Ephedra, the herbal dietary supplement implicated in the heatstroke death Monday of Baltimore Orioles pitcher Steve Bechler, has long been controversial.
Medical organizations including the American Medical Association and Health Canada have recommended stopping sales of ephedra. And the Food and Drug Administration has issued warnings about its possible side effects, which include dizziness, restlessness, anxiety, irritability, personality changes, difficulty concentrating, increased heart rate, palpitations and elevated blood pressure.
Heart attack and blood clotting abnormalities also are possible.
Bechler had been taking Xenadrine, an over-the-counter product that contains ephedra, which is usually billed as a weight-loss supplement and energy booster. Ephedra has been banned by the International Olympic Committee, the NFL and the NCAA, and, although professional baseball discourages its use, the league hasn’t banned it.
Bechler had high blood pressure and liver abnormalities that might also have contributed to his multi-organ failure, said Dr. Joshua Perper, the Broward County, Fla., medical examiner. The Associated Press reported the baseball player’s body temperature was measured at 108 degrees after the spring-training workout in Fort Lauderdale.
Peg Verrico, a drug information pharmacist at the University of Pittsburgh’s drug information center, noted that a common side effect of the herbal supplement is increased body temperature.
Verrico said ephedra, as well as the drug ephedrine which is derived from the ephedra plant stimulates the nervous system, opens the airways and was once prescribed as an asthma medication. Safer and more effective drugs have taken ephedrine’s place. Studies have shown that at doses greater than 32 mg per day, the risk of hemorrhagic stroke triples. A San Francisco study that will be published next month in the the Annals of Internal Medicine found that, although ephedra-containing products represented less than 1 percent of sales of all herbal supplements, they accounted for 64 percent of the adverse reactions.
The same researchers also calculated that ephedra poses a 200-fold greater risk than all other herbal supplements combined. Critics countered that the study methods, which compared adverse events case reports among different herbal supplements, were flawed and could not provide an accurate measure of risk.
The FDA has said a public education campaign, manufacturing standards and product warning labels are needed.
“One of the big problems is that there’s not been large studies looking at the safety of ephedra,” Verrico said. “Most of the data is case reports.”
Different products contain different concentrations of the active ingredient. Ephedra also may be mixed with other agents, such as caffeine and pseudoephedrine, and the combinations can multiply the risk of side effects.