CoChat
Sign Up
Cited by 956Complementary and Alternative Medicine StudiesPharmacology and Obesity TreatmentPharmacovigilance and Adverse Drug Reactions

Adverse Cardiovascular and Central Nervous System Events Associated with Dietary Supplements Containing Ephedra Alkaloids

Open access
Haller, Christine A., Benowitz, Neal L.·2000·New England Journal of Medicine
DOI 10.1056/nejm200012213432502
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Dietary supplements that contain ephedra alkaloids (sometimes called ma huang) are widely promoted and used in the United States as a means of losing weight and increasing energy. In the light of recently reported adverse events related to use of these products, the Food and Drug Administration (FDA) has proposed limits on the dose and duration of use of such supplements. The FDA requested an independent review of reports of adverse events related to the use of supplements that contained ephedra alkaloids to assess causation and to estimate the level of risk the use of these supplements poses to consumers. METHODS: We reviewed 140 reports of adverse events related to the use of dietary supplements containing ephedra alkaloids that were submitted to the FDA between June 1, 1997, and March 31, 1999. A standardized rating system for assessing causation was applied to each adverse event. RESULTS: Thirty-one percent of cases were considered to be definitely or probably related to the use of supplements containing ephedra alkaloids, and 31 percent were deemed to be possibly related. Among the adverse events that were deemed definitely, probably, or possibly related to the use of supplements containing ephedra alkaloids, 47 percent involved cardiovascular symptoms and 18 percent involved the central nervous system. Hypertension was the single most frequent adverse effect (17 reports), followed by palpitations, tachycardia, or both (13); stroke (10); and seizures (7). Ten events resulted in death, and 13 events produced permanent disability, representing 26 percent of the definite, probable, and possible cases. CONCLUSIONS: The use of dietary supplements that contain ephedra alkaloids may pose a health risk to some persons. These findings indicate the need for a better understanding of individual susceptibility to the adverse effects of such dietary supplements.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1056/nejm200012213432502

Cites

22 of 22 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Herbal and other substances including alcohol, ma-huang, ginseng at high doses, liquorice, St. John's wort, and yohimbine may affect blood pressure.

    “Alcohol, ma-huang, ginseng at high doses, liquorice, St. John's wort, yohimbine”

    From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [44]

    The Discussion links ephedrine, the alkaloid in ma-huang, to severe hypertension and describes a mechanism by which it can raise blood pressure; Table 4 also records hypertension in users of ephedra-containing supplements. The paper does not establish blood-pressure effects for high-dose ginseng, liquorice, St. John’s wort, or yohimbine. It records alcohol as a concurrent exposure in one case, not as an independent cause of a blood-pressure change. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. [1]1. Adverse events associated with ephedrine-containing products -Texas, December 1993-September 1995. JAMA 1996;276:1711-2.
  2. [10]10. Costello JF, May CS, Paterson JW, Pickup ME. Pharmacokinetics of ephedrine in asthmatics receiving acute and chronic treatment. Br J Clin Pharmacol 1975;2:180-1. abstract.
  3. [12]12. To LB, Sangster JF, Rampling D, Cammens I. Ephedrine-induced car- diomyopathy. Med J Aust 1980;2:35-6.

Cited by

Sorted by citations

Related

Authors
Haller, C. A., & Benowitz, N. L.
Affiliations
University of California, San Francisco (US)
ORCID
Haller, Christine A.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2000-12-21
Volume
343
Issue
25
Pages
1833-1838
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm200012213432502
OpenAlex
W2319416888
Cited by
956
References
22
Citations by year
2026: 11 · 2025: 16 · 2024: 22 · 2023: 17 · 2022: 15 · 2021: 24 · 2020: 25 · 2019: 21 · 2018: 24 · 2017: 33 · 2016: 34 · 2015: 31 · 2014: 31 · 2013: 25 · 2012: 44
FWCI
132.11
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute on Drug Abuse (DA02277, DA 12393, P30DA012393)
  • National Institute of General Medical Sciences (T32GM007546)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
ephedrine alkaloids, dietary supplements, Ma Huang, adverse events, cardiovascular adverse events, central nervous system adverse effects, hypertension, stroke, seizures, palpitations, causality assessment, supplement safety, weight loss supplements
MeSH terms
Adolescent, Adult, Arrhythmias, Cardiac, Cardiovascular Diseases, Drugs, Chinese Herbal, Ephedrine, Female, Humans, Hypertension, Male, Middle Aged, Seizures, United States, United States Food and Drug Administration, Adverse Drug Reaction Reporting Systems, Fatal Outcome, Dietary Supplements, Intracranial Hemorrhages, Plant Preparations, Ephedra, Ephedra sinica

About these checks

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.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review