Ephedrine and Pseudoephedrine

Also indexed as: Novafed®, Pretz-D®, Sudafed®, Vick's Vatronol®

Combination drugs: Alka-Seltzer Plus®, Allegra®-D, Chlor-Trimeton® 12 Hour, Claritin®-D, Nyquil®, Nyquil® Hot Therapy Powder, Primatene® Dual Action, Theraflu®, Tylenol® Allergy Sinus, Tylenol® Cold, Tylenol® Flu NightTime Maximum Strength Powder, Tylenol® Multi-Symptom Hot Medication, Tylenol® Sinus

Ephedrine and pseudoephedrine are closely related drugs with actions and side effects similar to the hormone epinephrine (adrenaline). Ephedrine, available in prescription and nonprescription strengths, is sometimes used to dilate bronchi, making it easier for people with asthma to breathe. Nonprescription ephedrine nose drops and spray are used to relieve nasal congestion due to the flu or hay fever. Pseudoephedrine, a nonprescription drug taken by mouth, can also be used to relieve this symptom.

Summary of Interactions with Vitamins, Herbs, and Foods
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.

Coleus*
Avoid Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.

Tannin-containing herbs* such as green tea, black tea, uva ursi, black walnut, red raspberry, oak, and witch hazel
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Caffeine

Ephedra
Check Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.

Vitamin C
Depletion or interference

None known
Side effect reduction/prevention

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Herbs

Ephedra sinica (Ma huang)
Ephedra is the plant from which ephedrine was originally isolated. Ephedra—also called ma huang—is used in many herbal products, including supplements promoted for weight loss. To prevent potentially serious interactions, people taking ephedrine or pseudoephedrine should avoid using ephedra-containing drug products and should read product labels carefully for ma huang or ephedra content. Native North American ephedra, sometimes called Mormon tea, contains no ephedrine.

Coleus
A test tube study demonstrated that the bronchodilating effects of salbutamol, a drug with similar actions in the lung to ephedrine, were significantly increased by the addition of forskolin, the active component of the herb Coleus forskohlii.1 The results of this preliminary research suggest that the combination of forskolin and beta-agonists (like ephedrine) might provide an alternative to raising the doses of the beta-agonist drugs as they lose effectiveness. Until more is known, coleus should not be combined with ephedrine without the supervision of a doctor.

Tannin-containing herbs
Tannins are a group of unrelated chemicals that give plants an astringent taste. Herbs containing high amounts of tannins may interfere with the absorption of ephedrine or pseudoephedrine taken by mouth.2 Herbs containing high levels of tannins include green tea, black tea, uva ursi (Arctostaphylos uva-ursi), black walnut (Juglans nigra),red raspberry (Rubus idaeus),oak (Quercus spp.), and witch hazel (Hamamelis virginiana).

Interactions with Foods and Other Compounds

Food
Foods that acidify the urine may increase the elimination of ephedrine from the body, potentially reducing the action of the drug.3 Urine-acidifying foods include eggs, peanuts, meat, chicken, vitamin C (greater than 5 grams per day), wheat-containing foods, and others.

Foods that alkalinize the urine may slow the elimination of ephedrine from the body, potentially increasing the actions and side effects of the drug.4 Urine-alkalinizing foods include dairy products, nuts, vegetables (except corn and lentils), most fruits, and others.

Caffeine
Caffeine, which is found in coffee, tea, chocolate, guaraná (Paullinia cupana), and some nonprescription and supplement products, can amplify the side effects of ephedrine and pseudoephedrine. People should avoid combination products containing ephedrine/pseudoephedrine/ephedra and caffeine.

References

1. Yousif MH, Thulesius O. Forskolin reverses tachyphylaxis to the bronchodilator effects of salbutamol: an in-vitro study on isolated guinea-pig trachea. J Pharm Pharmacol 1999;51:181–6.

2. Brinker F. Interactions of pharmaceutical and botanical medicines. J Naturopathic Med 1997;7(2):14–20.

3. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 105.

4. Holt GA. Food & Drug Interactions. Chicago: Precept Press,1998, 105–6.