Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-analysis
Open accessAbstract
Context: Ephedra and ephedrine sometimes are used for weight loss or enhanced athletic performance, but the efficacy and safety of these compounds are uncertain. Objective: To assess the efficacy and safety of ephedra and ephedrine used for weight loss and enhanced athletic performance. Data Sources: We searched 9 databases using the terms ephedra , ephedrine , adverse effect , side effect , efficacy , effective , and toxic . We included unpublished trials and non–English-language documents. Adverse events reported to the US Food and Drug Administration MedWatch program were assessed. Study Selection: Eligible studies were controlled trials of ephedra or ephedrine used for weight loss or athletic performance and case reports of adverse events associated with such use. Eligible studies for weight loss were human studies with at least 8 weeks of follow-up; and for athletic performance, those having no minimum follow-up. Eligible case reports documented that ephedra or ephedrine was consumed within 24 hours prior to an adverse event or that ephedrine or an associated product was found in blood or urine, and that other potential causes had been excluded. Of the 530 articles screened, 52 controlled trials and 65 case reports were included in the adverse events analysis. Of more than 18 000 other case reports screened, 284 underwent detailed review. Data Extraction: Two reviewers independently identified trials of efficacy and safety of ephedra and ephedrine on weight loss or athletic performance; disagreements were resolved by consensus. Case reports were reviewed with explicit and implicit methods. Data Synthesis: No weight loss trials assessed duration of treatment greater than 6 months. Pooled results for trials comparing placebo with ephedrine (n = 5), ephedrine and caffeine (n = 12), ephedra (n = 1), and ephedra and herbs containing caffeine (n = 4) yielded estimates of weight loss (more than placebo) of 0.6 (95% confidence interval, 0.2-1.0), 1.0 (0.7-1.3), 0.8 (0.4-1.2), and 1.0 (0.6-1.3) kg/mo, respectively. Sensitivity analyses did not substantially alter the latter 3 results. No trials of ephedra and athletic performance were found; 7 trials of ephedrine were too heterogeneous to synthesize. Safety data from 50 trials yielded estimates of 2.2- to 3.6-fold increases in odds of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations. Data are insufficient to draw conclusions about adverse events occurring at a rate less than 1.0 per thousand. The majority of case reports are insufficiently documented to allow meaningful assessment. Conclusions: Ephedrine and ephedra promote modest short-term weight loss (≈0.9 kg/mo more than placebo) in clinical trials. There are no data regarding long-term weight loss, and evidence to support use of ephedra for athletic performance is insufficient. Use of ephedra or ephedrine and caffeine is associated with increased risk of psychiatric, autonomic, or gastrointestinal symptoms, and heart palpitations.
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Ephedrine is associated with increased risk of psychiatric, autonomic, gastrointestinal, and cardiovascular symptoms.
“Unfortunately, ephedrine is associated with increased risk of psychiatric, autonomic, gastrointestinal, and cardiovascular symptoms 134, which likely will preclude the use of ephedrine itself for the treatment of obesity.”
From Cellular bioenergetics as a target for obesity therapy (2010) · cites this paper as [134]
A meta-analysis of several dozen trials showed that ephedrine promotes modest short-term weight loss, but there are no data on longer-term efficacy.
“A meta-analysis of several dozen trials showed that ephedrine promotes modest short-term weight loss, but there are no data on longer-term efficacy 134.”
From Cellular bioenergetics as a target for obesity therapy (2010) · cites this paper as [134]
Ephedrine itself likely will be precluded for the treatment of obesity.
“Unfortunately, ephedrine is associated with increased risk of psychiatric, autonomic, gastrointestinal, and cardiovascular symptoms 134, which likely will preclude the use of ephedrine itself for the treatment of obesity.”
From Cellular bioenergetics as a target for obesity therapy (2010) · cites this paper as [134]
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- Authors
- Shekelle, P. G., Hardy, M. L., Morton, S. C., Maglione, M., Mojica, W. A., Suttorp, M. J., Rhodes, S. L., Jungvig, L., & Gagné, J.
- Affiliations
- RAND Corporation (US)
- Cedars-Sinai Medical Center (US)
- University of Southern California (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2003-03-26
- Volume
- 289
- Issue
- 12
- Pages
- 1537
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1999289755
- Cited by
- 511
- References
- 43
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 10 · 2023: 11 · 2022: 15 · 2021: 15 · 2020: 9 · 2019: 15 · 2018: 16 · 2017: 16 · 2016: 19 · 2015: 21 · 2014: 20 · 2013: 17 · 2012: 23
- FWCI
- 5.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- VTechWorks (Virginia Tech) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Health Services Research and Development
- U.S. Public Health Service (290-97-0001)
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Social Sciences › Sociology and Political Science › Doping in Sports
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Pharmacological Effects and Assays
- Keywords
- Ephedra, ephedrine, weight loss, athletic performance, stimulants, caffeine, adverse events, drug safety, efficacy, herbal supplements, performance-enhancing drugs
- MeSH terms
- Caffeine, Ephedrine, Humans, Physical Endurance, Risk, Sports, Weight Loss, Randomized Controlled Trials as Topic, Controlled Clinical Trials as Topic, Anti-Obesity Agents, Dietary Supplements, Plant Preparations, Ephedra
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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