Ephedra

Information
Application
Notes
References

Photo: aus Hänsel/Hölzl

Botanical name

Ephedra sinica Stapf (North China)

Ephedra equisetina Bunge (syn. E. shennungiana Tang) (Central Asia, Mongolia, North China)

Ephedra intermedia Schrenk et C.A. May (different varieties, Iran to India)

Ephedra distachya L. = E. vulgaris Rich. (Mediterranean region, west coast of France, southern Russia, Black Sea area to Siberia)

Ephedra gerardiana Wall. ex Klotzsch & Garcke

Family

Ephedraceae

Common name

Joint-pine, Jointfir, Mormon tea, Brigham tea, Worehouse tea

Information about the plant

The genus Ephedra consists of around 40 species found in Europe, Asia, and America. It belongs to the ‘gymnosperms’ and is closely related to the conifers. However, in terms of appearance, the Ephedra species show clear similarities with angiosperms, placing the genus Ephedra on the threshold between conifers and deciduous trees. They are dioecious, richly branched shrubs up to 2 meters high, with very small, scale-like leaves. These grow in pairs or threes on the green stem and are fused into a tube at the base. The cone-shaped male and female flowers sit individually, in pairs, or clusters at the ends of the branches, either in the axils of decussate bracts or even terminally. The fruits are often berry-like red pseudo-fruits.

The German name ‘Meerträubel’ is not used in a medicinal context; the plant is known there as ‘Ephedra’, although it is no longer used as a medicinal plant today. Until 2001, the quality specifications for the drug ‘ephedra herb’ were still included in the German Pharmacopoeia. However, the monograph ‘Ephedra herb’ was not included in the European Pharmacopoeia (Ph. Eur.). This was due to the finding that the alkaloid ephedrine is primarily responsible for the effect of the ephedra herb. Ephedrine was initially isolated from the ephedra herb, but it soon became possible to produce it synthetically, leading to a loss in its significance as a source of ephedrine. In a new assessment, the benefit/risk ratio for ephedrine was evaluated negatively, resulting in a significantly decline in its use as a pure substance.

Medicinally used parts of plants (herbal drug)

The young, dried twigs collected in autumn (ephedra herb - Ephedrae herba) are used.

Constituents of the herbal drug

Ephedra herb contains 1 to 2% alkaloids of the 2-aminophenylpropane type. The main alkaloids are (-)-ephedrine (0.5 to 1.6%) and (+)-pseudoephedrine (0.2 to 0.8%).
Secondary alkaloids include norephedrine, methylephedrine, and others. The drug also contains flavonoids and tannins.

Quality of the drug

For ephedra herb (Ephedrae herba), no quality specification is available in the pharmacopoeia. The European Pharmacopoeia (Ph. Eur.) has a quality specification for Ephedra vulgaris for homeopathic preparations (Ephedra distachya recens ad praeparationes homoeopathicas).

Medical applications

Recognised medical use

(-)-Ephedrine is an indirect sympathomimetic. It releases noradrenaline from the storage granules of sympathetic nerve endings and acts as a broncholytic (dilation of the bronchi and bronchioles) while increasing blood pressure through local vasoconstriction. The local vasoconstriction justifies its use in nasal drops, where ephedrine causes the nasal mucosa to decongest and provides a ‘clear nose’ in case of a cold. Ephedrine is used for coughs, rhinitis (colds), hay fever, and bronchial asthma.

In the central nervous system (CNS), ephedrine releases dopamine, serotonin, noradrenaline, producing a central effect. It increases alertness, motivation, and the ability to concentrate, while the feeling of hunger and tiredness are reduced. Because of these central effects, ephedrine is used for doping in sport. It is included in the doping list of the International Olympic Committee (IOC) and the German Olympic Sports Confederation (DOSB).

The effect profile of ephedrine described below is the reason why ephedra herb was neither evaluated by the HMPC nor by the ESCOP.

Traditional use

Due to its content of highly potent alkaloids (in this case ephedrine), ephedra herb cannot be classified as a traditional herbal medicinal product (Article 16a of Directive 2001/83/EC).

Herbal drug preparations in finished dosage forms

Ephedra herb is no longer used as a medicinal drug, and the external use of nasal drops for ‘blocked nose’ (colds, hay fever) is no longer indicated due to better alternatives. Ephedrine is only used in the form of injections to increase blood pressure during spinal or epidural anesthesia.

Dosage

Not applicable.

Preparation of a tea

Not applicable.

Notes

The use of ephedra herb is not recommended because of its strong side effects due to the ephedrine it contains. These include insomnia, motor restlessness, headaches, nausea, vomiting, and tachycardia; ephedrine also interacts with other heart and blood pressure medications, so that health risks must also be anticipated.