(L)-Ephedrine

CAS RN: 299-42-3

Health Effects

0.2.1 SUMMARY OF EXPOSURE
  • A) USES: Oral sympathomimetics are used as decongestants, weight loss agents, bronchodilators, anabolic bodybuilding agents, aphrodisiacs, mood stimulants, and to stay awake.
  • B) PHARMACOLOGY: Clinical effect is achieved by direct binding at beta and alpha-adrenergic receptors or by indirectly causing an increase of norepinephrine or dopamine (catecholamines) at the neural junction.
  • C) TOXICOLOGY: Direct receptor binding or catecholamine increase leads to a hyperadrenergic physiologic state.
  • D) EPIDEMIOLOGY: Toxicity is common due to the large number of agents with sympathomimetic activity. Severe poisoning is uncommon.
  • E) WITH THERAPEUTIC USE
    • 1) ADVERSE EFFECTS: Adverse effects from oral sympathomimetics are common. The most common effects are hypertension, palpitations, nausea, and restlessness.
  • F) WITH POISONING/EXPOSURE
    • 1) MILD TO MODERATE TOXICITY: Most patients will experience tachycardia, hypertension, mydriasis, insomnia, headache, and agitation.
    • 2) SEVERE TOXICITY: Large overdoses and severe toxicity may lead to seizures, hallucinations, agitated delirium, and tachydysrhythmias including supraventricular tachycardia and ventricular tachycardia. Vasospasm can lead to myocardial ischemia or focal cerebrovascular deficits. Severe hypertension may also result in intracranial hemorrhage or renal insufficiency. Reflex bradycardia due to significant hypertension is possible. Prolonged agitation can lead to rhabdomyolysis and hyperthermia. 1,3 DIMETHYLAMYLAMINE: Cerebral hemorrhage has been reported in several cases of recreational use of 1,3-dimethylethylamine (DMAA). CLENBUTEROL: The beta-2 agonists (clenbuterol) can cause significant electrolyte abnormalities including hypokalemia.
0.2.3 VITAL SIGNS
  • A) Hypertension may occur, accompanied by tachycardia may occur.
  • B) Bradycardia has been reported following overdoses of phenylpropanolamine and as a late presentation following norepinephrine depletion.
  • C) Increased temperature may occur.
0.2.5 CARDIOVASCULAR
  • A) WITH POISONING/EXPOSURE
    • 1) Cardiac dysrhythmias, tachycardia, precordial pain, and increased blood pressure may occur. Bradycardia may occur as a late presentation following profound depletion of norepinephrine.
    • 2) Hypertensive crisis, cerebral hemorrhage, and myocardial ischemia and infarction may develop following acute ingestion of pseudoephedrine, PPA, phenylephrine, amphetamine, dexamphetamine, and methamphetamine.
0.2.6 RESPIRATORY
  • A) Sympathomimetics may cause hyperventilation. Bronchodilation may occur. Pulmonary edema may occur in massive overdoses.
0.2.7 NEUROLOGIC
  • A) Anxiety, nervousness, insomnia, muscle tremor, headache, seizures, altered mental status and cerebral hemorrhage and ischemia may be noted.
  • B) Toxic psychosis may develop following acute overdoses or abuse of sympathomimetics.
0.2.8 GASTROINTESTINAL
  • A) Anorexia, nausea and vomiting may occur following overdose.
0.2.10 GENITOURINARY
  • A) Acute renal failure, acute tubular necrosis and rhabdomyolysis may occur.
  • B) Chronic ephedra use may result in nephrolithiasis.
0.2.12 FLUID-ELECTROLYTE
  • A) Hypokalemia may occur. Volume depletion may occur.
0.2.13 HEMATOLOGIC
  • A) Leukocytosis has been reported following overdoses.
0.2.15 MUSCULOSKELETAL
  • A) Rhabdomyolysis has been reported following acute overdoses, and may result in acute tubular necrosis and acute renal failure.
0.2.16 ENDOCRINE
  • A) Hyperglycemia has been reported as an overdose effect.
0.2.19 IMMUNOLOGIC
  • A) Allergic reactions, including anaphylaxis, have been reported following ingestions of sympathomimetics.
0.2.20 REPRODUCTIVE
  • A) Beta sympathomimetic drugs appear to cross the placenta. Albuterol, isoxsuprine, metaproterenol, and rivaroxaban are classified as FDA pregnancy category C. Terbutaline is classified as FDA pregnancy category B. Ephedrine, isoetharine, nylidrin, phenylephedrine, phenylpropanolamine, and pseudoephedrine are considered a risk category of C during pregnancy. According to a case series, cord serum insulin concentration was significantly higher in the treated group of 18 preterm infants whose mothers received beta sympathomimetic therapy (17 received salbutamol and one received terbutaline) for labor sedation compared with the 21 women who did receive sympathomimetic treatment.
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