Physicians routinely used intravenous ephedrine for the prophylaxis and treatment of hypotension caused by spinal anesthesia particularly during cae-sarean section (9). In the past, ephedrine was used to treat Stokes-Adams attacks (complete heart block), and was also recommended as a treatment for narcolepsy. Over the years, ephedrine has been replaced by other, more effective agents (10), and the advent of highly selective ^-agonists has mostly eliminated the need to use ephedrine in treating asthma.
European medical researchers have, for several years, used ephedrine to help promote weight loss, at least in the morbidly obese (11,12), and nutritional supplements containing naturally occurring ephedra alkaloids are sold in the United States for the same purpose. Clinical trials confirm that, taken as directed, use of these supplements does result in weight loss, though whether such losses are sustained has not been determined (13,14,15).
Prior to its banning by the Food and Drug Administration (FDA) in 2004, ephedra was found in many "food supplements," used by bodybuilders. Generally, it was compounded with other ingredients such as vitamins, minerals, and amino acids in products, which are said to increase muscle mass and enhance endurance (16). Performance improvement secondary to ephedrine ingestion has been established in a controlled clinical trials (17,18,19), and use of ephedrine has been prohibited by the International Olympic Committee.
Ephedra was also sold in combination with many other herbs in obscure combinations. Labels frequently listed 10 or 15 different herbs, but, analysis usually disclosed only the ephedra alkaloids and caffeine as present in sufficient quantities to be physiologically active. After several well-publicized accidental deaths, products clearly intended for abuse, such as "herbal ecstasy," and other "look-alike drugs" (products usually containing ephedrine or phenyl-propanolamine designed to look like illicit methamphetamine, but in concentrations higher than recommended by industry or the FDA) were withdrawn from the market. Labels on these products were frequently misleading. For example, one might suppose that a product called "Ephedrine 60™" contained 60 mg of ephedrine when, in fact, the actual ephedrine content was 25 mg.
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