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Ephedrine as I.Randi drug

Generality

The use of ephedrine as a drug occurs in cases of nasal congestion, bronchospasm and hypotension induced by anesthesia.

The ability to treat the aforementioned conditions varies depending on the way in which ephedrine is administered. More in detail, when administered nasally, ephedrine is able to exert a decongestant action; while when it is administered parenterally, it is able to counter bronchospasm and hypotension.

Ephedrine is a molecule of natural origin and, more precisely, it is an alkaloid present inside some plants belonging to the genus Ephedra .

Examples of Medicinal Specialties Containing Ephedrine

  • Argotone®
  • Deltarinolo®
  • Rinovit®
  • Ephedrine Galenic Senese® Hydrochloride

Therapeutic indications

When is the use of Ephedrine indicated?

The therapeutic indications of ephedrine as a drug vary depending on the pharmaceutical form, consequently, depending on the route of administration through which the active principle is given to the patient.

Ephedrine in the form of ointment, drops and nasal sprays - therefore, ephedrine as a drug administered at the level of the mucous membrane of the nose - is indicated in the treatment of nasal congestion .

Ephedrine in the form of an injectable solution, therefore administered parenterally, is indicated in:

  • Acute bronchospasm treatment ;
  • Treatment and prevention of hypotension caused by spinal, intrathecal or epidural anesthesia.

Warnings

Warnings and Precautions for the use of Ephedrine

Before taking ephedrine as a drug, you must tell your doctor if:

  • You suffer from kidney disorders and diseases;
  • You are suffering from cardiovascular diseases;
  • You suffer from hypertension;
  • One is suffering from prostatic hypertrophy;
  • You are pregnant or breastfeeding.

Please note

The use of ephedrine as a drug in the absence of an effective therapeutic need constitutes doping and, in any case, can cause positivity to doping tests.

Finally, it should be remembered that following the administration of ephedrine parenterally, side effects could occur that could negatively affect the ability to drive vehicles and use machinery.

Pharmacological Interactions

Interactions of Ephedrine with Other Drugs

Ephedrine as a parenteral drug should not be given in combination with:

  • Monoamine oxidase inhibitors (MAOIs);
  • guanethidine;
  • Cardioactive glycosides;
  • Theophylline, aminophylline and ethylenediamine;
  • procarbazine;
  • Sodium bicarbonate.

Ephedrine as a nasal drug, on the other hand, should not be given in combination with antidepressant drugs and products of any type containing terpenic derivatives. Furthermore, it should be used with caution when the patient is taking or has recently taken medications, such as:

  • Non-steroidal anti-inflammatory drugs (NSAIDs);
  • Corticosteroids;
  • antihypertensive;
  • Diuretics such as acetazolamide;
  • Theophylline and caffeine;
  • reserpine;
  • Digoxin;
  • cyclopropane;
  • Psuedoefedrina and phenylpropanolamine.

Side effects

Side Effects Caused by the Assumption of Ephedrine

Like any other drug, ephedrine is also capable of giving rise to side effects following its administration. However, not all patients manifest these effects or manifest them in the same way. In fact, each individual reacts subjectively to the administration of ephedrine. However, below are some of the side effects that may occur during and after taking the active substance in question.

Cardiac disorders

Following the use of ephedrine as a drug may occur:

  • Hypertension;
  • Tachycardia;
  • Ventricular arrhythmias;
  • Palpitations;
  • Precordial pain;
  • Myocardial ischemia.

Gastrointestinal disorders

The administration of ephedrine could cause undesirable effects on the gastrointestinal tract, giving rise to:

  • Nausea and vomit;
  • Gastric disorders;
  • Anorexia.

Nervous system disorders

Taking ephedrine may favor the appearance of disorders such as:

  • agitation;
  • Anxiety;
  • Feeling of fear;
  • Restlessness;
  • Irritability;
  • Insomnia;
  • Hallucinations;
  • Paranoia;
  • Feeling of weakness;
  • Tremor.

Other side effects

Other side effects that could occur following the administration of ephedrine as a drug consist of:

  • Urinary retention,
  • Breathing difficulties;
  • Dryness of the nasal and pharyngeal mucosa;
  • Profuse sweating.

Please note

Systemic side effects can be caused either by parenteral ephedrine, or by the administration of ephedrine via the nose due to the absorption of the drug by inflamed nasal mucosa and by the gastrointestinal tract. However, such absorption generally occurs when the drug is used in excessive and / or improperly doses.

Overdose

Taking excessively high doses of ephedrine as a drug can lead to symptoms such as:

  • Hypertension;
  • Tachycardia;
  • photophobia;
  • Intense headache;
  • Sweating;
  • He retched;
  • Neurological disorders.

The overdose treatment is symptomatic and requires the intervention of health personnel. For this reason, in case of suspected or confirmed overdose of ephedrine, it is necessary to immediately contact the doctor or go to the nearest emergency room.

Action mechanism

How does Ephedrine work?

Ephedrine is an active ingredient with sympathomimetic action and, therefore, able to interact and activate alpha and beta adrenergic receptors . At the same time, ephedrine is also able to promote the release of noradrenaline from neuronal endings. Therefore, thanks to this mechanism of action, the active ingredient in question is capable of exerting a sympathomimetic action both direct and indirect.

Thanks to the aforementioned mechanisms of action, when ephedrine as a drug is administered at the level of the nasal mucosa, it is able to induce a vasoconstriction with a consequent decongestant effect.

Thanks to the same mechanisms of action, when administered parenterally, ephedrine is able to induce a relaxation of the bronchial smooth muscle (treating bronchospasm in this way) and a cardiac stimulation with an increase in blood pressure (treating in this way the 'hypotension).

Method of use and Posology

How to take Ephedrine

Ephedrine is available in pharmaceutical formulations suitable for nasal administration (drops, ointments and sprays) and suitable for parenteral administration (solution for injection).

Drops, Ointment and Nasal Sprays

Although the dosage of the medicinal product containing ephedrine should be indicated by the doctor, the doses usually used to counter nasal congestion are the following:

  • Nasal drops : 2-3 drops per nostril, inhaling deeply, from two to three times a day.
  • Nasal ointment : apply with a massage a small amount of ointment inside each nostril two or three times a day.
  • Nasal spray : a nebulization in each nostril every 3-4 hours for a maximum of four times a day.

Nasal ephedrine treatment should not exceed 3-4 days.

Did you know that ...

Prolonged administration of ephedrine as a nasal drug (decongestant action) can cause sensitization and reduced efficacy of the drug administered (tachyphylaxis).

Injectable solution

Ephedrine as a parenteral drug should only be administered by a healthcare professional. The correct dosage must be established by the doctor. However, the doses usually used will be reported below.

  • Treatment of bronchospasm :
    • Adults : 12.5-25 mg of ephedrine intravenously, intramuscularly or subcutaneously.
    • Children up to 12 years of age : 750 micrograms per kg of body weight, or 25 micrograms per square meter of body surface intravenously or subcutaneously.
  • Treatment of hypotension induced by epidural, spinal or intrathecal anesthesia:
    • Adults : 25-50 mg of ephedrine administered intramuscularly or subcutaneously. If a rapid response is required, intravenous administration may be used.
    • Children up to 12 years of age : 0.2-0.3 mg per kg of body weight every 4-6 hours, depending on the patient's response to treatment.

When administering ephedrine as a parenteral drug, it is important to remember that it is:

  • Incompatible with phenobarbital, pentobarbital, secobarbital, thiopental, hydrocortisone sodium succinate and hydrolysed proteins.
  • Compatible with glucose solutions, sodium chloride and Ringer's solution.

Pregnancy and breastfeeding

Can ephedrine be taken in pregnancy and during breastfeeding?

Ephedrine is able to cross the placenta and can cause hyperactivity, irritability and fetal tachycardia. For this reason, ephedrine as a drug should not be used during pregnancy unless it is absolutely necessary and only under the strict supervision of a doctor.

As regards the use of the drug during breastfeeding, since it is not known whether or not ephedrine is excreted in breast milk, as a precautionary measure, the use of the active ingredient in question is generally contraindicated and should be carried out only if the doctor considers it absolutely essential.

Contraindications

When Ephedrine Should Not Be Used

The use of ephedrine as a drug is contraindicated:

  • In the event of hypersensitivity to the ephedrine itself or to any of the excipients contained in the medicinal product to be used;
  • In patients with closed-angle glaucoma;
  • In pregnancy and during lactation.

In addition to what has been said so far, the use of ephedrine as a drug administered parenterally is contraindicated in patients suffering from psychosis; while the use of ephedrine as a drug against nasal congestion is also contraindicated in:

  • Patients suffering from cardiovascular diseases;
  • Patients with hyperthyroidism;
  • Patients suffering from prostatic hypertrophy;
  • Patients with pheochromocytoma;
  • Patients suffering from diabetes mellitus;
  • Children under 12 years of age and children with a history of epilepsy or febrile convulsions.

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