine:

Use this medication as directed by your doctor. Check the label on the medicine for exact dosing instructions. Check the label on the medicine for exact dosing instructions.

  • ephedrine may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation.
  • If you miss a dose of ephedrine and are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use ephedrine.

Important safety information:

  • ephedrine may cause dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to ephedrine. Using ephedrine alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks.
  • If your symptoms do not improve within 7 days or if you develop a high fever, check with your doctor.
  • If you have trouble sleeping, ask your pharmacist or doctor about the best time to take this medication.
  • Do not take diet or appetite control medicines while you are taking ephedrine.
  • Before you begin taking any new prescription or nonprescription medicine, read the ingredients to see if it also contains ephedrine. If it does or if you are uncertain, contact your doctor or pharmacist.
  • Diabetes patients – ephedrine may affect your blood sugar. Check blood sugar levels closely and ask your doctor before adjusting the dose of your diabetes medicine.
  • Use this medication with caution in the elderly because they may be more sensitive to its effects.
  • Use ephedrine with extreme caution in children. Safety and effectiveness have not been confirmed.
  • Pregnancy and breast-feeding: It is unknown if this medication can cause harm to the fetus. If you become pregnant while taking ephedrine, discuss with your doctor the benefits and risks of using ephedrine during pregnancy. Ephedrine is excreted in breast milk. If you are or will be breast-feeding while you are using ephedrine, check with your doctor or pharmacist to discuss the risks to your baby.

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most common side effects persist longer than one hours or become worse:

  • Dizziness; headache; nausea; nervousness; tremor; loss of appetite; restlessness; sleeplessness; stomach irritation.

Seek medical attention right away if any of these severe side effects occur:

  • Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating.

This is not a complete list of all side effects that may occur.

Proper storage of ephedrine

Store this medication at room temperature, between 59 and 77 degrees F (15 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep ephedrine the reach of children and away from pets.

General information:

  • If you have any questions about ephedrine, please talk with your doctor, pharmacist, or other health care provider.
  • ephedrine is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about ephedrine.

If you have questions about the medicine you are taking or would more information, check with your doctor, pharmacist, or other health care provider.

Copyright 1996-2018. Version: 2.01.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Source: https://www.drugs.com/ephedrine.html

EPHEDRINE – INJECTABLE side effects, medical uses, and drug interactions

9 Uses of Ephedrine + Side Effects, Dangers, Overdose

Warning | Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage

WARNING: This drug should not be used in combination with other stimulant products (e.g., caffeine), other cough-and-cold products, or as a dietary supplement for the purpose of weight loss or body building.

Doing so may increase your risk of unly but potentially fatal side effects including: stroke, heart attack, seizures, or severe mental disorders (see Side Effects section and Precautions section).

Exceeding recommended ephedrine doses increases your risk of the side effects noted above. For detailed information, consult your pharmacist.

USES: Ephedrine injection is a central nervous system stimulant used to treat low blood pressure (hypotension) during certain surgical procedures, severe allergic-type reactions (e.g., bronchospasm or bronchial asthma), certain heart rhythm problems (e.g., Stokes-Adams syndrome), narcolepsy, and myasthenia gravis.

HOW TO USE: Inject this medication into a vein (IV), into a muscle (IM), or under the skin (SC-subcutaneously) as directed by the doctor. When given IV, the dose is injected slowly and may be repeated in 5 to 10 minutes, if necessary. The dosage is your medical condition and response to therapy. Do not exceed 150 mg (adults) or 3 mg per kg (children) in 24 hours.

When used for an extended period, this medication may not work as well and may require different dosing. Talk with your doctor if this medication stops working well. Before using, check this product visually for particles or discoloration. If either is present, do not use the liquid. Learn how to store and discard needles and medical supplies safely. Consult your pharmacist.

SIDE EFFECTS: Nervousness, dizziness, headache, nausea, loss of appetite, or trouble sleeping may occur. If any of these effects persist or worsen, notify your doctor promptly.

Tell your doctor immediately if any of these serious side effects occur: chest pain, unusually fast or irregular heartbeat, vomiting, tremor/shakiness, sweating, severe weight loss, difficult or painful urination, stomach pain.

Tell your doctor immediately if any of these unly but serious side effects occur: severe mental/mood changes, fever, trouble breathing, one-sided weakness, confusion, vision problems, slurred speech. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: This medication is not recommended for use if you have the following medical conditions: glaucoma (closed-angle type), certain psychiatric conditions (e.g., psychoneurosis). Tell your doctor your medical history, especially of: heart problems (e.g., arrhythmias, chest pain), blood vessel problems (e.g.

, stroke or TIA), diabetes, over-active thyroid (hyperthyroidism), prostate problems, high blood pressure (hypertension), kidney problems, dehydration, any allergies. This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor. It is not known whether this drug passes into breast milk.

Due to the potential risk to the infant, breast-feeding while using this drug is not recommended.

DRUG INTERACTIONS: This drug is not recommended for use with other adrenalin- drugs (e.g., caffeine, epinephrine, methylphenidate, pseudoephedrine). Also, avoid taking any MAO inhibitors (e.g.

, furazolidone, isocarboxazid, linezolid, moclobemide, phenelzine, procarbazine, selegiline, tranylcypromine) for at least 2 weeks before or after using this drug. Ask your doctor or pharmacist for more details. Tell your doctor of all prescription and nonprescription medication you may use, especially: beta-blockers (e.g.

, metoprolol, propranolol), other blood pressure medicine (e.g., guanethidine, methyldopa, reserpine, or alpha-blockers such as prazosin and terazosin), tricyclic antidepressants (e.g., amitriptyline, desipramine), “water pills” (e.g.

, furosemide, hydrochlorothiazide), digoxin, atropine, theophylline, oxytocin, certain anesthetics used in surgery (e.g., cyclopropane, halothane), certain herbal/natural medications (e.g., ma huang, St John's wort). Check the labels on all your medicines (e.g.

, cough-and-cold products, diet aids, natural products) because they may contain ingredients that could increase your heart rate or blood pressure. The use of ephedrine with these products is not recommended. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include: seizures, cold sweats, vision problems (dilated pupils).

NOTES: Do not share this medication with others; it is against the law. Laboratory and/or medical tests (e.g., blood pressure) will be performed to monitor your progress.

MISSED DOSE: Not applicable.

STORAGE: Store at room temperature between 59 and 86 degrees F (15 and 30 degrees C) away from light.

Low Blood Pressure (Hypotension): Symptoms, Signs, Causes See Slideshow Symptoms & Signs FAQs & Doctor's Views FDA Drug Labels on RxList.com

Source: https://www.medicinenet.com/ephedrine-injectable/article.htm

Ephedra and Its Application to Sport Performance: Another Concern for the Athletic Trainer?

9 Uses of Ephedrine + Side Effects, Dangers, Overdose

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Ephedrine Hydrochloride 15mg Tablets

9 Uses of Ephedrine + Side Effects, Dangers, Overdose

This information is intended for use by health professionals

Ephedrine Hydrochloride 15mg Tablets

Ephedrine hydrochloride 15mg

For excipients see 6.1

Tablet

White, circular tablets marked E15 on one face and CP on the reverse.

Ephedrine tablets are indicated for the treatment or prevention of attacks of bronchospasm in asthma.

Adults

15 – 60mg three times daily

Children

under 1 year

1 – 5 years

6 – 12 years

not recommended

15mg three times daily

30mg three times daily

Elderly

Dosage should be substantially reduced. Initial therapy should be 50% of adult dose.

Ischaemic heart disease

Hypertension

Thyrotoxicosis

Prostatic hypertrophy

Ephedrine has positive inotropic and chronotropic effects on the heart and its use should be avoided in patients with ischaemic heart disease.

Ephedrine increases blood pressure in man. Over the counter acquisition of sympathomimetics should always be considered in hypertensive patients whose blood pressure control has suddenly deteriorated.

Patients with hyperthyroidism may be susceptible to the effects of ephedrine. Ephedrine may precipitate acute urinary retention in patients with prostatic hypertrophy.

Ephedrine should be given with care to patients with hyperthyroidism, diabetes mellitus, angle-closure glaucoma and renal impairment.

Ephedrine has potentially life threatening effects in its acute cardiovascular and central stimulant effects.

Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

Other adrenoceptor stimulants: Concurrent use of ephedrine with theophylline may result in increased nausea, nervousness, and insomnia.

Anaesthetics: There may be an increased risk of arrhythmias when used with volatile liquid anaesthetics.

Antidepressants:Ephedrine should not be given to patients who are being treated with monoamine oxidase inhibitors as they may cause hypertensive crisis with marked headache, severe hypertension and subarachnoid haemorrhage.

Noradrenaline is displaced by ephedrine with the release of large amounts of catecholamine. The interaction may occur up to two weeks after stopping MAOI therapy.

There may be an increased risk of arrhythmias when ephedrine is used with tricyclic antidepressants.

Antihypertensives: Loss of blood pressure control has been detected in hypertensive patients undergoing concurrent therapy with ephedrine and adrenergic neurone blocking drugs and may also occur with other antihypertensives.

Antimigraine drugs: Enhanced vasoconstriction and pressor effects with ergotamine or methysergide; concurrent use of ergotamine not recommended (risk of gangrene).

Cardiac glycosides:Increased risk of arrhythmias in patients receiving ephedrine and cardiac glycosides.

Corticosteroids: Ephedrine has been shown to increase the clearance and prolong the half-life of dexamethasone in asthmatic patients.

Oxytocin:Increased risk of vasoconstrictor or pressor effects in patients receiving oxytocin and ephedrine.

Urinary acidifiers/alkalinisers:Effects of ephedrine may be reduced by acidification and increased by alkalinization of the urine.

The use of ephedrine in pregnancy should be avoided as ephedrine crossed the placenta and this has been associated with an increase in foetal heart rate and beat to beat variability. Ephedrine is excreted in breast milk and therefore its use during lactation should be avoided. Irritability and disturbed sleep patterns have been reported in breast fed infants.

The most common side-effects of ephedrine are tachycardia, anxiety,nausea, restlessness and insomnia. Tremor, dry mouth, impaired circulation to the extremities, hypertension, headache and cardiac arrhythmias may occur. Tolerance with dependence has been reported with prolonged administration.

Myocardial infarction has occurred very rarely in patients taking ephedrine or pseudoephedrine.

Ephedrine may act as stimulant in children with nocturnal enuresis and cause sleeplessness. It may have sedative effects in some children.

The elderly are more sensitive to the cardiovascular effects of ephedrine.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

a) Symptoms

The symptoms of overdose are normally seen as nausea, vomiting, hypertension, fever, palpitations, tachycardia, restlessness, respiratory depression and convulsions. Paranoid psychosis, delusions and hallucinations may also follow ephedrine overdosage.

b) Treatment

In severe overdosage, the stomach should be emptied by emesis and lavage. Management is by supportive symptomatic therapy.

Ephedrine is a sympathomimetic agent with direct and indirect effects on adrenergic receptors.

When given by mouth in therapeutic doses, ephedrine constricts the peripheral vessels, thus increasing blood pressure. It also relaxes bronchioles.

Ephedrine is rapidly and completely absorbed after oral administration and extensively distributed throughout the body with accumulation in the liver, lungs, kidneys, spleen and brain.

Peak plasma concentrations are attained during therapy of 65-120 ug/ml, effective bronchodilator plasma levels are in the range 35-80 ug/ml.

The plasma half-life is reported to be between 3-11 hours, with up to 95% being excreted in the urine.

Studies in mice have shown that the lethal toxicity of ephedrine is increased by elevation of body temperature.

Ephedrine induces acute locomotor stimulatory activity in rats and mice. The estimated lethal dose in children up to 2 years of age is 200mg and for adults 2g. Fatalities are rare and single doses up to 400mg have been given without serious toxic effects.

Lactose

Maize starch

Acacia spray-dried

Stearic acid

Magnesium stearate

Polypropylene and polyethylene containers – Three years.

Blister strips – Two years

Do not store above 25°C.

Store in the original container in order to protect from light.

Polypropylene or polyethylene containers with tamper evident closure. Each pack contains 28, 30, 56, 60, 84, 90, 100, 250 or 1000 tablets.

Blister strips of 28, 30, 56, 60, 84, 90 tablets.

Wockhardt UK Ltd

Ash Road North

Wrexham

LL13 9UF

United Kingdom

Source: https://www.medicines.org.uk/emc/product/2577/smpc

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