Orthostatic Hypotension : Supplements

On February 6 th 2004 The Food and Drug Administration (FDA) issued a final rule prohibiting the sale of dietary supplements containing ephedrine alkaloids (ephedra) because such supplements present an unreasonable risk of illness or injury. The rule became effective 60 days from the date of publication. In April of 2005, a Utah Judge competed with this rule. It remains unclear whether ephedra will find its way back onto shelves, despite widespread acknowledgement of significant safety risks, including serious potential cardiovascular events or death . Ephedra sinica , a species of ephedra (ma huang), contains the alkaloids ephedrine and pseudoephedrine, which have been found to induce central nervous system stimulation, bronchodilation, and vasoconstriction. In combination with caffeine, ephedrine appears to elicit weight loss (in trials of 1-12 months duration). However, studies of ephedra or ephedrine monotherapy have been equivocal. Numerous trials have documented the efficacy of ephedrine in the management of asthmatic bronchoconstriction and hypotension. However, commercial preparations of non-prescription supplements containing ephedra have not been systematically studied for these indications. Major safety concerns have been associated with ephedra or ephedrine use, including hypertension, tachycardia, CNS excitation, arrhythmia, myocardial infarction, and stroke. Despite widely publicized safety concerns and the highly publicized 2003 death of a U.S. major league baseball pitcher thought to be related to ephedra, prior to the ban on ephedra, 14% of individuals using non-prescription weight-loss products in the U.S. continued to take ephedra or ephedrine-containing products.

Ephedra, also known as Ma Huang, is an herb utilized by Chinese medicine for more than 2,500 years due to its ability to remedy symptoms of asthma and upper respiratory infections . A member of the Ephedracae family of herbs ( Ephedra sinica ), ephedra is native to northern China and Inner Mongolia where it thrives in desert areas as a jointed, barkless plant with branches that bear few leaves and tiny yellow-green flowers that bloom in summer. While varieties of ephedra grow throughout the world, the United States version flourishes in the dry southwest. Ephedra became popular to Mormon settlers in the early 1800s as a stimulant consumed in the form of tea in place of the coffee and black tea from which they abstained, giving the plant one of its many names, Mormon Tea. Other folk names that have resulted over time include Desert Tea, Desert Herb, and Squaw Tea. The herbal drink was named Whorehouse Tea after it was served in brothels during the 1800s due to unproven beliefs that it cured gonorrhea and syphilis . The medicinal herb Ma Huang is made of the dried, young branchlets of ephedra. Harvested in the autumn, ephedra is reproduced from seed or by root division and the stems are dried in the sun throughout the year for production. The herb should be stored away from light. Ephedra gains its strength primarily from the alkaloid ephedrine, pseudephedrine, and norpseudephedrine. These active ingredients produce central nervous system stimulation. Other key components of ephedra include: tannin, an acidic substance found in the bark saponin, originating in the roots flavone, the chemical from which natural colors of many plants originate volatile oil