The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.


Avoid in people with a known allergy or sensitivity to ephedra, ephedrine, or pseudoephedrine (Sudafed®). Signs of allergy may include rash, itching, or red, flaking skin.

Side Effects and Warnings

The U.S. Food and Drug Administration (FDA) has collected more than 800 reports of serious toxicity, including more than 22 deaths. The U.S. Federal Government has banned the sale of ephedra in the United States since 2004.

Ephedra may affect blood sugar levels. Caution is advised when using medications that may also affect blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Ephedra may cause high blood pressure. Caution is advised in people taking drugs that affect blood pressure.

Use cautiously in people sensitive to stimulants or in combination with other known stimulant agents (e.g. coffee).

Use cautiously in people with kidney, thyroid, liver, or peptic ulcer disease.

Use cautiously in people with heart disease, such as structural heart disease, irregular heart rhythms, clogged arteries, high blood pressure, stroke, or in those taking agents for the heart.

Use cautiously in people with glaucoma, problems with the stomach or intestines, or seizure disorders.

Use cautiously in people with depression, anxiety disorders, anorexia/bulimia, a history of suicidal ideation, or previous use of monoamine oxidase inhibitor (MAOI) anti-depressants.

Use cautiously in people that have difficulty urinating or have an enlarged prostate.

Avoid use during major medical procedures (such as surgery), as ephedra may decrease effectiveness of anesthetics. Discontinue use at least one week prior to major surgery or other procedures.

Avoid using doses higher than suggested or using for a long duration (over seven days), due to risk of toxicity.

Avoid use in children due to risk of toxicity and death.

Avoid use during pregnancy or breastfeeding since ephedra may pass into breast milk.

Avoid in people with known allergy or sensitivity to ephedra or its parts.

Adverse effects of ephedra may include abdominal discomfort, agitation, anxiety, blindness (transient), blood clots, bloody diarrhea, brain disease, breathing difficulties, changes in liver enzymes, chest tightness, clogged arteries, confusion, constipation, contractions of the uterus, damage, damage to the heart muscle, death, delirium, depression, diarrhea, dizziness, dry mouth, dull headedness, euphoria, exaggerated reflexes, excitation, fainting, fluid build-up in the lungs, hallucinations, headache, hearing loss, heart attack, heart problems, heartburn, inability to urinate, increased thyroid hormone, increased urination, inflammation of the heart, insomnia, irregular heart rhythms, irritability, liver damage, liver inflammation, loss of appetite, loss of consciousness, low potassium levels in the blood, kidney failure, kidney stones, mania, muscle aches, muscle breakdown, nausea, obsessive-compulsive disorder (OCD), organ failure, overly active reflexes, painful urination, Parkinson's disease-like symptoms, psychosis, rapid heartbeat, restlessness, satiety, seizures, shortness of breath, skin inflammation, skin tingling, spasm in blood vessels, stomach pain, stroke, suicidal ideas, tiredness, tremor, vomiting, weakened and enlarged heart, weakness, and weight loss.

Pregnancy and Breastfeeding

Avoid in pregnant and breastfeeding women. Ephedra may cause uterine contractions or problems in babies such as crying, increased heart rate, irritability, and sleep difficulties.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration