Q&A

Ephedra and ephedrine: Modest short-term weight loss, with a price

J Fam Pract. 2003 July;52(7):512-525
By
Cari Worley, MD
Erik Lindbloom, MD, MSPH
Author and Disclosure Information

  • BACKGROUND: The US Department of Health and Human Services requested an analysis of the past studies of products containing ephedrine and ephedra after the recent deaths of several high-profile athletes attributed to these products. Most trials have been small, but several were similar enough to combine into a meta-analysis.
  • POPULATION STUDIED: The researchers analyzed controlled trials of products containing ephedrine and ephedra; the trials assessed weight loss over 8 weeks or measures of athletic performance. Published and unpublished studies were included. Due to the small number of athletic performance trials identified (n=7) and the heterogeneity of outcomes, the authors reviewed these studies individually.
  • STUDY DESIGN AND VALIDITY: This was an extremely thorough meta-analysis, with several reviewers searching 9 databases and identifying unpublished evidence. The authors also tried to account for publication bias and the variable quality of the included articles.
  • OUTCOMES MEASURED: The primary outcome measures were monthly weight loss, various measures of athletic performance, and any adverse event. Aside from the serious adverse events listed above, other events were grouped into psychiatric symptoms, autonomic hyperactivity symptoms (such as tremor, insomnia, and sweating), upper gastrointestinal symptoms, palpitations, tachycardia, hypertension, and headache.
  • RESULTS: Fifty-two trials with 1706 patients were identified. Trials that assessed weight loss showed that ephedrine promoted weight loss of 0.6 kg/mo compared with placebo (95% confidence interval, 0.2–1.0) with a pooled average weight loss of 11% at 4 months. However, when only studies of moderate or high quality were included, this estimate decreased to 0.2 kg/mo.
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PRACTICE RECOMMENDATIONS

Products containing ephedrine and ephedra promote a 0.6–1.0 kg/mo weight loss over 2 to 6 months. However, the impact of these products on long-term weight loss or athletic performance is uncertain. Their use is associated with a 2- to 3-fold higher rate of psychiatric symptoms, autonomic hyperactivity, upper gastrointestinal symptoms, and heart palpitations. Several serious adverse events—such as death, myocardial infarction, and stroke—have been reported, with a rate estimated at <0.1%.

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