Ephedrine and Pseudoephedrine
Also indexed as: Novafed, Pretz-D, Sudafed, Vick’s
Combination drugs: Alka-Seltzer Plus, Allegra-D, Chlor-Trimeton 12 Hour, Claritin-D, Nyquil,
Nyquil Hot Therapy Powder, Primatene Dual
Action, Theraflu, Tylenol Allergy Sinus, Tylenol Cold, Tylenol Flu NightTime Maximum Strength Powder, Tylenol Multi-Symptom Hot Medication, Tylenol Sinus
Ephedrine and pseudoephedrine are closely related drugs with actions and side effects
similar to the hormone epinephrine
(adrenaline). Ephedrine, available in prescription and nonprescription strengths, is sometimes
used to dilate bronchi, making it easier for people with asthma to breathe. Nonprescription ephedrine nose
drops and spray are used to relieve nasal congestion due to the flu or hay
fever. Pseudoephedrine, a nonprescription drug taken by mouth, can also be used to relieve
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
Avoid: Reduced drug absorption/bioavailability—Avoid these supplements
when taking this medication since the supplement may decrease the absorption and/or activity
of the medication in the body.
Tannin-containing herbs* such as green tea, black tea, uva ursi,
black walnut, red raspberry, oak, and witch hazel
Avoid: Adverse interaction—Avoid these supplements when taking this
medication because taking them together may cause undesirable or dangerous results.
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details.
|Depletion or interference
|Side effect reduction/prevention
An asterisk (*) next to an item in the summary indicates that the
interaction is supported only by weak, fragmentary, and/or contradictory scientific
Interactions with Herbs
Ephedra is the plant from which ephedrine was originally isolated. Until 2004,
ephedra—also called ma huang—was used in many herbal products, including
supplements promoted for weight loss. To
prevent potentially serious interactions, people taking ephedrine or pseudoephedrine should
avoid using ephedra-containing drug products and should read product labels carefully for ma
huang or ephedra content. Native North American ephedra, sometimes called Mormon tea, contains
A test tube study demonstrated that the bronchodilating effects of salbutamol, a drug with
similar actions in the lung to ephedrine, were significantly increased by the addition of
forskolin, the active component of the herb Coleus forskohlii.1 The
results of this preliminary research suggest that the combination of forskolin and
beta-agonists (like ephedrine) might provide an alternative to raising the doses of the
beta-agonist drugs as they lose effectiveness. Until more is known, coleus should not be
combined with ephedrine without the supervision of a doctor.
Tannins are a group of unrelated chemicals that give plants an astringent taste. Herbs
containing high amounts of tannins may interfere with the absorption of ephedrine or
pseudoephedrine taken by mouth.2 Herbs containing high levels of tannins include green tea, black tea, uva ursi (Arctostaphylos uva-ursi),
black walnut (Juglans nigra),red
raspberry (Rubus idaeus),oak
(Quercus spp.), and witch
hazel (Hamamelis virginiana).
Interactions with Foods and Other Compounds
Foods that acidify the urine may increase the elimination of ephedrine from the body,
potentially reducing the action of the drug.3 Urine-acidifying foods include eggs,
peanuts, meat, chicken, vitamin C (greater
than 5 grams per day), wheat-containing foods, and others.
Foods that alkalinize the urine may slow the elimination of ephedrine from the body,
potentially increasing the actions and side effects of the drug.4
Urine-alkalinizing foods include dairy products, nuts, vegetables (except corn and lentils),
most fruits, and others.
Caffeine, which is found in coffee, tea, chocolate, guaraná (Paullinia cupana), and
some nonprescription and supplement products, can amplify the side effects of ephedrine and
pseudoephedrine. People should avoid combination products containing
ephedrine/pseudoephedrine/ephedra and caffeine.
1. Yousif MH, Thulesius O. Forskolin reverses tachyphylaxis to the
bronchodilator effects of salbutamol: an in-vitro study on isolated guinea-pig trachea. J
Pharm Pharmacol 1999;51:181–6.
2. Brinker F. Interactions of pharmaceutical and botanical medicines.
J Naturopathic Med 1997;7(2):14–20.
3. Holt GA. Food & Drug Interactions. Chicago: Precept
Press, 1998, 105.
4. Holt GA. Food & Drug Interactions. Chicago: Precept