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Psychiatric Complications of Ma-Huang (2000)

Psychiatric Complications of Ma-Huang (2000)

  1. Jatelka
    Psychosomatics 2000 Jan-Feb;41(1):58-62

    KARL M. JACOBS, M.D.
    KENNETH A. HIRSCH, M.D., PH.D.

    The use of dietary supplements containing Ma-huang, an extract of the plant species Ephedra, has caused a significant rise in adverse health consequences attributable to the sympathomimetic and central stimulant properties of ephedrine, its active ingredient.

    Ma-huang, a noncontrolled substance, has been used in traditional Chinese medicine since ancient times as a stimulant and as a remedy for asthma.1 Between 1993 and 1997, the Food and Drug Administration (FDA) received notices of 34 deaths and about 800 medical and psychiatric complications directly linked to Ma-huang.2 This trend reflects the increased use of the herbal medicines and dietary supplements. The sales of these drugs were $3.3 billion in 1990 and $6.5 billion in 1996.2 Parallel national surveys of American use of alternative medicines estimated that the use of herbal remedies increased by 380% from 1990 to 1997. In 1997, 15 million adults in the United States used herbal remedies and/or high-dose vitamins together with prescribed medications.

    Herbal or botanical preparations are widely available, relatively inexpensive, and often attractively packaged to
    appeal to adolescents and young adult consumers. These preparations can be bought at rock concerts, via the Internet, in convenience stores, sports clubs, and shopping malls. Ma-huang–containing products with names such as “Herbal Ecstasy,” “Nature’s Sunshine,” “Metabolift,” and “Ripped Fuel” promise a “natural” means to improve health, increase energy and sexual functioning, obtain a legal “high,” and to lose weight and build muscle.

    In a recent review of the literature, Crone andIn a recent review of the literature, Crone and Wise summarized the traits of alternative-medicine consumers, noting that they tend to be Caucasian, well-educated, employed, female, young-to-middle–aged, and “aware of the importance of a healthly lifestyle.” According to Kaptchuk and Eisenberg,6 alternative medicine appeals to devotees who share the belief that the “innocence” and “benevolence” of nature is preferable to biomedicine that is, in contrast, associated with sophistication and technology and is therefore artificial and synthetic. These consumers may erroneously equate “natural” with safe.
    The psychiatric complications linked to Ma-huang include psychosis and affective disturbances, akin to reactions previously observed in patients who misused asthma medications containing ephedrine. Herridge and O’Brook first described ephedrine-induced psychosis in 1968. Later reports of ephedrine-induced psychosis as well as mania occurred under three main circumstances: 1) abuse of over the counter asthma medications in otherwise psychiatrically well individuals,8 2) abuse of ephedrine for its central nervous system-stimulant properties alone,9,10 and 3) Mahuang combined with other stimulants. A recent case report described Ma-huang in a food supplement for weight loss that induced psychosis