Ephedrines in over-the-counter cold medicines and urine specimens collected during sport competitions

Ephedrine (EPH), pseudoephedrine (PEPH), phenylpropanolamine (PPA), and methylephedrine (MEPH) are ephedrine alkaloids commonly found in cold medications and are banned by the International Olympic Committee (IOC). These compounds were detected in the urinary doping tests during the national sport competitions in Taiwan. To study the sources of these compounds, 91 over-the-counter (OTC) nonprescription cold remedies, along with 1803 athletes' urine samples collected (from 1999 to 2001) in competitions were analyzed using gas chromatography-nitrogen-phosphorus detection (GC-NPD) for initial screening and GC-mass spectrometry (MS) for confirmation. We found that 80% of OTC cold medicines showed banned ephedrines in their ingredients lists, in which MEPH (52%) was the most common drug labeled. However, when these OTC cold medicines were analyzed by GC-NPD and GC-MS, EPH (35.4%) was found substantially higher than that labeled in the OTC products (1.3%). In the total urine specimens tested, approximately 2.8% contained banned ephedrines and 1.3% exceeded the IOC cutoff levels. Within the urine specimens that exceeded the IOC cutoff values, PEPH accounted for a 44% occurrence rate, followed by EPH (28%), PPA (17%), and MEPH (11%). In agreement with the other report, bodybuilders showed a high incidence rate for ephedrines misuse. Nevertheless, it is likely that the high incidence of doping violations for ephedrine-related substances was related to misuse of ephedrines present in most OTC common cold medicines and some dietary supplements for relieving cold symptoms, reducing body weight, and preserving muscle.