PDR for Herbal Medicines

HERBAL MONOGRAPHS MA-HUANG/489

Unproven Uses: Ma-Huang is used for diseases of the

respiratory tract with mild bronchospasms in adults and

children over the age of six. Various indications include

asthma, cardiovascular stimulation and as a CNS stimulant.

Chines&"Me"dicine: The drug has been used for over 4000

years for severe febrile illnesses, bronchial asthma, joint

symptoms, inability to perspire, coughing with dyspnea,

edema and pains in the bones.

CONTRAINDICATIONS

Contraindications include states of anxiety and restlessness,

high blood pressure, angle-closure glaucoma, cerebral perfu-

sions, prostate adenoma with residual urine volume, pheo-

chromocytoma and thyrotoxicosis.

PRECAUTIONS AND ADVERSE REACTIONS

General: Common side effects include headache, irritability,

motor restlessness, nausea, sleeplessness, tachycardia, uri-

nary disorders and vomiting. Higher dosages may result in

blood pressure and cardiac rhythm disorders.

Dependence can develop with extended intake. Because of

the danger of the development of tachyphylaxis and of

dependence, the drug should only be administered for short

periods.

Pregnancy: Ma-Huang should not to be used during

pregnancy

Drug Interactions: Ephedra has an addictive effect on the

CNS when used in conjunction with caffeine, decongestants

and other central stimulants.

Cardiac heart glycosides or halothane: disturbance of heart

rhythm.

Guanethidine^njfeanGement of the sympathomimetic effect

MAO-inhibitors: potentiate the sympathomimetic action of
ephedrine.
Secale alkaloid derivatives or oxytocin: development of high
blood pressure.
OVERDOSAGE
Life-threatening poisonings are seen with very high dosages
of the drug (over 100 gm, lethal dosage with oral administra-
tion corresponding to approximately 1 to 2 gm L-ephedrine).
Symptoms of poisoning include severe outbreaks of sweat-
ing, enlarged pupils, spasms and elevated body temperature.
Death following overdose is due to heart failure and
asphyxiation. Following stomach emptying (gastric lavage
with burgundy-colored potassium permaganate solution),
therapy consists of the administration of activated charcoal
and prophylaxis against shock. Spasms should be treated
with diazepam, electrolyte substitution should be employed,
and sodium bicarbonate infusions should be used to prevent

acidosis. Intubation and oxygen respiration are also on

occasion necessary.

DOSAGE

Mode of Administration: Ma-Huang is administered as a

comminuted herb, as well as other galenic preparations for

internal use.

Daily Dosage: For adults, the average single dose is 15 to 30

mg total alkaloid, calculated as ephedrine, for a total dose of

120 mg per day. When used in children, single doses of herb

preparations corresponding to 0.5 mg total alkaloid per kg of

body weight are employed. The recommended daily dosage

for children is 2 mg.

Tea — Made with 1 to 4 gm, 3 times daily.

Ephedra tincture (1:1) — medium single dose 5 gm.

Ephedra extract — 1 to 3 ml 3 times daily.

Ephedra tincture (1:4) — 6 to 8 ml 3 times daily.

Storage: Ma-Huang must be protected from light.

LITERATURE

Gazaliev AM, Fazilov SD, Zhurinov MZ, Khim Prorod Soed

23:862-864. 1987.

Harada M, Nishimura M, J Pharm Dyn 4:691-699. 1981.

Further information in:

Hansel R, Keller K, Rimpler H, Schneider G (Hrsg.), Hagers

Handbuch der Pharmazeutischen Praxis, 5. Aufl., Bde 4-6

(Drogen), Springer Verlag Berlin, Heidelberg, New York, 1992-

1994.

Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3,

Nachdruck, Georg Olms Verlag Hildesheim 1979.

Roth L, Daunderer M, Kormann K, Giftpflanzen, Pflanzengifte,

4. Aufl., Ecomed Fachverlag Landsberg Lech 1993.
   Schulz R, Hansel R, Rationale Phytotherapie, Springer Verlag
   Heidelberg 1996.
   Steinegger E, Hansel R, Pharmakognosie, 5. Aufl., Springer
   Verlag Heidelberg 1992.
   Tang W, Eisenbrand G, Chinese Drugs of Plant Origin,
   Springer Verlag Heidelberg 1992.
   Teuscher E, Lindequist U, Biogene Gifte - Biologie, Chemie,
   Pharmakologie, 2. Aufl., Fischer Verlag Stuttgart 1994.
   Teuscher E, Biogene Arzneimittel, 5. Aufl., Wiss. Verlagsges.
   mbH Stuttgart 1997.
   Wagner H, Wiesenauer M, Phytotherapie. Phytopharmaka und
   pflanzliche Homoopathika, Fischer-Verlag, Stuttgart, Jena, New
   York 1995.