BMA Concise Guide to Medicine & Drugs

Ephedrine

Brand name Cam

Used in the following combined preparations Do-Do Chesteze, Haymine, and others

QUICK REFERENCE

Drug group Bronchodilator and decongestant

Overdose danger rating Medium

Dependence rating Low

Prescription needed No

Available as generic Yes

GENERAL INFORMATION

Chemically related to amfetamine, ephedrine promotes the release of the neurotransmitter norephedrine. It was once widely prescribed to relax constriction of muscles around the airways due to asthma, bronchitis, and emphysema but more effective drugs have largely replaced ephedrine for these uses. Its main use now is as a nasal decongestant. Ephedrine injections may be used to restore normal blood pressure after anaesthetic procedures, especially spinal and epidural anaesthesia.

Adverse effects are unusual from nasal drops used in moderation, but taken by mouth or injection the drug may stimulate the heart and central nervous system, causing palpitations and anxiety, and it is best avoided by people with high blood pressure.

Ephedrine was also widely used in dietary supplements and is present in the Chinese herbal medicine ma huang.

INFORMATION FOR USERS

Follow instructions on the label. Call your doctor if symptoms worsen.

How taken/used Tablets, liquid, injection, nasal drops.

Frequency and timing of doses By mouth 3 x daily. Nasal drops 3–4 x daily.

Dosage range Adults 45–180mg daily (by mouth); 1–2 drops into each nostril per dose (drops); 3–6mg every 3–4 minutes to a maximum of 30mg (injection). Children Reduced dose according to age and weight.

Onset of effect Within 15–60 minutes.

Duration of action 3–6 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Do not take the missed dose. Take your next dose as usual.

Stopping the drug Can be safely stopped as soon as you no longer need it.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause shortness of breath, high fever, seizures, or loss of consciousness. Notify your doctor immediately.

POSSIBLE ADVERSE EFFECTS

Adverse effects from ephedrine nasal drops are uncommon, although local irritation may occur. When taken by mouth, the drug may affect the central nervous system, causing anxiety, restlessness, and insomnia. Taking the last dose before 4pm may help to prevent insomnia. Ephedrine may also affect the cardiovascular system, causing palpitations or chest pain; if these occur, stop taking the drug and seek urgent medical advice. Other adverse effects include cold hands and feet, dry mouth, and tremor; discuss with your doctor if these are severe or if you experience urinary difficulties. Long-term use may cause other problems and is not advised (see Prolonged use).

INTERACTIONS

Monoamine oxidase inhibitors (MAOIs) Ephedrine may interact with these drugs to cause a dangerous rise in blood pressure.

Beta blockers Ephedrine may interact with these drugs to cause a dangerous rise in blood pressure.

Antihypertensive drugs Ephedrine may counteract the effects of some antihypertensive drugs.

Theophylline taken with ephedrine can lower potassium levels in children. The two drugs should not be given together.

SPECIAL PRECAUTIONS

Be sure to tell your doctor or pharmacist before taking this drug if:

· You have a long-term kidney problem.

· You have heart disease.

· You have high blood pressure.

· You have diabetes.

· You have an overactive thyroid gland.

· You have had glaucoma.

· You have urinary difficulties.

· You are taking other medicines, especially an MAOI antidepressant.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk and may affect the baby. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 Not usually prescribed.

Driving and hazardous work Avoid such activities until you have learned how ephedrine affects you. No special problems with nasal drops.

Alcohol No special problems.

Surgery and general anaesthetics Ephedrine may need to be stopped before you have a general anaesthetic. Discuss this with your doctor or dentist before surgery.

PROLONGED USE

Prolonged use is not recommended. Excessive use in nasal drops leads to reduced decongestant effects and rebound congestion when stopped. Long-term use of ephedrine-containing herbal preparations is associated with stroke.