Ephedrine Uses, How It Works, Safety & Legal Status [Review]

Ephedrine is the primary active alkaloid found in the Ephedra Sinica or Chinese “Ma Huang” plant.

It has a stimulatory effect on the human body and has been used both to promote weight loss and as a medicinal agent for the treatment of asthma and allergy symptoms.

Ephedrine works by mimicking some of the effects of adrenaline (epinephrine) in the nervous system. It raises resting energy metabolism by increasing thermogenic activity (heat expenditure) in the body.

Ephedrine also exhibits an appetite-suppressing effect and influences fat storage and metabolism. It is commonly stacked with caffeine and aspirin in an ECA stack, which have a synergistic effect.

Prior to 2004, ephedra diet pills with ephedrine alkaloids were estimated to be used by over 12 million Americans to help them lose weight and boost energy levels. However, this plant alkaloid was found to pose an unreasonably high risk of dangerous side effects.

Ephedrine was banned as an ingredient in dietary supplements as of 2004. While it remains a controlled substance in the United States, it is still legal to buy in some forms as an over-the-counter remedy for nasal congestion, chest tightness and wheezing.

What Is Ephedrine?

Ephedrine was first identified as the major active alkaloid in the Ephedra plant in 1885. Its chemical formula is C10H15NO.

Ephedrine and the related chemical alkaloid Pseudoephedrine are believed to be responsible for most of the physiological effects of Ephedra. [4]

Ephedra refers to a genus of approximately 65 species of shrubs that grow around the world, including E. sinica, E. distachya, E. vulgaris, E. equisetina. E. gerardiana, E. intermedia, and E. nevadensis.

Ephedra plant extracts have long been used as medicinal agents in China, India, the Middle East and North America. In traditional Chinese medicine (TCM), Ephedra Sinica is one of the most important herbs used to treat bronchial asthma, cold and flu, and nasal congestion.

Not all species of this plant contains ephedrine and other (E)-type alkaloids including pseudoephedrine, norephedrine, and methylephedrine. [1]

Varieties of the plant native to the Western United States tend to have little to no ephedrine content in their stems. Ephedra viridis (jointfir, Mormon tea or Brigham tea) lacks any ephedrine or pseudoephedrine alkaloids.

Note: Do not confuse ephedrine with a monoamine alkaloid found in the Catha edulis shrub called Ephedrone. This compound is chemically similar to ephedrine and other amphetamines like cathinone and methcathinone, but they are not the same.

Also do not confuse ephedrine with the neurotransmitter and neurohormone epinephrine (adrenaline). This chemical messenger is secreted by the adrenal glands and is involved in the Fight-or-Flight Response when danger is perceived.

Ephedrine exhibits some of the same effects as epinephrine in the human body, but the two are distinct compounds.

Ephedrine Uses

The Natural Medicines Comprehensive Database reports that people use ephedrine orally for weight loss, increasing energy, and enhancing athletic performance.

Ephedrine increases activation of the Sympathetic Nervous System (SNS) by stimulating beta-adrenergic receptors throughout the body.

According to Drugbank, ephedrine has been shown to cause weight loss by suppressing the appetite and boosting the metabolism. It also increases the heart rate, activates the CNS (central nervous system), and promotes greater caloric expenditure. [4]

While it is reliably effective for promoting weight loss, the FDA does not permit pharmaceutical companies to advertise this ingredient as a diet pill or appetite suppressant due to concerns about safety risks.

Ephedrine is well-tolerated by some people when used appropriately in low doses. However, it can cause very serious adverse effects when used inappropriately or by those with certain underlying health conditions.

Ephedrine is also used medicinally for allergic rhinitis (hay fever), allergies, asthma, bronchospasm, and respiratory tract conditions like bronchitis. [1] Ephedrine remains FDA-approved for the treatment of bronchial asthma and other conditions affecting the the respiratory tract.

Research shows that use of this stimulant can reduce temporary symptoms of wheezing, chest tightness and shortness of breath in people suffering from intermittent respiratory issues.

Ephedrine is a bronchodilator, which means it causes bronchial tubes to dilate, making it easier for asthmatics and people with bronchitis to breathe.

In traditional medicine practices, ephedrine has also been used for:

• Edema symptoms (redness and swelling);
• As a diuretic to reduce water retention;
• Anhidrosis (inability to perspire normally);
• Nephritis (kidney inflammation);
• Colds, flu, and swine flu;
• Bone and joint pain;
• Headache;
• Fever;
• Chills; [1]

Ephedrine Sulfate Injections are also used to treat hypotension (low blood pressure) in patients under the effects of anesthesia. [5]

It is common knowledge that ephedrine and pseudoephedrine are used for manufacturing the highly-addictive street drug called Crystal Methane (methamphetamine).

To combat the diversion of ephedrine for the manufacturing of illicit street drugs, the US Congress passed the Combat Methamphetamine Epidemic Act of 2005. This Act sets out strict restrictions on the sale of medications containing ephedrine for consumers and retailers alike.

While you do not need a prescription to buy OTC medicines that contain ephedrine or pseudoephedrine, you will be asked for an ID and your purchases will be tracked and limited.

Legal Status

During the 1980s and 1990s, diet pills that contained ephedrine became popular in the United States and internationally.

They were used by students, shift workers, bodybuilders, athletes and the general public to increase energy levels, decrease appetite, boost mood, and promote weight loss.

Some well-known ephedrine fat-burner products of the past include:

• Yellow Swarm
• Hydroxycut
• Metabolife
• Xenadrine
• Mini Thins

These products have now been banned in the United States due to a high risk of side effects associated with ephedrine use. Some of these brands re-formulated their products with safer, natural ingredients designed as legal ephedra alternatives.

There is ongoing confusion about the legal status of ephedrine and ephedra. Many online sources mistakenly report that all forms of ephedrine and ephedra are illegal within the United States.

This can be confusing for consumers who continue to see ephedrine products for sale online and at some major pharmacies and retailers. While this drug is a controlled substance in the USA, it is legal in certain forms.

After the FDA ban of dietary supplements containing ephedrine alkaloids in 2004, hundreds of products were removed from store shelves in the USA.

The FDA cited an unreasonably-high risks for various adverse side effects and the potential for consumer abuse as the reason for issuing the ban.

However, the FDA ban applies only to dietary supplements that contain ephedrine alkaloids. It did not address the sale of pharmaceutical drugs containing this active ingredient.

Certain medications that contained these alkaloids remain legal to buy without a prescription. For example, OTC medications like Sudafed which contains pseudoephedrine, are still available for purchase and use.

Because it is still legal to buy OTC drugs that contain ephedrine alkaloids, some bodybuilders and dieters continue to use these products for their purported weight loss and fat-burning effects.

However, these drugs are classified as bronchodilators are intended to treat asthma symptoms. Using them for off-label purposes like weight loss is not recommended and potentially very dangerous.

Further, different US states have different laws regulating the maximum dosage and other formulation requirements for these products. Check with your local authorities to be sure about the current legal status of ephedrine in your state or country.

Where to Buy

Since 2004, the sale of dietary supplements that contain ephedrine alkaloids has been banned by the US Food and Drug Administration.

Before the ban, these products were commonly marketed for boosting energy, metabolism, and weight loss results. Consumer abuse and excessive reports of serious side effects prompted the FDA’s ban.

However, the FDA did not ban the sale of OTC medications that contain small amounts of ephedrine alkaloids intended to treat respiratory complaints

You can still buy low-dose ephedrine decongestant medications online and at some brick-and-mortar stores. [2] These products can contain a maximum of 12.5 or 25 milligrams ephedrine per dose.

Stores like CVS, Walgreens, and Walmart may or may not stock these products. It depends on what state you are in and local regulations.

Many pharmacies stopped selling these products to avoid any liability and the extra responsibilities involved with distributing these controlled substances.

At a federal level, all people who wish to purchase ephedrine products in the US must be at least 18 years old, provide government issued photo identification with an address, and answer various questions about their intended uses for the products.

These measures are intended to deter people from visiting multiple pharmacies and purchasing bulk amounts of ephedrine to make illicit drugs with. There are also limitations on the amount of ephedrine that an individual can purchase in a given time frame.

According to Ephedrine Web, “Users cannot buy more than 3.6 grams per day or 9 grams per 30-day period. If you do buy more than this amount, you may find yourself facing criminal proceedings. You could be arrested, fined and given jail time.” [2]

OTC Medications

Depending on where you live, different brands of over-the-counter ephedrine medications may be available to buy.

Some popular OTC ephedrine drugs available online and in some retail stores in the United States are:

• Primatene
• Bronkaid
• EPHED

All three of these products are marketed for relieving nasal congestion and reducing sinus pressure. They all contain combinations of either ephedrine or pseudoephedrine, and a medication called guaifenesin (glyceryl guaiacolate).

Guaifenesin is an expectorant that works to thin mucus, making it easier to clear it from the lungs. It is believed to cause a reflex stimulation of bronchial glands, resulting in a decrease in the thickness of bronchial secretions. [6]

Guaifenesin does contribute to the therapeutic efficacy of these medications for alleviating asthma symptoms. However, it is a CNS depressant and makes these products less effective for weight loss.

Bodybuilders who are interested in taking ephedrine to help them lose weight should be aware that products made with guaifenesin may not work as well as pure ephedrine tablets.

Primatene Tablets

Primatene is now only available in tablet form but was previously also sold in the form of an oral mist inhaler. Each tablet contains 12.5 milligrams of Ephedrine HCL (hydrochloride) and 200 mg of guaifenesin.

This product is manufactured by Pfizer Consumer Healthcare and is recommended for treating symptoms of asthma and COPD (chronic obstructive pulmonary disease). [7]

The maximum recommended dose of Primatene is 1-2 tablets every 4 hours as needed to manage symptoms. Do not exceed more than 12 tablets in any 24-hour period. Possible side effects include nervousness, insomnia, tachycardia, tremor, and seizure.

According to Pharmacy Times, “Primatene Mist was discontinued not because it was ineffective, but because its operation relied on chlorofluorocarbon (CFC) propellants, which are harmful to the environment because they deplete the ozone layer in the earth’s upper atmosphere.” [8]

Bronkaid Caplets

Armstrong Pharmaceuticals, Inc. manufactures Bronkaid® Caplets, which is a non-prescription medication used to treat asthma symptoms.

Bronkaid® is advertised to “provides temporary relief of mild asthma symptoms including: bronchial congestion, wheezing, tightness of chest and shortness of breath.”

It is also promoted for the following:

• Restore free breathing
• Loosen phlegm
• the strongest formula available in a 1 caplet dose

Each caplet provides 25 mg Ephedrine Sulfate with 400 mg Guaifenesin.

The recommended dose for adults and children over 12 years of age is 1 caplet every 4 hours as needed with a maximum of 6 caplets in a 24-hour period. This product is not recommended for anyone under 12 years of age.

According to the product website, 24 and 60-count packages are available at Walgreens, Rite Aid, Meijer, Walmart, HEB, CVS, and Target. [5]

EPHED Plus

EPHED Plus is a nasal decongestant and expectorant medication manufactured by DMD Pharmaceuticals. This product was previously manufactured with real ephedrine alkaloids, but now uses pseudoephedrine as the active ingredient.

Each tablet contains 30 mg of pseudoephedrine and 200 mg of guaifenesin. [9]

Canadian Brands

For consumers based in Canada, ephedrine product regulations are different than those in the United States.

Manufacturers can sell pure ephedrine HCL tablets in Canada without a prescription, but all products are limited to a maximum of 8 mg active alkaloids per serving, with a maximum recommended dose of 24 mg per day.

Some of the brands of this product that can be purchased in Canadian stores like GNC, Shopper’s Drug Mart or Rexall include:

• Kaizen Ephedrine HCL
• Synergenex Ephedrine HCL
• 4EverFit Ephedrine HCL

How Ephedrine Works in The Body

According to Drugbank, ephedrine is a bronchodilator and decongestant with stimulant effects. It is used as a concentration aid, appetite suppressant, and thermogenic enhancer.

Ephedrine is described as a sympathomimetic amine, which means that it increases activation of the Sympathetic Nervous System (SNS).

It works primarily by activating pre-synaptic beta-adrenergic receptors which are involved in regulating the SNS. It also works by enhancing the effects of norepinephrine at both alpha- and beta-adrenergic receptors.

Indirectly, ephedrine causes greater release of both dopamine and serotonin, two neurotransmitters involved in regulating mood, desire, energy levels, attention span and hunger.

By increasing activation of the SNS, ephedrine constricts blood vessels in the nasal passage and reduces inflammation, making it easier to breathe and alleviating nasal congestion. [4]

This stimulant also increases heart rate, heart contractile force, blood pressure and circulatory delivery throughout the body.

Research shows that consumption of ephedrine increases metabolic rate and oxygen consumption for 30-60 minutes after ingestion. It can also increase thermogenesis in brown adipose tissue, resulting in more body fat being burned to produce heat.

Ephedrine also appears to modestly preserve muscle mass in people who are losing weight. It may work by decreasing the excretion of nitrogen from the body, promoting a positive nitrogen balance and a nutrient partitioning effect.

According to Examine, ephedrine:

• Is fairly reliable for short- to medium-term weight loss (up to 6 months);
• May increase metabolism in humans by as much as 5%;
• Increases heat expenditure in both muscle and fat cells;
• Modestly prevents muscle tissue breakdown;
• Appears to decrease serum triglycerides;

Ephedrine for Bodybuilding

Some bodybuilders use ephedrine during their cutting cycles to help them reduce body fat before competitions. This thermogenic stimulant is taken to achieve a ripped, toned physique and to promote the preferential burning of fat mass over muscle mass.

Research shows that taking ephedrine can increase weight loss results by 1.3 pounds per month more compared to treatment with a placebo. If combined with caffeine, results were 2.2 pounds per month greater compared to those on a placebo.

According to Examine, “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 support this hypothesis.” [3]

Bodybuilders have also used ephedrine pills as a pre-workout supplement to enhance stamina, strength and physical performance.

Research is mixed concerning ephedrine’s effects on power output. While some studies have suggested it can improve performance, other studies have not found significant changes in performance.

According to NMCD, use of ephedrine with caffeine has been shown to increase cycling power on a test known as the Wingate test.

However, another study found that taking ephedra with caffeine did not improve results for anaerobic exercise performance or muscle strength compared to taking caffeine alone. [1, 3]

Bodybuilders and athletes that use this drug may be putting themselves at risks for various serious side effects. Bodybuilders commonly take this drug as dangerously high dosages, which can put excess strain on the heart and lead to dangerous cardiovascular complications.

ECA Stack

The ECA Stack is a combination of ephedrine, caffeine, and aspirin designed to enhance the efficacy of this stimulant for weight loss.

Caffeine acts synergistically with ephedrine, resulting in a greater increase in metabolism than if you were to use either of these substances on their own. Caffeine is commonly taken as an ECA stack ingredient in divided doses totaling 100-210 mg per day.

Aspirin is purported to potentiate the effects of ephedrine on beta-adrenergic receptors. According to Examine, it “works through prostaglandin inhibition, which increases ephedrine-induced adrenaline release.” [3]

In animal research, use of ephedrine alone has been shown to caused an 18% decrease in body fat. Using ephedrine and aspirin together was reported to cause a 27% decrease in body fat.

Note that even in recommended amounts, this stack can temporarily increase blood pressure and lead to harmful cardiovascular side effects.

When taken in higher-than-recommended doses, an ECA stack can cause hyperstimulation, heart palpitations, hypertension, nervousness, irritability, and various other adverse reactions.

Dosage Guidelines

Medicinenet reports that 12.5-25 mg oral doses of Ephedrine HCL have been used every 4 hours for treating bronchospasms. The total daily dosage used should not exceed 150 mg.

For treating nasal congestion, doses between 25-50 mg have been used every 6 hours as needed. [10]

NMCD reports that the following oral doses have been used in research studies:

• 24 mg daily for asthmatic bronchoconstriction for an unspecified duration of time;
• 15-40 mg ephedrine alkaloids, up to 3 times daily for treating obesity;
• 50 mg ephedrine sulfate taken to promote sexual arousal ;
• 1mg per kilogram of body weight taken for athletic performance enhancement 90 minutes before exercise once per week for four weeks
• 60 mg ephedrine taken with Kola Nut and Willow Bark;
• 25mg of ephedrine sulfate every 8 hours for 8 weeks;
• 4 grams Ephedra Extract daily for 8 weeks;
• 0.65-2.1 mg/kg bodyweight every 6 hours for 1 week; [1]

NMCD states that ephedrine is not recommended for children because it increases their risks for “toxicity and death.” Under medical supervision, 2-3 mg/kg oral doses have been used in 4-6 divided daily doses in children older than 2 years of age.

Safety and Side Effects

According to the Natural Medicines Comprehensive Database, Ephedrine is rated Likely Unsafe for all people in any amount when used orally.

Research shows that some people can tolerate this drug well when taking it as directed and following appropriate dosage guidelines.

However, it can cause life-threatening side effects in some users, even when using standard dosages such as those commonly found in over-the-counter asthma medications.

Ephedrine has been linked to several cases of ischemic stroke, high blood pressure, myocardial infarction (heart attack), seizure, and psychosis. [1]

Taking more than 32 mg of ephedrine in a single dose might increase the risks for subarachnoid hemorrhage, intracerebral hemorrhage, and hemorrhagic stroke by more than 300%.

Ephedrine Web states that using ephedrine in any amount is linked to 2-3 times greater risk for anxiety, heart palpitations, hyperactivity, nausea, mood changes, and vomiting.

Side effects generally become more frequent and more severe with repeated use, high doses, or when combining this drug with other stimulant compounds. [2]

PubChem reports that ephedrine can cause: [11]

• Damage to fertility or the unborn child;
• Harm to breast-fed children;
• Acute oral toxicity;
• Organ damage;

For many, the risks of using ephedrine outweigh any possible health benefits.

NMCD states, “Advise patients against using products containing ephedra, especially in combination with other stimulants such as caffeine, or if they have a pre-existing condition such as cardiovascular disease.” [1]

Interactions and Contraindications

Use of ephedrine is contraindicated for people with certain health conditions. It may exacerbate symptoms for people with the following medical diagnoses:

• Angina
• Anxiety Disorders
• Arrhythmia
• Diabetes
• Essential Tremor
• Hyperseptation
• Hyperthyroid/Thyrotoxicosis:
• Kidney Stones (Nephrolithiasis)
• Long QT Interval Syndrome
• Narrow-Angle Glaucoma
• Pheocromocytoma
• Seizure Disorders

Ephedrine has the potential to interact with certain medications, herbs, dietary supplements, and foods. It is known to cause major interactions with 50 well-known drugs and may cause moderate interactions with more than 275 others.

If you are currently taking prescription medications for the treatment of a health condition, it is important to consult with a doctor first before using ephedrine.

Use of this stimulant drug should be discontinued at least two weeks before any elective or planned surgeries.

Ephedrine may cause false positives on urine amphetamine or methamphetamine drug tests. This drug may also interfere with tests of thyroid function, blood glucose levels, catecholamine levels or blood lactate levels.

Ephedrine HCL tablets should not be taken by women who are pregnant or nursing. Its use should be avoided by anyone under the age of 18 or people with a high sensitivity to stimulant drugs.

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