Ephedrine Pharmacokinetics After the Ingestion of Nutritional Supplements Containing Ephedra sinica (ma huang)

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Abstract
Nutritional supplements containing Ephedra sinica (ma huang), a botanical source of ephedrine alkaloids, have been linked to several episodes of ephedrine toxicity and at least 17 deaths, yet these products remain unregulated. Ten subjects were enrolled in a randomized, crossover study aimed at characterizing the pharmacokinetics of ephedrine after the ingestion of three commercially available ma huang products compared with a 25-mg ephedrine capsule. Pharmacokinetic parameters for botanical ephedrine were similar to those for synthetic ephedrine hydrochloride. Gender-based comparisons of V ss/F and CL/F revealed higher values for women than for men (V ss/F, 3.49 ± 1.04 vs 2.98 ± 0.73 1/kg; CL/F, 0.48 ± 0.11 vs 0.37 ± 0.11 1/hour·kg). The current study suggests that the increased incidence of ma huang toxicity does not stem from differences in the absorption of botanical ephedrine compared with synthetic ephedrine; rather, it results from accidental overdose often prompted by exaggerated off-label claims and a belief that"natural" medicinal agents are inherently safe.