Some science behind the scenes

Ephedrine

Ephedrine is commonly used as a bronchodilator and also as a stimulant and appetite suppressant, and to treat hypotension associated with anaesthesia. It is similar in structure to the derivatives amphetamine and methamphetamine. It works mainly by increasing the activity of noradrenaline on adrenergic receptors and is usually marketed in the hydrochloride and sulfate forms. It is treated as an agonist at both the alpha and beta receptors. 

Both ephedrine and pseudoephedrine act as a bronchodilator, but pseudoephedrine has considerably less effect. Both also increase blood pressure, with again pseudoephedrine being considerably less effective

Chemically, it is an alkaloid derived from various plants in the genus Ephedra (family Ephedraceae).

Raw materials for the production of ephedrine and traditional Chinese medicine are produced in China on a large scale. In 2007, companies produced for export extract US$13 million worth of ephedrine from 30,000 tons of ephedra annually, 10 times the amount that is used in traditional Chinese medicine.

I quote now “Ephedrine should not be used by patients with inadequate fluid replacement, impaired adrenal function, hypoxia, hypercapnia, acidosis, hypertension, hyperthyroidism, prostatic hypertrophy, diabetes mellitus, cardiovascular disease, and during pregnancy, delivery and lactation

Adverse drug reactions (ADRs) are more common with systemic administration (e.g. injection or oral administration) compared to topical administration (e.g. nasal instillations).

ADRs associated with ephedrine therapy include:

  • Cardiovascular: tachycardia, cardiac arrhythmias, angina pectoris, vasoconstriction with hypertension
  • Dermatological: flushing, sweating, acne vulgaris
  • Gastrointestinal: anorexia, nausea
  • Genitourinary: decreased urination due to vasoconstriction of renal arteries. Also, difficulty urinating is not uncommon, as alpha-agonists such as ephedrine constrict the internal urethral sphincter, mimicking the effects of sympathetic nervous system stimulation.
  • Nervous system: restlessness, confusion, insomnia, mild euphoria, mania/hallucinations (rare except in previously existing psychiatric conditions), delusions, paranoia, hostility, panic, agitation
  • Respiratory: dyspnea, pulmonary edema
  • Miscellaneous: dizziness, headache, tremor, hyperglycemic reactions, dry mouth

Because of ephedrine's structural similarity to methamphetamine it can be used to create methamphetamine using chemical reduction in which ephedrine's hydroxy group is removed; this has made ephedrine a highly sought-after chemical precursor in the illicit manufacture of methamphetamine.

In Canada, Ephedrine is sold as a oral nasal decongestant in 8 mg pills, OTC.

In the USA, Ephedrine distribution is controlled by the government, and pharmacists may refuse to sell it to customers without a prescription.

Observations

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