Efficacy and Safety of Ephedra and Ephedrine for Weight Loss and Athletic Performance: A Meta-analysis

JAMA

Volumn 289, Issue 12, 2003, Pages 1537-1545

  Shekelle, Paul G ^a,c   Hardy, Mary L ^b   Morton, Sally C ^a   Maglione, Margaret ^a   Mojica, Walter A ^a   Suttorp, Marika J ^a   Rhodes, Shannon L ^a   Jungvig, Lara ^a   Gagné, James ^d  

^a RAND CORPORATION   (United States)

^b CEDARS SINAI MEDICAL CENTER   (United States)

^c UNIVERSITY OF SOUTHERN CALIFORNIA   (United States)

^d UNIVERSITY OF SOUTHERN CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CAFFEINE; EPHEDRA EXTRACT; EPHEDRINE; PLACEBO; ANTIOBESITY AGENT; PLANT MEDICINAL PRODUCT;

ATHLETE; AUTONOMIC DYSFUNCTION; BIBLIOGRAPHIC DATABASE; CLINICAL TRIAL; DRUG EFFICACY; DRUG SAFETY; FOLLOW UP; FOOD AND DRUG ADMINISTRATION; GASTROINTESTINAL SYMPTOM; HEART PALPITATION; HUMAN; MENTAL DISEASE; META ANALYSIS; PHYSICAL PERFORMANCE; PRIORITY JOURNAL; REVIEW; WEIGHT REDUCTION; ARTICLE; CONTROLLED CLINICAL TRIAL; DIET SUPPLEMENTATION; DRUG EFFECT; ENDURANCE; EPHEDRA; RANDOMIZED CONTROLLED TRIAL; RISK; SPORT;

ANTI-OBESITY AGENTS; CAFFEINE; CONTROLLED CLINICAL TRIALS; DIETARY SUPPLEMENTS; EPHEDRA; EPHEDRINE; HUMANS; PHYSICAL ENDURANCE; PLANT PREPARATIONS; RANDOMIZED CONTROLLED TRIALS; RISK; SPORTS; WEIGHT LOSS;

EID: 0037467338     PISSN: 00987484     EISSN: None     Source Type: Journal    
DOI: 10.1001/jama.289.12.1537     Document Type: Review

References (54)

1. Abrahamson A. Wheeler used supplement. Los Angeles Times. August 11, 2001; Sports section: D1, D9.
2. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med. 2000;343:1833-1838.
3. Carey B. Risks of ephedra usage in spotlight. Los Angeles Times. August 27, 2001; Health section: D11, D13.
4. Public Citizen. Public Citizen Calls On FDA To Ban Dietary Supplements Containing Ephedra. September 5, 2001. Available at: http://www.citizen.org /pressroom/release.cfm?ID=654. Accessibility verified February 17, 2003.
5. Marsa L. A tug of war in a larger battle: ephedra is now under intense scrutiny. Los Angeles Times. September 2, 2002; Health section: D10, D12.
6. Department of Health and Human Services. HHS announces plans to study ephedra. HHS News. June 14, 2002. Available at: http://www.hhs.gov/news /press/2002press/20020614.html. Accessibility verified February 17, 2003.
7. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-188.
8. Berkey CS, Hoaglin DC, Mosteller F, Colditz GA. A random-effects regression model for meta-analysis. Stat Med. 1995;14:395-411.
9. Moheb MA, Geissler CA, Lancer K. Effect of ephedrine, caffeine, and aspirin, in combinations of weight loss in obese women [abstract]. Int J Obes Relat Metab Disord. 1998;22(suppl 3):S264.
10. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17: 1-12.
11. Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998;352:609-613.
12. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088-1101.
13. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629-634.
14. Stata [computer program]. Release 7.0. College Station, Tex: Stata Corp; 2001.
15. StatXact 4 [computer program]. Version 4.0. Cambridge, Mass: Cytel Software Corp; 2000.
16. Astrup A, Buemann B, Christensen NJ, et al. The effect of ephedrine/caffeine mixture on energy expenditure and body composition in obese women. Metabolism. 1992;41:686-688.
17. Boozer CN, Daly PA, Homel P, et al. Herbal ephedra/caffeine for weight loss. Int J Obes Relat Metab Disord. 2002;26:593-604.
18. Boozer CN, Nasser JA, Heymsfield SB, Wang V, Chen G, Solomon JL. An herbal supplement containing Ma Huang-Guarana for weight loss. Int J Obes Relat Metab Disord. 2001;25:316-324.
19. Buemann B, Marckmann P, Christensen NJ, Astrup A. The effect of ephedyine plus caffeine on plasma lipids and lipoproteins during a 4.2 MJ/day diet. Int J Obes Relat Metab Disord. 1994;18:329-332.
20. Colker CM, Swain MA, Lynch L. A pilot study evaluating the effects of an ephedrine and forskolin-based product on body weight and body composition in overweight, healthy women [abstract]. J Am Coll Nutr. 2001;20:98.
21. Daly PA, Krieger DR, Dulloo AG, Young JB, Landsberg L. Ephedrine, caffeine and aspirin. Int J Obes Relat Metab Disord. 1993;17(suppl 1):S73-S78.
22. Jensen KB, Dano P, Draeby N, Hansen SH, Kanstrup J. Elsinore tablets and ephedrine as slimming agents [in Danish]. Ugeskr Laeger. 1980;142:1499-1501.
23. Kalman DS, Colker CM, Shi Q, Swain MA. Effects of a weight-loss aid in healthy overweight adults. Curr Ther Res Clin Exp. 2000;61:199-205.
24. Kettle R, Toubro S, Astrup A. Ephedrine/caffeine enhances abdominal fat loss in females. Int J Obes Relat Metab Disord. 1998;22(suppl 3):S264.
25. Lumholtz IB, Thorsteinsson B, Wamberg T, et al. Ephedrine in the treatment of obesity [in Danish]. Ugeskr Laeger. 1980;142:1487-1490.
26. Malchow-Moller A, Larsen S, Hey H, Stokholm KH, Juhl E, Quaade F. Ephedrine as an anorectic: the story of the "Elsinore pill." Int J Obes. 1981;5:183-187.
27. Molnar D, Torok K, Erhardt E, Jeges S. Safety and efficacy of treatment with an ephedrine/caffeine mixture. Int J Obes Relat Metab Disord. 2000;24:1573-1578.
28. Pasquali R, Baraldi G, Cesari MP, et al. A controlled trial using ephedrine in the treatment of obesity. Int J Obes. 1985;9:93-98.
29. Quaade F, Astrup A, Breum L, Toubro S, Hein P. The effect of an ephedrine/caffeine combination as a supplement to a weight-reducing diet [in Danish]. Ugeskr Laeger. 1992;154:1258-1263.
30. Roed P, Hansen PW, Bidstrup B, Kaem M, Helles A, Petersen KP. Elsinore banting tablets [in Danish]. Ugeskr Laeger. 1980;142:1491-1495.
31. Van Mil E, Molnar D. Drug treatment in obese adolescents [abstract]. Int J Obes. 2000; 24(suppl 1): S184.
32. Breum L, Pedersen JK, Ahlstrom F, Frimodt-Moller J. Comparison of an epheddne/caffeine combination and dexfenfluramine in the treatment of obesity. Int J Obes Relat Metab Disord. 1994;18:99-103.
33. Oksbjerg N, Meyer T, Hvid-Jacobsen K. Aerobic training increases the effect of ephedrine on energy expenditure [in Danish]. Ugeskr Laeger. 1986;148: 2021-2024.
34. Bell DG, Jacobs I, Zamecnik J. Effects of caffeine, ephedrine and their combination on time to exhaustion during high-intensity exercise. Eur J Appl Physiol Occup Physiol. 1998;77:427-433.
35. Bell DG, Jacobs I. Combined caffeine and ephedrine ingestion improves run times of Canadian Forces Warrior Test. Aviat Space Environ Med. 1999;70:325-329.
36. Bell DG, Jacobs I, McLellan TM, Miyazaki M, Sabiston CM. Thermal regulation in the heat during exercise after caffeine and ephedrine ingestion. Aviat Space Environ Med. 1999;70:583-588.
37. Bell DG, Jacobs I, McLellan TM, Zamecnik J. Reducing the dose of combined caffeine and ephedrine preserves the ergogenic effect. Aviat Space Environ Med. 2000;71:415-419.
38. Pasternak H, Jacobs I, Bell D. Effects of ingesting caffeine and ephedrine on muscular endurance. Can J Appl Physiol. 1999;24;471.
39. Bell DG, Jacobs I, Ellerington K. Effect of caffeine and ephedrine ingestion on anaerobic exercise performance. Med Sci Sports Exerc. 2001;33:1399-1403.
40. Sidney KH, Lefcoe NM. The effects of ephedrine on the physiological and psychological responses to submaximal and maximal exercise in man. Med Sci Sports. 1977;9:95-99.
41. Toubro S, Astrup A. Randomised comparison of diets for maintaining obese subjects' weight after major weight loss. BMJ. 1997;314:29-34.
42. Bray GA. Evaluation of drugs for treating obesity. Obes Res. 1995;3(suppl 4):425S-434S.
43. Fujioka K, Seaton TB, Rowe E, et al. Weight loss with sibutramine improves glycaemic control and other metabolic parameters in obese patients with type 2 diabetes mellitus. Diabetes Obes Metab. 2000;2:175-187.
44. Gokcel A, Karakose H, Ertorer EM, Tanaci N, Tutuncu NB, Guvener N. Effects of sibutramine in obese female subjects with type 2 diabetes and poor blood glucose control. Diabetes Care. 2001;24:1957-1960.
45. Smith IG, Goulder MA. Randomized placebo-controlled trial of long-term treatment with sibutramine in mild to moderate obesity. J Fam Pract. 2001; 50:505-512.
46. Wirth A, Krause J. Long-term weight loss with sibutramine. JAMA. 2001;286:1331-1339.
47. Van Gaal LF, Broom JI, Enzi G, Toplak H, for the Orlistat Dose-Ranging Study Group. Efficacy and tolerability of orlistat in the treatment of obesity. Eur J Clin Pharmacol. 1998;54:125-132.
48. Hill JO, Hauptman J, Anderson JW, et al. Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study. Am J Clin Nutr. 1999; 69:1108-1116.
49. Karhunen L, Franssila-Kallunki A, Rissanen P, et al. Effect of orlistat treatment on body composition and resting energy expenditure during a two-year weight-reduction programme in obese Finns. Int J Obes Relat Metab Disord. 2000;24:1567-1572.
50. Micic D, Ivkovic-Lazar T, Dragojevic R, et al. Orlistat, a gastrointestinal lipase inhibitor, in therapy of obesity with concomitant hyperlipidemia [in Serbo-Croatian]. Med Pregl. 1999;52:323-333.
51. Muls E, Kolanowski J, Scheen A, Van Gaal L. The effects of orlistat on weight and on serum lipids in obese patients with hypercholesterolemia. Int J Obes Relat Metab Disord. 2001;25:1713-1721.
52. Munro JF, MacCuish AC, Wilson EM, Duncan LJ. Comparison of continuous and intermittent anorectic therapy in obesity. BMJ. 1968;1:352.
53. Morgenstern LB, Viscoli CM, Kernan WN, et al. Use of ephedra-containing products and risk for hemorrhagic stroke. Neurology. 2003;60:132-135.
54. Bent S, Tiedt TN, Odden MC, Shlipak MG. The relative safety of ephedra compared with other herbal products. Available at: http://www.acpontine.org /journals/annals/ephedra.htm?hp. Accessibility verified February 17, 2003.