Stephen Bent, MD; Thomas N. Tiedt, PhD; Michelle C. Odden, BS; Michael G. Shlipak, MD, MPH
Bent S, Tiedt TN, Odden MC, Shlipak MG. The Relative Safety of Ephedra Compared with Other Herbal Products. Ann Intern Med. 2003;138:468-471. doi: 10.7326/0003-4819-138-6-200303180-00010
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Published: Ann Intern Med. 2003;138(6):468-471.
Ephedra is widely used in dietary supplements that are marketed to promote weight loss or increase energy; however, the safety of this product has been questioned because of numerous case reports of adverse events.
To compare the risk for adverse events attributable to ephedra and other herbal products.
Comparative case series.
American Association of Poison Control Centers Toxic Event Surveillance System Database Annual Report, 2001.
The relative risk and 95% confidence interval for experiencing an adverse reaction after ephedra use compared with other herbs. This risk was defined as the ratio of adverse reactions to ephedra versus other products, divided by the ratio of their relative use in the United States.
Products containing ephedra accounted for 64% of all adverse reactions to herbs in the United States, yet these products represented only 0.82% of herbal product sales. The relative risks for an adverse reaction in persons using ephedra compared with other herbs were extremely high, ranging from 100 (95% CI, 83 to 140) for kava to 720 (CI, 520 to 1100) for Ginkgo biloba.
Ephedra use is associated with a greatly increased risk for adverse reactions compared with other herbs, and its use should be restricted.
Ephedra (ma huang) is used in dietary supplements to “promote weight loss and enhance energy.” Is it safe?
This study, based on data from U.S. poison control centers and sales information, shows that products containing ephedra accounted for 64% of all reported adverse effects from herbs even though they represented less than 1% of total herbal product sales. The relative risk for an adverse effect from ephedra was 100 (95% CI, 83 to 140) compared with kava and 720 (CI, 520 to 1100) compared with Ginkgo biloba.
Ephedra is associated with greatly increased risk for adverse effects compared with other herbs.
0.82% = best estimate from SPINS, Inc., San Francisco, California; 2.20% = Whole Foods Magazine survey estimate; 13.5% = high estimate assuming that ephedra sales represent half of all nonretail sales in addition to 0.82% of retail sales.
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