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Ephedrine

(1R 2S) 1 Phenyl 1 Hydroxy 2 Methylaminopropane


Presentation

  • A 36-year-old man presented to the emergency department acutely unwell after being found collapsed while running a halfmarathon. He presented with a reduced Glasgow coma score, was tachycardic, agitated, hypoxic and profusely sweating.[ncbi.nlm.nih.gov]
  • Author information 1 Laboratory of Toxicology, Research Institute for Veterinary Science and College of Veterinary Medicine, Seoul National University, Korea. 2 Present address: New Drug Development Center, Daegu-Gyeongbuk Medical Innovation Foundation[ncbi.nlm.nih.gov]
  • A 22-year-old woman ingesting an ephedrine- and caffeine-containing product for 2 days presented with multiple symptoms, including palpitations, nausea, tremulousness, abdominal pain, and vomiting.[ncbi.nlm.nih.gov]
  • A 22‐year‐old woman ingesting an ephedrine‐ and caffeine‐containing product for 2 days presented with multiple symptoms, including palpitations, nausea, tremulousness, abdominal pain, and vomiting.[doi.org]
  • We present 3 case studies of consecutive patients who presented with hypothalamic obesity and were treated with caffeine (200 mg) and ephedrine hydrochloride (25 mg) 3 times a day. All patients were gaining weight at the time of initial assessment.[ncbi.nlm.nih.gov]
Asymptomatic
  • Ten months after the event, the patient was entirely asymptomatic and showed further improvement of her ejection fraction to 0.45.[ncbi.nlm.nih.gov]
  • These events have occurred in asymptomatic, otherwise healthy young adults with normal coronary or cerebral blood vessels (Ref. 25), a finding also noted with pharmaceutical preparations of ephedrine alkaloids (Refs. 60, 61, and 65), where vasospasm with[web.archive.org]
  • J., Cost-Effectiveness of Screening for Asymptomatic Carotid Atherosclerotic Disease,'' Stroke, vol. 27, pp. 1944-1950, 1996. 144.[web.archive.org]
Intravenous Administration
  • PEA and higenamine exposure levels simulated published blood levels in humans or animals after intravenous administration. Ephedrine and caffeine levels approximated published blood levels following human oral intake.[ncbi.nlm.nih.gov]
  • Gastrointestinal decontamination may be indicated There is no antidote. 10.2 Life supportive procedures and symptomatic/specific treatment Severe hypertension and tachycardia should be treated with the intravenous administration of a short-acting, selective[inchem.org]
Rigor
  • This study uses ARIMA-intervention time-series analysis to more rigorously evaluate the regulations' impacts on laboratory seizures.[ncbi.nlm.nih.gov]
  • Abstracts are not subject to the same rigorous peer review that full manuscripts go through.[web.archive.org]
Pallor
  • Cardiovascular: Arrhythmias, chest pain, elevation or depression of blood pressure, hypertension, palpitation, tachycardia, unusual pallor Central nervous system: Agitation, anxiety, apprehension, CNS stimulating effects, dizziness, excitation, fear,[web.archive.org]
Relapsing Polychondritis
  • A case of relapsing polychondritis of the larynx and upper trachea is presented.[ncbi.nlm.nih.gov]
Nausea
  • Nausea Level on a Scale of 0-3, Where 0 no Nausea, 1 Mild Nausea, 2 Moderate Nausea, and 3 Severe Nausea. [ Time Frame: intra-operation ] Subjects were asked to rate their nausea level on a scale of 0-3, where 0 no nausea, 1 mild nausea, 2 moderate nausea[clinicaltrials.gov]
  • Anesthesia and Critical Care Concerns/Other Considerations Clinical Pearls/Comments: May administer I.M. (0.5 mg/kg) to treat postoperative nausea nad vomiting in adults who failed traditional antiemetic therapy (Gan, 2003).[web.archive.org]
  • The following case report describes the benefits of using ephedrine to mitigate postoperative nausea and vomiting and associated dizziness while waiting for longer lasting therapy to take effect and/or use as a secondary agent.[ncbi.nlm.nih.gov]
  • Reported adverse events ranged in severity from tremor and headache to death in eight ephedrine users and included reports of stroke, myocardial infarction, chest pain, seizures, insomnia, nausea and vomiting, fatigue, and dizziness.[ncbi.nlm.nih.gov]
  • A 22-year-old woman ingesting an ephedrine- and caffeine-containing product for 2 days presented with multiple symptoms, including palpitations, nausea, tremulousness, abdominal pain, and vomiting.[ncbi.nlm.nih.gov]
Regurgitation
  • Troponins at presentation and the following morning were negative, and an echocardiogram showed only trace tricuspid regurgitation. A serum ephedrine level, drawn approximately 6 to 7 hr after ingestion, was 150 ng/mL.[ncbi.nlm.nih.gov]
Hypertension
  • Ephedra containing products (ECPs), which most often contain additional sources of caffeine alkaloids, may be an under-recognized cause of hypertension.[ncbi.nlm.nih.gov]
  • : May cause hypertension. • Psychiatric disorders: Long-term use may cause anxiety and symptoms of paranoid schizophrenia.[web.archive.org]
  • She developed intracranial hypertension and focal cerebral deficits related to multiple haemorrhagic cerebral infarcts associated with a reversible beading appearance on angiography consistent with the diagnosis of acute cerebral arteritis.[ncbi.nlm.nih.gov]
  • Antidepressants: Ephedrine should not be given to patients who are being treated with monoamine oxidase inhibitors as they may cause hypertensive crisis with marked headache, severe hypertension and subarachnoid haemorrhage.[medicines.org.uk]
  • The most serious side effects are those on cardiovascular function, including acute myocardial infarction, severe hypertension, myocarditis and lethal cardiac arrhythmias. A 19-year-old woman was taking ephedrine to enhance her sports performance.[ncbi.nlm.nih.gov]
Tachycardia
  • The proarrhythmic effect most likely occurred because of underlying idiopathic left ventricular tachycardia.[ncbi.nlm.nih.gov]
  • More patients receiving ephedrine (24.5%) developed tachycardia than those receiving phenylephrine (3.8%) (P 0.004).[ncbi.nlm.nih.gov]
  • The patient developed sub-sternal chest pain, was noted to have 10 beats of non-sustained ventricular tachycardia, ST abnormalities were observed on her ECG and cardiac enzymes were elevated.[ncbi.nlm.nih.gov]
  • The use of this psychoactive substance can have acute health implications such as tachycardia, arrhythmias and cardiovascular disease.[ncbi.nlm.nih.gov]
Blurred Vision
  • You may experience dizziness, blurred vision, restlessness (use caution when driving or engaging in tasks requiring alertness until response to drug is known); or difficulty urinating (empty bladder immediately before taking this medication).[web.archive.org]
  • In acute poisoning the following signs and symptoms may occur: nausea, vomiting, chills, cyanosis, irritability, nervousness, fever, suicidal behavior, tachycardia, dilated pupils, blurred vision, opisthotonos, spasms, convulsions, pulmonary edema, gasping[rxlist.com]
Stroke
  • Several sympathomimetic agents have been associated with ischemic and hemorrhagic stroke.[ncbi.nlm.nih.gov]
  • After induction, patient receiving ephedrine had higher mean arterial pressure, systemic vascular resistance (SVRI), cardiac (CI), stroke volume (SVI), and left ventricular stroke work (LVSWI) indices.[ncbi.nlm.nih.gov]
  • We report a first case of stroke associated with the parenteral use of ephedrine. A 44-year-old woman underwent spinal anaesthesia for varicose vein surgery. She was usually treated with propranolol and occasionally with phenoxazoline.[ncbi.nlm.nih.gov]
  • Reported adverse events ranged in severity from tremor and headache to death in eight ephedrine users and included reports of stroke, myocardial infarction, chest pain, seizures, insomnia, nausea and vomiting, fatigue, and dizziness.[ncbi.nlm.nih.gov]
  • Many of these signs and symptoms occurred in young adults who generally would not have been expected to be at high risk for such conditions (e.g., heart attack and stroke).[web.archive.org]
Headache
  • Reported adverse events ranged in severity from tremor and headache to death in eight ephedrine users and included reports of stroke, myocardial infarction, chest pain, seizures, insomnia, nausea and vomiting, fatigue, and dizziness.[ncbi.nlm.nih.gov]
  • Common side effects include palpitations, nervousness, and headache. More severe adverse reactions include cardiomyopathy and vasospasm.[ncbi.nlm.nih.gov]
  • Ephedrine Professional Information SIDE EFFECTS With large doses of ephedrine sulfate most patients will experience nervousness, insomnia, vertigo, headache, tachycardia, palpitation and sweating. Some patients have nausea, vomiting and anorexia.[rxlist.com]
  • Some withdrawal symptoms may be less severe than others, but all will be unpleasant to the user; such as, headache, nausea, vomiting, irritability, uncontrollable shaking, irregular heartbeat, paranoia, and depression.[thecabinchiangmai.com]
  • […] vasoconstriction with hypertension, flushing, sweating, acne vulgaris, nausea, decreased urination, difficulty urinating, restlessness, confusion, insomnia, mild euphoria, mania/hallucinations, delusions, formication, dyspnea, pulmonary edema, dizziness, headache[drugs.tripsit.me]
Tremor
  • Reported adverse events ranged in severity from tremor and headache to death in eight ephedrine users and included reports of stroke, myocardial infarction, chest pain, seizures, insomnia, nausea and vomiting, fatigue, and dizziness.[ncbi.nlm.nih.gov]
  • Adverse events were mild and included palpitations, tremor and restlessness. Although all ECGs were normal, ephedrine prolonged the corrected QT interval.[ncbi.nlm.nih.gov]
  • Ephedrine Side Effects Be sure to tell your doctor if you are using ephedrine and watch for any of these side effects: • Inability to sleep • Nervousness • Anxiety • Lack of appetite • Nausea • Rapid heat beat and increased blood pressure • Shaking or tremors[livestrong.com]
  • Malchow-Moller et al found "Elsinore pills" containing ephedrine and caffeine, to cause complaints of "exaltation, tremor and insomnia", leading to their withdrawal for obesity treatment.[idmu.co.uk]
  • Report excessive nervousness or excitation, inability to sleep, facial flushing, pounding heartbeat, muscle tremors or weakness, chest pain or palpitations, bronchial irritation or coughing, or increased sweating.[web.archive.org]
Agitation
  • He presented with a reduced Glasgow coma score, was tachycardic, agitated, hypoxic and profusely sweating. He had taken a 'supplement' given to him prior to the race by a friend, as he was concerned about not finishing.[ncbi.nlm.nih.gov]
  • Cardiovascular: Arrhythmias, chest pain, elevation or depression of blood pressure, hypertension, palpitation, tachycardia, unusual pallor Central nervous system: Agitation, anxiety, apprehension, CNS stimulating effects, dizziness, excitation, fear,[web.archive.org]
  • I was obsessed with nutrition, my body image, easily agitated, sometimes depressed. I finally stopped taking it two months ago at the end of my degree.[nationaleatingdisorders.org]
  • She presented to the ED two hours post ingestion, with a HR of 116, BP 146-60 mmHg, she was agitated and anxious, with tremor and vomiting. Treatment included gastric lavage, activated charcoal, and 1 mg propranolol.[inchem.org]
  • These are the most frequently seen side effects of ephedrine: Heart issues such as hypertension Sweating/flushing Stomach problems including nausea Difficulty urinating Insomnia, confusion, agitation, restlessness Dry mouth, headache, dizziness Forums[evolutionary.org]
Excitement
  • Report excessive nervousness or excitation, inability to sleep, facial flushing, pounding heartbeat, muscle tremors or weakness, chest pain or palpitations, bronchial irritation or coughing, or increased sweating.[web.archive.org]
  • Adverse reactions CNS: insomnia, nervousness, dizziness, headache, euphoria, confusion, delirium, nervousness and excitation with nasal solution.[glowm.com]
  • Its stimulating effect is often overpowering and can cause a great deal of excitement. It can also trigger temporary psychosis, a condition many thrill seekers may crave.[drugrehab.org]
  • (Comment 22) Several comments focused on the known pharmacological and toxicological effects of ephedrine/ephedra on the cardiovascular and nervous systems, explaining that ephedra contains vasopressor amines that excite the heart and constrict the blood[web.archive.org]

Workup

Prolongation of Corrected QT Interval
  • Although all ECGs were normal, ephedrine prolonged the corrected QT interval. Ephedrine as add-on treatment for myasthenia gravis resulted in a small but consistent reduction of symptoms and weakness in patients with moderate disease severity.[ncbi.nlm.nih.gov]
T Wave Inversion
  • The amplitude of her T wave inversions notably diminished with therapy; however, they did not completely resolve. Troponins at presentation and the following morning were negative, and an echocardiogram showed only trace tricuspid regurgitation.[ncbi.nlm.nih.gov]
Normal Electrocardiogram
  • The patient population enrolled in these studies were not only clinically stable (i.e. normal electrocardiogram, blood pressure, and pulse) but also had no apparent history of adverse events related to treatment with other stimulant bronchodilators used[web.archive.org]

Treatment

  • CONCLUSIONS: Associated with changes in CO, decreased after phenylephrine treatment, but remained unchanged after ephedrine treatment.[ncbi.nlm.nih.gov]
  • We studied the effect and safety of ephedrine as add-on treatment for patients with myasthenia gravis with acetylcholine receptor antibodies (AChR MG), who do not sufficiently respond to standard treatment.[ncbi.nlm.nih.gov]
  • Median age at treatment was 12 years (range 5-15 years). Two children had spina bifida occulta. There were no other co-morbidities.[ncbi.nlm.nih.gov]
  • Treatment with the atypical antipsychotic drug clozapine appears to be associated with an increased incidence of urinary incontinence (UI).[ncbi.nlm.nih.gov]
  • Here we aimed to determine whether adaptive thermogenesis can be induced via chronic treatment with ephedrine.[ncbi.nlm.nih.gov]

Prognosis

  • Although fatalities have been reported the prognosis is usually good (Burkhart, 1992; Snook et al., 1992; MMWR, 1996; Backer et al., 1997; Theoharides, 1997; Hedetoft et al., 1999). 9.4 Systematic description of clinical effects 9.4.1 Cardiovascular The[inchem.org]
  • AG Dulloo, Division of Physiology, Department of Medicine, University of Fribourg, Chemin du Musée 5, CH-1700 Fribourg, Switzerland Every year millions of individuals diet to lose weight, but the long-term prognosis of such treatment is poor since, to[nature.com]
  • By AG Dulloo Division of Physiology, Department of Medicine, University of Fribourg, Chemin du Musée 5, CH-1700 Fribourg, Switzerland Every year millions of individuals diet to lose weight, but the long-term prognosis of such treatment is poor since,[nature.com]

Etiology

  • Graft factors and preoperative and intraoperative recipient factors did not differ between the 2 groups, except the prevalence of diabetes mellitus and etiology of liver disease.[ncbi.nlm.nih.gov]
  • A nesthesiology 2001; 95: 307–13Ngan Kee, WD Lau, TK Khaw, KS Lee, BB Johnson JW, Richards DS: The etiology of fetal acidosis as determined by umbilical cord acid-base studies.[anesthesiology.pubs.asahq.org]

Epidemiology

  • This total included reports by individuals and reports identified by the Bureau of Epidemiology, TDH, in a review of records from the six centers of the Texas Poison Center Network.[ncbi.nlm.nih.gov]
  • Reported by: DM Perrotta, PhD, Bur of Epidemiology; G Coody, C Culmo, Bur of Food and Drug Safety; Texas Poison Center Network, Texas Dept of Health.[cdc.gov]
  • Obesity epidemiology, pathophysiology, and prevention (2nd ed.). Boca Raton, Florida: CRC Press. p. 692. ISBN 9781439854266. Archived from the original on 2017-09-08. Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery.[en.m.wikipedia.org]
  • Although not as rigorous as an epidemiological case control study, this evidence is the best available to estimate the benefits of this rule.[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • Obesity epidemiology, pathophysiology, and prevention (2nd ed.). Boca Raton, Florida: CRC Press. p. 692. ISBN 9781439854266. Archived from the original on 2017-09-08. Fischer, Jnos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery.[en.m.wikipedia.org]
  • The pathophysiology of acute amphetamine poisoning with pathologic correlation. J. Pharmacol. Exp. Ther. 158, 115 –127. 2000 Society of Toxicology[toxsci.oxfordjournals.org]
  • ., Hypertension: Pathophysiology, Diagnosis, and Management, New York: Raven Press Ltd., pp. 127-144, 1995. 31.[web.archive.org]

Prevention

  • Arterial Hypotension / Valve Surgery 1 2 Completed Prevention Cesarean Section / Nausea / Vomiting 1 2 Completed Prevention Coagulation Defect; Bleeding 1 2 Completed Treatment BMI 30 kg/m2 1 2 Not Yet Recruiting Prevention Post Anaesthetic Shivering[drugbank.ca]
  • Stringent regulation of all ephedrine products is necessary to prevent misuse and to protect the public's health.[ncbi.nlm.nih.gov]
  • A combination of an ephedrine infusion at 1.25 mg.minute(-1) with a crystalloid co-load was more effective than fluid preloading with crystalloid or colloid in the prevention of moderate and severe hypotension.[ncbi.nlm.nih.gov]
  • Alendronate slows bone loss while increasing bone mass, which may prevent bone fractures. Alendronate is used to treat or prevent postmenopausal osteoporosis and steroid-induced osteoporosis.[emedicinehealth.com]
  • […] information 1 Department of Anesthesiology, Cumhuriyet University School of Medicine, Sivas, Turkey. driclal@gmail.com Abstract We designed a randomized, double-blinded study to determine the efficacy and safety of 0.5 mg/kg intravenous ephedrine for the prevention[ncbi.nlm.nih.gov]

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