Ephedrine is one of the four active components of the herb Ephedra.

It is able
to induce fat loss via increasing the amount of fat available for fuel as well as
by increasing heat expenditure. It has been implicated in increasing the
metabolic rate by up to 5% in humans. It has also been noted to cause
serious side-effects in some instances, and its legal status varies by region.

This page features 98 unique references to scientific papers.

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Summary (All Essential Benefits/Effects/Facts & Information)

Examine.com special safety warning on ephedrine and ephedra products:
While dietary supplements containing ephedrine alkaloids have been used
with an acceptable margin of safety and efficacy by many individuals, they
can be downright dangerous for those with certain underlying medical
conditions. A number of case reports have implicated ephedrine alkaloids as
the cause of serious adverse health effects in isolated individuals- including
but not limited to heart attack, stroke, seizures, and even death.[9] It should
also be noted that supplements ephedrine alkaloids are currently banned in
the United States.[10] Any decision to use ephedrine or ephedra products
should be made in close consultation with your personal physician.
Ephedrine (ih-fed-rin) is one of the four active components of the herb
Ephedra. It is able to induce fat loss via increasing the amount of fat available
for fuel as well as by increasing heat expenditure. It has been implicated in
increasing the Metabolic Rate by up to 5% in humans.
Ephedrine also interacts with muscle cells, increasing heat expenditure in
them as well as fat cells. It can also prevent the breakdown of muscle tissue
to a small degree.

Ephedrine is highly synergistic with Caffeine, and for this reason is commonly
found in something called an ECA stack (Ephedrine, Caffeine, and Aspirin).

Side effects include an increase in Blood Pressure that goes away with
cessation and increases in some blood parameters (Glucosamine, Insulin)
that also go away with cessation of use. It has been reported to be a
hyperstimulant when taken in doses above what is recommended.

Ephedrine is well studied and a fairly reliable compound for short- to mediumterm weight loss (less than 6 months) and mild performance improvements,
usually in trained individuals. However, it does not work under all situations;
longer-term weight loss and effects in untrained individuals have not been
studied much and sometimes produce negative results. While it has been
implicated in weight reduction independent of exercise and diet changes,
efficacy is maximized with minimal side-effects when ephedrine is combined
with diet and exercise.

Things to Know
Also Known As

Ephedra Vulgaris, Ephedraceae, ma huang

Do Not Confuse With

Ephedrone, Epinephrine

Things to Note

Ephedrine is highly stimulatory, and the plant (Ephedra) more-so.

Is a Form Of

Fat-Burner

Goes Well With

Methylxanthines such as Caffeine and theophylline (a component of green

tea)

Caution Notice

Ephedrine can also increase dopamine levels in the brain, and caution should
be taken pairing ephedrine with MAOIs such as Yohimbine.

Ephedrine should only be used under the supervision of a Medical Doctor,

especially if pre-existing cardiac complications exist, due to potentially
serious adverse effects.

The legal status of ephedrine varies by country and is a banned substance by

certain sports agencies.

Examine.com Medical Disclaimer

How to Take (recommended dosage, active amounts, other details)

All Doses Standardized to Ephedrine HCl

In an ECA stack, ephedrine is dosed at 20-24mg for three doses taken

throughout the day.

Human studies have found success with ephedrine in isolation on fat

metabolism with doses of 20-50mg thrice a day. The higher range (150mg)
may be too stimulatory for some, and can induce headaches or light hand
tremors.

Ephedrine tends to be consumed with xanthine compounds like Caffeine and

sometimes with Aspirin. The combination of Ephedrine and caffeine is shown
repeatedly to be highly synergistic.

Frequently Asked Questions Related to Ephedrine

Do I need to cycle ephedrine?

Human Effect Matrix

The Human Effect Matrix looks at human studies (it excludes animal and in
vitro studies) to tell you what effects ephedrine has on your body, and how
strong these effects are.
GRADE
A

LEVEL OF EVIDENCE

Robust research conducted with repeated double-blind clinical trials

B
Multiple studies where at least two are double-blind and placebo
controlled
C

Single double-blind study or multiple cohort studies

Uncontrolled or observational studies only

LEVEL OF EVIDENCE

EFFECT

CHANGE

MAGNITUDE OF EFFECT SIZE

SCIENTIFIC CONSENSUS
B

COMMENTS

Fat Mass

Notable
100%
See all 4 studies
It is thought that most weight lost with ephedrine administration is due to fat
mass, due to a slight muscle preserving effect; studies that note reductions in
fat mass
... show

Metabolic Rate

Notable
100%
See all 6 studies
Ephedrine, secondary to the stimulatory properties, appears to reliably
increased metabolic rate

Weight

Notable
77%
See all 10 studies
Ephedrine tends to result in reliable weight loss over time relative to control
(assuming calories are held equal), which is mostly due to a loss of body fat

Blood Pressure

Minor
25%
See all 5 studies
There may be an acute increase in blood pressure seen with ephedrine
intake, although this does not appear to be overly reliable; long-term usage
of ephedrine does not
... show

Heart Rate

Minor
50%
See all 5 studies
An increase in heart rate is present following ephedrine administration which
correlates well with its psychostimulatory properties; this is not 100%
reliable, and heart ... show

Nasal Congestion

Notable
100%
See 2 studies
Ephedrine appears to result in notable nasal decongestion

Minor

HDL-C

100%
See 2 studies
An increase in HDL-C has been noted with ingestion of ephedrine, may be
confounded with weight loss also seen in the trials

LDL-C

Minor
100%
See study
A decrease in LDL-C has been noted to be associated with ephedrine,
although this may be confounded with weight loss (also seen in the trials)

Skeletal Muscle Atrophy

Minor
100%
See study
May decrease the rate of skeletal muscle breakdown over time

Subjective Well-Being

Minor
100%
See study
Appears to increase well being acutely following the first doses of ephedrine,
secondary to the psychostimulatory effects

Triglycerides

Minor
100%
See 2 studies
There appears to be a decrease in triglycerides over time with ephedrine
ingestion, which may be due to either the fat burning effects of ephedrine or
the weight loss that
... show

Power Output

100%
See study
No significant influence on power output with standard oral doses of
ephedrine (higher doses may influence power output, but this is not well
researched)

Appetite

Minor
100%
See study
A decrease in appetite following ephedrine intake is noted and thought to be
secondary to its psychostimulatory effects

Nausea

0%
See study

Ephedrine has been noted to reduce postoperative nausea, but is also linked
to inducing nausea secondary to its psychostimulatory and appetite
suppressing effects. The ... show

Studies Excluded from Consideration

Confounded with the inclusion of caffeine[1][2][3][4][5][6][7]
Confounded with both aspirin and caffeine (the ECA stack)[8]

Disagree? Join the Ephedrine Discussion

Scientific Research
Table of Contents:

Sources and Structure

Composition (Ephedra)
Ephedrine (Ephedrine Alkaloids)
Properties
Pharmacology
Digestion and Absorption
Systemic
Neurology
Sensitivity
Fat Mass and Obesity
Mechanisms

Metabolic Rate and Oxygen consumption

Longterm Human Interventions on Fat Loss
Exericse Performance and Skeletal Muscle
Skeletal Muscle Hypertrophy
Power Output
Physical endurance
Interactions with Hormones
Estrogen
Cardiovascular Interactions
Blood Pressure
Heart Rate and Cardiac Health
Cardiotoxicity and Overdose
Lipoproteins and Triglycerides
Nutrient-Nutrient Interactions
ECA stack
Nicotine
Safety and Toxicity
Safety and Toxicity within Recommended Dosage Range
Case studies
Legality

1. Sources and Structure

1.1. Composition (Ephedra)

Ephedrine is found in the Ephedra Sinica plant, also known as Ma Huang or

Chinese Ephedrea. This distinction is important as there is an entire genus
called Ephedrea in the family Ephedraceae, and the ephedrine alkaloids
touted as fat burners are only present in Sinica.[11]

Ephedra in general contains more than 50 species, and is found world-wide.

Many are adapted to semiarid and desert conditions, although some are
found in humid or temperate climates in the Mediterrean and North America.
[11][12]

Ma Huang (Ephedra Sinica), the one sold as a fat burner, contains:

Ephedrine alkaloids (main fat burning compounds, topic of article) mostly in

Ephedra Sinica, distachya, equisetina, monosperma and gerardiana[11]
Ephedrine precursor, cathinone (norpseudoephedrine)[13] and derivative
ephedroxane.[14]
Cyclopropyl analogues of amino acids (glutamate) including (2S,3R,4S)-3,4methanoproline in the stems and leaves of many plants, and in the seeds in
high amounts.[11] Not in the stems or leaves of Ephedra altissima or Viridus.
(2S,3S,4S)-2-(carboxycyclopropyl)glycine, a cyclopropyl compound that is an
agonist of some glutamate receptors (MGluR2, MGluR3) and found in high
amounts in Ephedra antisyphilitica (0.5% by stem weight). The related
compound (2S,3S,4R)-2-(carboxycyclopropyl)glycine may also be
psychoactive, and is found in the berries of Ephedra foemina
Kynurenate compounds (6-hydroxykynurenate, 6-methoxykynurenate, 7methoxykynurenate) in the stem, none in the root. Also contains the parent
compound of kynurenate acid (4-hydroxyquinoline-2-carboxylic acid) at
concentrations up to 1% dry mass in Ephedra fasciculata and funerea
Proanthocyanidin compounds, and the tannin compounds ellagitannins and
gallotannins.[11]
New world ephedra plants (those found in North and South America, about
half of the species by number) do not contain substantial amounts of
ephedrine alkaloids,[11] although there are unconfirmed claims that there
may be a pseudoephedrine content.[15][16] The one study to analyze various
Ephedra species noted no ephedrine or pseudoephedrine in North American
species.[11]

1.2. Ephedrine (Ephedrine Alkaloids)

'Ephedrine', as a molecule, possesses two chiral centers. Due to this flexibility

in its structure, it can exist in four states (or stereoisomers). They are:

1R,2S (-)- Ephedrine

1S,2S (+)- Pseudoephedrine
1S,2R (+)- Ephedrine
1R,2R (-)- Pseudoephedrine
Additionally, ephedrine and pseudorephedrine can lose a methyl group to
become norephedrines, or be methylated to become N-methylephedrine.
Norephedrine and Norpseudoephedrine are also known as
Phenylpropinolamine, or PPA.

1.3. Properties

Ephedrine appears to be stable in the urine for up to 9 months at

temperatures ranging from -20C to 37C, and 15 hours at 60C which
simulated a weekend left in a car trunk or glovebox in a hot environment.[17]
[18] Ephedrine was also stable during 6 freeze-thaw cycles (-20C to 22C).
[17]

2. Pharmacology

2.1. Digestion and Absorption

Ephedrine administration at 50mg is able to reduce gastric emptying rate in

humans, and potentially reduce meal absorption speeds.[19][20]

2.2. Systemic

All below pharmacology can be reviewed here.[21]

Ephedrine is able to act with the muscle cells directly and induce
thermogenesis in myocytes. It has also been reported that urinary excretion
of nitrogen is reduced during ephedrine supplementation, indicating that this
interaction or a like interaction exerts a muscle sparing effect.

Ephedrine can also increase thermogenesis via its vasoconstrictory abilities

and the phenomena of 'hot pipes', otherwise known as vascular
thermogenesis[22] as well as acting on brown adipose tissue's betaadrenergic receptors system.

Supplementation with ephedrine increases plasma insulin, glucose, and Cpeptide in a dose dependent manner, possibly due to the state of transient
insulin resistant classical stimulants induce.

Ephedrine seems to be synergistic with methylxanthine compounds (such as

Caffeine and theophylline), a dose of 22mg/30mg/50mg
ephedrine/caffeine/theophylline has been shown to be twice as effective as
ephedrine alone[23], and in comparisons between different combinations of
ephedrine and caffeine a dose of 20mg/200mg has been shown to be the
most synergistic.[24] This discovery led to the rise of the ECA stack, which is

a stack of ephedrine/caffeine/aspirin which is dosed 20mg/200mg/91mg

accordingly.

3. Neurology

3.1. Sensitivity

Ephedrine appears to be a more potent stimulant during periods of caloric

restriction, relative to higher caloric intakes.[25] The neural stimulant effects
are further increased when paired with Caffeine.[26]

4. Fat Mass and Obesity

4.1. Mechanisms

Ephedrine is able to directly agonize all three subsets of -adrenergic

receptors of brown adipose tissue, leading to increased thermogenesis[27]
without significantly activating the -adrenergic receptor class[28] and
possibly antagonizing activation from agonists of these receptors.[28] The class of adrenergic receptors are seen as the class that stimulate lipolysis,
where the alpha class is inhibitory.[29]

The order of potency (EC50 followed by relative potency to the reference

standard of isoproterenol) of the isomers of ephedrine on 1 subunits are
1R,2S(500uM, 68%) > 1S,2R(72mM, 66%) > 1S,2S(309mM, 53%) =
1R,2R(1122mM, 53%)[29] while the influence on the 2 subunits have a
similar order of potency of 1R,2S(360uM, 78%) > 1R,2R(7mM, 50%) >

1S,2S(10mM, 47%) > 1S,2R(106mM, 22%).[29] 3-subunits only appear to be

agonized in humans weakly by the 1R,2S isomer at an EC50 value of 45mM
and 31% response relative to isoproterenol while other isomers are mostly
inactive.[29]

This agonism may not appear to be seen in vivo at doses of 50mg taken
thrice daily.[30]

It has been shown to increase only the beta-3 subunit in white adipose tissue
in rats, but enhances glycerol release from brown adipose tissue and inhibits
glucose uptake for both types of adipocyte.[31]

Ephedrine isomers are direct agonists at beta-adrenergic receptors and may

directly stimulate lipolysis, but the EC50 values are fairly high and may not
reflect serum levels following ingestion

4.2. Metabolic Rate and Oxygen consumption

Human studies have found that oxygen consumption via an initial ephedrine
dose (20mg) increases an expected amount 30-60 minutes after ingestion in
all cases (with more potency in those not adapted to stimulants), although
chronic ingestion of ephedrine alleviates the expected drop between 1-3
hours post ingestion. This suggests that ephedrine confers more benefits to
fat burning with usage over a longer period (4-12 weeks) rather than
intermittently, and the suspected mechanism is augmentation of betaadrenergic sensitization.[32]

Ephedrine seems to, in and of itself, increase metabolic rate via REE
independent of exercise; this is dissimilar to Caffeine, which requires exercise
to induce it's fat-burning effects to significant levels. Coincidentally, this may
be the reason why the combination of Ephedrine and Caffeine shows
synergism with exercise in increased oxygen consumption.[33] The
combination of ephedrine and caffeine has been noted to be similarly
effective (trending to be more effective) than 15mg dexfenfluramine over 12
weeks.[3]

It has been noted that caffeine ingestion does, however, increase ephedrine's
effects on REE independent of exercse[34] and that this effect on potentiating
was also noted with green tea, suggesting that the methylxanthine class of
compounds (via increasing adrenaline) are causative of the potentiation.[23]

The previous animal studies have noted a 10% increase in REE with
ephedrine supplementation, however human studies are more variable at
3.6%,[30] 10.7% (with caffeine),[7] and 7.1%.[35] Studies using indirect
calorimetry note various increases, such as 30.15.4kcal/3hours at 20mg
ephedrine + 200mg caffeine, and 22.77.7kcal/3hours at half the ephedrine
dosage.[24] It has also been noted to reduce a 13% reduction in REE (from
caloric restriction) into an 8% reduction, saving 5% of the metabolic rate.[6]

Metabolic rate, thermogenesis, and oxygen consumption are all reliably

increased with ephedrine supplementation. The increase is greater with
caffeine or other xanthine compounds, is greater in obese persons, and
shows most practical significance during periods of caloric restriction.
Estimates are around 5-12% increases in metabolic rate.

4.3. Longterm Human Interventions on Fat Loss

Some case studies have supported the idea that ephedrine (paired with
caffeine) can be of use to hypothalamic obesity with long-term success.[5]

Human studies in overweight females indicate that a 20mg x 3 dosage

protocol is capable of reducing bodyweight independent of dietary and
exercise changes by 2.5kg in 4 weeks and 5.5kg in 12 weeks, suggesting a
reduced return-on-investment with ephedrine supplementation (independent
of changes in oxygen consumption). In a sample of 5, 2 subjects reported
slight hand tremors upon initial supplementation.[36]

Usage of the ECA stack has been investigated, and without intentional caloric
restriction in obese persons showed 2.2kg weight loss over 8 weeks against
0.7kg for placebo.[37] When unblinded, the 2.2kg loss increased to 3.2kg.

With caloric restriction, EC shows 3.4kg greater weight loss relative to

placebo over 16 weeks in obese persons[38] and 30-60mg (paired with 300600mg Caffeine) showed 5.9kg more fat loss in 20 weeks in adolescents.[1]

Additionally, long-term use of ephedrine (5 months) is associated with

continued fat loss (5.2kg) relative to control (-0.03kg).[37] In some studies
where fat loss between groups is not statistically significant, significant
positive trends in body composition are seen.[6]

5. Exericse Performance and Skeletal Muscle

5.1. Skeletal Muscle Hypertrophy

Ephedrine, as a beta-adrenergic agonist, can preserve muscle mass by

reducing nitrogen excretion (and titrating nitrogen balance towards a positive
state). Human interventions note a decrease in urinary nitrogen with acute
ephedrine usage[39] and at least one study that did not note weight loss was
due to a loss of bodyfat concurrent with an increase in muscle gain, with
4.5kg more fat lost and 2.8kg less muscle mass lost over 8 weeks.[6] These
numbers may be inflated due to the women being obese at baseline.

Skeletal muscle may contribute up to 50% of the fat burning potential of

ephedrine, as it acts mostly in brown fat stores and skeletal muscle.[40]

5.2. Power Output

In 9 otherwise healthy resistance trained men, ingestion of 300mg Caffeine

with 60mg ephedra sinicus (ephedrine content not disclosed) 60 and 150
minutes prior to muscular testing with a 1 rep max bench press and lat
pulldown test noted that despite increased attitude towards and alertness
during weight lifting that there was no significant differences in strength
when compared to 300mg glucose placebo.[41] Another trial assessing
muscular output with weight training with a higher dose of ephedrine
(0.8mg/kg 90 minutes before leg press:bench press supersets to failure)
noted 3 more reps on the leg press associated with ephedrine over placebo
(16 over 13) and when combining with caffeine this was increased to 6 reps
(19 versus 16) with less improvement (1 and 2 extra reps, respectively) with
the bench press; the authors noted that fatigue during supersets may have
played a role, and these results were only significant during the first superset
test (with a 2 minute rest period, the subsequent two tests were not
statistically significance).[42]

One study using a single acute dose of 24mg ephedrine in otherwise healthy
untrained men failed to note any power output enhancement after acute
dosing.[43]

Studies using ergometer assessments of power fail to find improvements in

power output associated with 60mg ephedra sinicus (and 300mg caffeine)
[41] and ephedrine in isolation has been associated with improving power
output during a 30s wingate test (at time points of 5 and 10 seconds,
insignificant at other time points) when measured 90 minutes after ingestion
of 1mg/kg;[44] this latter study has been criticized for its conclusions, where
the clinical significance was minor (less than 1% improvement when
averaged over all 30 seconds) and may not be worth the risks associated with
high dose ephdrine consumtption.[45]

Power output improvement with lower doses of ephedrine appears

unreliable, whereas higher doses (0.8-1mg/kg) have been associated with
enhanced power output when taken 90 minutes before exercise. The costbenefit analysis of these high doses of ephedrine has been questioned,
however, with some authors arguing it may not be the best intervention due
to possible side-effects associated with stimulant usage

5.3. Physical endurance

In a test on performing high intensity cycling until failure (where placebo

managed to pedal for 12.6 minutes) the ingestion of 1mg/kg ephedrine is
associated with a trend to reduce time to exhaustion (by 19%) that failed to
reach statistical significance, but combining this dose with 5mg/kg caffeine
improved the effects (to 39%) and was significant.[46] This improvement has
been replicated elsewhere with similar dosing, and the increase in heart rate
was replicated and a lower rate of percieved exertion was noted.[47]

One study assessing performance on a weighted (11kg) 10 kilometer run

following ingestion of 0.8mg/kg ephedrine noted a 2.8% improvement in run
time associated with ephedrine over placebo (similar effects in caffeine plus
ephedrine) associated with improved pace during the last 5k and no
significant influence on VO2 max; this was attributed to the increase in serum
free fatty acids and modulation of catecholamines (less adrenaline and more
dopamine).[48]

Limited evidence, but ephedrine appears to enhance endurance exercise

performance which may merely be secondary to increased free fatty acid
levels in serum and possibly a reduced rate of percieved exertion

6. Interactions with Hormones

6.1. Estrogen

Ephedrine, at 0.5mg/kg daily, exerts an anti-estrogenic effect in mice and was

more potent than Ephedra Sinica and Synephrine at doing so.[49]

7. Cardiovascular Interactions

7.1. Blood Pressure

Many of the human studies (to be discussed) noted slight increases in blood
pressure ranging from 5-23mmhg systolic with no influence on diastolic.[32]
[7] These effects were acute and causative of the ephedrine administration.

Over a long period of time (8-12 weeks) ephedrine is associated with reduced
blood pressure, although this is due to weight loss.[50][3] Sometimes blood
pressure is not significantly affected at all chronically, however.[51][52][53]
In regards to persons with hypertension who may still experience the acute
rise in blood pressure, treatment with ephedrine may be problematic acutely
but has been argued, over time, to be beneficial secondary to reduction in
weight.[50]

With a controlled dose of ephedrine, it does not seem to change heart rate in
and of itself. Variations in HR are typically causative of excessive adrenaline
levels when pairing ephedrine with an adrenaline increasing agent such as
Caffeine or from anxiety.

7.2. Heart Rate and Cardiac Health

One human study noted decreases in serum potassium levels when

ephedrine was being used (20mg x 3). The decreases were, on average, from
4.1mmol to 3.7mmol, although the decrease was blunted with chronic
administration.[36]

Other human studies[39][54] have noted less drastic increases in adrenaline

levels and no changes in urinary excretion of adrenaline markers but have
noted less urinary nitrogen excretion, indicating a better nitrogen balance
and thus muscle sparing potential of ephedrine supplementation (50mg
thrice a day).

7.3. Cardiotoxicity and Overdose

At high doses of 50mg/kg bodyweight (Ma Huang, or ephedra) or 25mg/kg

bodyweight ephedrine, clinical and biological signs of toxicity are apparent.
[55] Doses of 12.5mg/kg bodyweight Ma Huang (equivalent to 6.25mg/kg
ephedrine) paired with caffeine show minimal toxic signs. An acute dose of
25mg/kg bodyweight (14x recommended human dose) is lethal to rats when
fed by gavage.[56]

Cardiotoxicity, in rat models, appears to be more of a concern for older

animals.[57]

7.4. Lipoproteins and Triglycerides

Ephedrine (thus study using caffeine) has been noted to reduce the rate of
HDL-C decreases seen with hypocaloric dieting without significantly affecting
overall total cholesterol.[4]

8. Nutrient-Nutrient Interactions

8.1. ECA stack

The ECA stack was first proposed in 1989[58] and tested in 1990[59] as
nutraceuticals that interacted with each other. It was already noted at this
time that xanthine compounds (of which Caffeine is included) can cause the
efficacy of 22mg ephedrine in increasing the metabolic rate to approximately
double[23] and in animals to more effectively suppress the appetite.[60][61]
[62]

Caffeine is able to increase metabolic rate on its own, but its combination
with ephedrine appears to be synergistic (greater than the sum of its parts)
rather than just additive. The pairing of the two results in an increased
metabolic rate greater than the two added together mathematically.[24] The
mechanism appears to be through adenosine antagonism, as the other
theory (phosphodiesterase inhibtion) may not be relevant in vivo due to low
cellular concentrations of caffeine relative to what is needed to cause large
inhibition.[63]

Caffeine has been noted as a synergist with ephedrine in vivo[24] and used
effectively in a wide variety of studies to induce weight loss in conjunction
with a diet or diet with exercise program.[64] and some studies suggest that
it is needed for the fat loss effects of ephedrine to differ from placebo.[38]
This may be secondary to 'non-responders' to ephedrine, which seems to be
negated by coingestion of a xanthine compound.[35] Basically, those who do
not respond to ephedrine seem to respond to ephedrine with xanthines.

The synergism between ephedrine and xanthines has been roughly quantified
as 64% more than the expected values of the added value of the two
compounds in one study.[24] This is more of a pharmacodynamic synergism,
as taking the combination of ingredients does not appear to alter the
pharmacokinetic profile of either.[26]

One study noted the combination of Caffeine and ephedrine did not influence
diastolic blood pressure while either compound in isolation did, and that the
combination did not influence systolic blood pressure to a greater degree
than either compound in isolation.[24] This indicates that the combination is,
at least, no worse than either in isolation in regards to acute blood pressure
spikes.

Although aspirin has been shown to cause greater reductions in body fat
when combined with ephedrine, it does not significantly affect body weight
on its own.[65] In animals, ephedrine decreased body fat percentage by 18%
while ephedrine combined with aspirin decreased body fat percentage by
27%.[65] works through prostaglandin inhibition, which increases ephedrineinduced adrenaline release.[66] Aspirin in combination with caffeine and
ephedrine has failed to acutely increase the thermic effect of food.[8]

8.2. Nicotine

Ephedrine and caffeine mixtures have been used in attempts to reduce the
weight gain seen with smoking cessation, and although benefit has been
noted ephedrine has failed to significantly modify quitting rates.[2]

9. Safety and Toxicity

9.1. Safety and Toxicity within Recommended Dosage Range

Ephedrine, paired with caffeine, appears to be a safe supplement for

adolescents (16 years average, 14-17) given adequate supervision.[1]

Some reviews note that interventions are no different from placebo[67]

(although said meta-analysis established CI's ranging from 2-3.5[68]) and
that the benefits of fat loss outweigh the costs.[67]

No clinically significant withdrawal symptoms are seen from usage of

20mg/200mg ephedrine/caffeine three times daily for 24 weeks.[69][70]

9.2. Case studies

As a foreward, a large registry based case-crossover study comparing naive

and habitual ephedrine/caffeine users found no difference in adverse effects

between groups, and found no overall relation with adverse cardiovascular

outcomes.[71] Additionally, a meta-analysis of 50 studies and 284 case
reports reported to the FDA (out of 18,000) noted that there was an
association with ephedrine/ephedra and heart palpitations/autonomic side
effects, but that case reports are the data are insufficient to draw conclusions
about a rate less than 1 per thousand.[68] More dramatic side-effects are
seen when reviewing FDA 'reports of adverse events'[72] but these tend to be
associated with social panic; said meta-analysis[68] found only 284 out of
18,000 acceptable when controlling for temporal relations (ephedrine
consumed 24 hours prior to report) and no other confounds were present.
This suggests that 98.5% of non-medical cases were due to hypochondria,
although by no means excludes possible harm.

Ephedrine has been associated with stroke in unknown dosages in persons

with a history of drug abuse[73]

At least one case of human heart damage has been reported in a 44 year old
male, but this was confounded with usage of a wide variety of compounds.
[74] Another case study noted usage of Ephedrea, Xenadrine, and Hydroxycut
for 2 years resulting in coronary artery aneurysm[75] which may be related to
the Xenadrine formulation without Ephedrine.[76][77]

One study notes ephedrine associated with kidney stones, but takes an overly
dramatic approach in the abstract.[78] Ephedrine alkaloids were found to
comprise 95% of a kidney stone by weight in a person on 4 medications with
a single kidney who suffered from kidney failure in the past. However,
contacts of the author noted "over 200" other cases of kidney stones
containing Ephedra Alkaloids. The supplement used by the case subject
contained 170mg Ephedra (6% ephedrine).[78]

Ephedrine has, at least once, been used to commit suicide. The exact oral
dose was unknown, but was well beyond the highest recommended
therapeutic dosages.[78]

9.3. Legality

Many countries place restrictions on the sale of bulk ephedrine in order to

prevent mass methamphetamine production, as ephedrine is a substrate for
meth.[79]

In 2004 the United States Food and Drug Administration (FDA) issued a ruling
prohibiting the sale of dietary supplements containing ephedra, citing an
unreasonable risk of illness or injury.[80] In addition to the FDA ban on sales,
laws governing the sale, use, and possession of ephedra products have been
established at the state and local level. If you are considering the use of
ephedra, be sure to check first whether doing so complies with all
national/local laws in your region.

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(Common misspellings for Ephedrine include ephedrin, ephedirn, ephedirne,
ephdrin, ephdra)

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SUMMARY
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Quickly:

Ephedrine is one of the four active components of the herb Ephedra. It is able
to induce fat loss via increasing the amount of fat available for fuel as well as
by increasing heat expenditure. It has been implicated in increasing the
metabolic rate by up to 5% in humans. It has also been noted to cause
serious side-effects in some instances, and its legal status varies by region.

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