Published Online
on April 5, 2004

A more recent version of this article appeared on April 20, 2004

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Submitted on January 5, 2004
Revised on March 2, 2004
Accepted on March 3, 2004

Water Potentiates the Pressor Effect of Ephedra Alkaloids

Jens Jordan MD, John R. Shannon MD, André Diedrich MD, Bonnie Black RN, David Robertson MD, and Italo Biaggioni MD^*

From the Department of Medicine and Pharmacology, Vanderbilt University, Nashville, Tenn (J.R.S., A.D., B.B., D.R., I.B.), and Franz Volhard Clinical Research Center and HELIOS Klinikum-Berlin, Medical Faculty of the Charité, Humboldt-University, Berlin, Germany (J.J.).

^* To whom correspondence should be addressed. E-mail: italo.biaggioni{at}vanderbilt.edu.

Background--The use of ephedra alkaloids in over-the-counter preparations has been associated with potentially serious cerebrovascular events. Because of its potential association with hemorrhagic strokes, phenylpropanolamine has been largely substituted for by pseudoephedrine, but it is not clear whether this is indeed a safer alternative. It would be important to understand the cardiovascular effects of ephedra alkaloids, but these are normally masked by baroreflex buffering mechanisms. We therefore investigated the effects of ephedra alkaloids in patients with autonomic impairment and explored their potential interaction with water ingestion.

Methods and Results--The cardiovascular effects of phenylpropanolamine or pseudoephedrine, alone and in combination with water, were determined in 13 subjects with impairment of baroreflex function due to autonomic failure. Phenylpropanolamine, 12.5 to 25 mg PO, increased systolic blood pressure (SBP) by 21±14 mm Hg after 90 minutes. However, when ingested with 16 oz of room temperature tap water, phenylpropanolamine increased SBP by 82±2 mm Hg. Pseudoephedrine, 30 mg PO, increased SBP on average 52±9 mm Hg when taken with 16 oz of water and by as much as 88 mm Hg.

Conclusions--Ephedra alkaloids increase blood pressure significantly in individuals with impaired baroreflex function. Concomitant ingestion of ephedra alkaloids and water produced a greater increase in blood pressure. If used cautiously, this interaction can be beneficial in the treatment of orthostatic hypotension. On the other hand, it could contribute to the cardiovascular complications associated with the use of ephedra alkaloids, given that baroreflex function varies widely in normal individuals and is impaired in several medical conditions.

Key words: blood pressure • pharmacology • stroke

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