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Ma-huang strikes again: ephedrine nephrolithiasis
1Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Summary
Ephedrine, found in Ma-Huang extract, can cause kidney stones (ephedrine nephrolithiasis). This previously unreported toxicity is common in patients using ephedrine-containing supplements.
Area of Science:
- Pharmacology
- Nephrology
- Toxicology
Background:
- Ephedrine alkaloids, derived from evergreens, possess alpha and beta catecholamine effects.
- The alternative medicine industry widely uses ephedrine for various health applications, including weight loss and energy enhancement.
- Concerns regarding unsupervised ephedrine use and its associated dangers, including fatalities, have prompted FDA review.
Observation:
- A novel toxicity, ephedrine nephrolithiasis, was identified in a patient consuming an energy supplement containing ephedrine (Ma-Huang extract).
- Analysis of the Louis C. Herring and Company kidney stone database revealed numerous prior instances of ephedrine-related kidney stones.
Findings:
- Gas chromatography-mass spectrometry confirmed ephedrine, norephedrine, and pseudoephedrine as components of the patient's kidney stone.
- Similar chemical compositions were identified in other kidney stones from the Louis Herring database.
Implications:
- Ephedrine nephrolithiasis represents a significant, previously unrecognized complication of ephedrine-containing products.
- This finding underscores the potential risks associated with ephedrine use in dietary supplements and alternative medicine.
- Further research and regulatory scrutiny are warranted to ensure consumer safety regarding ephedrine-based products.