Ellen Campbell Grizzle - Pharmacy Today SPARKS ARE flying in the United States of America (USA) over plans to ban dietary supplements containing Ephedra (Ephedra sinica) a.k.a Ma Huang, desert herb, Bringham Young weed or squaw weed.
The US Food and Drug Administration (FDA) has found that Ephedra and its related alkaloids in dietary supplements "present an unreasonable risk of illness or injury under conditions of use recommended or suggested in the labelling of the products." The agency has given notice that it intends to recommend a ban of these products and has advised consumers to cease purchasing these dietary supplements.
However, the actions of the agency regarding Ephedra "does not pertain to Chinese traditional herbal remedies nor to products like herbal teas that are regulated as conventional foods". Health Canada also has taken a position on this matter. It has called for a voluntary withdrawal of such products by manufacturers while recommending tighter regulatory control and a strict new labelling regime Jamaican pharmacists are very familiar with Ephedra. The herb is 90 per cent ephedrine with small amounts of pseudoephedrine and norephedrine. For over 5,000 years, Chinese indigenous medicine used Ma Huang to treat hay fever, asthma, nasal and chest congestion. It was also used to produce excessive sweating and increase urinary retention. In 1927, Western medicine synthesised ephedrine and pseudoephedrine from Ephedra. These ingredients are present in most over-the-counter cough and cold preparations sold today. The Pharmacy Council of Jamaica places such products in the List 2 (Pharmacy Only) category.
Ephedra can stimulate the heart, constrict blood vessels and elevate blood pressure. It decreases blood flow to the kidneys and intestines. Ephedrine, its main constituent, is a strong bronchodilator while pseudoephedrine is an excellent nasal decongestant. In cough and cold medicines containing these ingredients, contraindications are noted for persons with heart disease, high blood pressure, thyroid disease, closed-angle glaucoma, diabetes, urinary retention due to prostate enlargement and those taking antidepressants.
The present concern about Ephedra is related to its thermogenicity (ability to increase metabolic rate and calorie consumption). It raises body temperature marginally, facilitates the release of fatty acids from stored cells and promotes the faster consumption of fat as energy. When combined with substances in the methylxanthine class such as caffeine in green tea, thermogenesis is increased by approximately 20 per cent. Ephedra is therefore aggressively promoted as a 'fat burner", weight-loss product, for performance enhancement and body building. It is banned by the International Olympic Committee and is presently implicated in
several adverse events including nervousness, tremor, gastrointestinal distress, shortness of breath, severe headaches, seizures, strokes, coma and death.
Ephedra has earned the reputation in some circles as giving the 'poor man's high'. It is related to the amphetamine class of drugs with consequent stimulant effect. Some young persons now spike Ephedra with a cocktail of other common drugs to get a longer 'high'. This Ephedra episode provides a good learning opportunity for us and reinforces the importance of sticking to safe medication basics. Remember that the use of all medicines offers benefits but also carries risks. Please follow the tips below:- know your medicines; take your medication as prescribed; read product labels carefully; natural products are not "neutral" and in their action may interact with foods and other medicines; seniors, children, persons living with chronic illnesses and pregnant women deserve special attention; purchase your medication from
registered premises and persons and ask your pharmacist, you have the right to know!
Ellen Campbell Grizzle, President of the Caribbean Association of Pharmacists (CAP) and Director, Information & Research, National Council on Drug Abuse (NCDA), Kingston, Jamaica.
