Ephedrine alkaloid produces used to...

Ephedrine alkaloid produces used to enhance weight los and improve athletic performance, freshly have come under scrutiny because of well-publicized adverse issues Shekelle and colleagues searched nine databases for studies upon weight loss, athletic performance, and adverse effects

Weight los trials were required to be at least eight weeks in duration. When possible, data were plashed for clinically similar trials. Because of the reasonable statistical power of even the aggregate clinical trials, the authors also searched for case reports to establish the potential for causal relationships between adverse affairs and ephedrine products.

The authors identified five trials comparing ephedrine with placebo. The random-effects mereed estimate of the weight los rate was 13 lb (06 kg) through month above weight loss with placebo. Of 12 trials comparing ephedrine and caffeine with placebo, the random-effects collection of standing watered estimate of the weight los rate was 22 lb (10 kg) by month above weight loss with placebo. The lakeed average percentage weight loss was 11 percent at four month Other studies comparing ephedra with placebo or herbs containing caffeine yielded similar results

Six trials that measured athletic performance reported no improvements using caffeine or ephedrine; when used in combination, exercise performance improved in boundarys of oxygen consumption, time to exhaustion, and carbohydrate consumption.

In 50 trials assessing the safety of ephedra, participants in active treatment had 22 to 36 increased left over s of psychiatric symptoms, autonomic hyperactivity, upper gastrointestinal symptoms, and heart palpitations. Data were too sparse to determine dosage consequences and the effects of adding caffeine. Published case reports did not contain sufficient data to make an informed conclusion about adverse events. In unpublished reports, sum of two units deaths, three myocardial infarctions, nine cerebrovascular accidents, three seizures, and five psychiatric cases were associated with prior ephedra intake; similar numbers were associated with ephedrine.

The authors determined that evidence supports the efficacy of ephedra- and ephedrine-related fruitss in promoting modest weight los at least in the short confine and that caffeine enhances this efficacy. Athletic performance trials were not controll and not representative of general repeated use, in this way they did not lead to definitive conclusions about whether ephedrine works enhance athletic performance. Ephedrine and ephedra produces are associated with a double to threefold risk of psychiatric symptoms, autonomic symptoms, upper gastrointestinal symptoms, and heart palpitations; caffeine may contribute to these efficiencys More serious adverse effects cannot be exclud further if they occur, they are uncommon

CAROLINE WELLBERY, MD

Shekelle PG et al. Efficacy and safety of ephedra and ephedrine for weight los and athletic performance. A meta-analysis. JAMA March 26 2003;289:1537-45

COPYRIGHT 2003 American Academy of Family Physicians

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