Ephedrine abuse -- WOW

Adverse Events Associated With Ephedrine Abuse

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Some people are just idiots and will always find ways to abuse drugs. Because of shit heads like this , the FDA had to step in. Below are just a few of the case reports that I was able to locate. There are around 200 different reports and in almost everyone the dosages were off the chart.


Burkhart (1992) reported a case of a 29-year old female who drank 8 beers and then ingested 700 ephedrine tablets 25 mg each (total ephedrine exposure 17.5g). She was admitted to the emergency department 1.5 hours later. Her vital signs included tachycardia and high blood pressure. Gastric lavage contained a large number of pills and undigested food. Her physical exam was remarkable for intoxication and mild agitation. Within 4 minutes of administration of propranolol, her vitals returned to almost normal levels. Over the next 24 hours her blood pressure returned to normal. No other information on adverse effects was provided.

Gualtieri and Harris, (1996) reported a case report of a 28-year old obese female smoker with a dilated cardiomyopathy associated with heavy ephedrine abuse. Before admission to hospital, the patient had a 3-week history of progressing dyspnea, dry cough, fatigue, and orthopnea. She admitted to taking 25 mg ephedrine tablets for 8 years to lose weight but denied any other chronic drug or alcohol use except tobacco (1 pack per day for the past 12 years). She later admitted to taking 80 tablets per day (usual total ephedrine intake of 2 g/day). One week after the onset of her symptoms, she reduced her daily intake from 80 tablets to 3 tablets per day. After the abrupt dose reduction, her symptoms rapidly worsened. Her symptoms included a higher blood pressure; however, no ST-T wave abnormalities were noted on ECG. There were 3+ pitting edema to the thighs. Electrolytes, ABG, CBC, LFTs, BUN, and glucose were within normal limits. Marked cardiomegaly with clear lung fields were observed. Echocardiogram showed pancardiomegaly with severe LV dysfunction and hypokinesis. Wall thickness was normal in all chambers and cardiac valves normal. Angiography was not performed. Vascular study revealed no evidence of deep vein thrombosis. Thyroid studies and urine screens were normal. Endomyocardial biopsy was consistent with chronic change rather than acute myocarditis. The author reported that although the patients’ dilated cardiomyopathy is characterized as idiopathic, the attending physician believed that her chronic heavy ephedrine use was a significant contributing factor.

Matthews et al. (1997), reported ischemic or hemorrhagic stroke related to ephedrine intake in a 19-year old female. The woman had a history of anorexia/bulemia and alcoholism and presented to the emergency department after ingestion of 15 to 18 tablets containing ephedrine 25 mg and guaifenesin 100 mg along with alcohol (total ephedrine 450 mg/day). She had previously taken 3 to 10 tablets at a time to lose weight, and in the past, laxatives and diuretics. She developed severe headache and right sided paralysis 75 minutes upon admission. CT scan revealed a large, left parieto-fronto parenchymal hemorrhage with extension into the left lateral ventricle. She underwent emergency craniotomy with hematoma evacuation. Following surgery, she was awake, alert and oriented with minimal speech defect and persistent right hemiplegia. The authors concluded that the stroke was related to the ingestion of many-times the maximum recommended daily dose of ephedrine in a young woman with no apparent risk factors for developing stroke.

Blau (1998) reported a case of nephrolithiasis associated with chronic ephedrine abuse. A 24-year old man presented with left abdominal pain radiating into the groin, hematuria and nausea. An excretory urogram revealed left hydronephrosis with ureteral obstruction. The medical and family history was negative for kidney stones. The patient did not smoke cigarettes but he did chew tobacco. He occasionally smoked marijuana and drank 6 to 8 beers a week. A review of his profile indicated that he took an average of 40 to 120 ephedrine-containing tablets a day (25 mg/tablet: total 1,000 to 3,000 mg/day) for several years due to the stimulant effects. The stone passed and analysis revealed ephedrine. No other harmful health effects were reported in this patient. The patient continued subsequent to this incident to abuse ephedrine and refused any professional assistance.

Assimos et al. (1999) studied case reports of kidney stone formation from overconsumption of preparations containing guaifenesin and ephedrine. Stone analysis from seven patients demonstrated metabolites of guaifenesin. HPLC revealed that the stone and urine from one subject revealed a high content of guaifenesin metabolites and a small amount of ephedrine. Demographic data were available on 5 of the 7 patients. Three had a history of alcohol or drug dependency which may have promoted their abuse of ephedrine + guaifenesin products. All subjects were consuming over-the-counter preparations containing ephedrine and guaifenesin. Four admitted to taking excessive quantities of these agents (50 to 100 tablets per day containing 25 mg of ephedrine and 200 mg of guaifenesin), mainly as a stimulant. Information on other effects from abuse level exposures was reported.

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