Ephedrine

Ephedrine is a central nervous system stimulant used to treat low blood pressure problems (hypotension). Ephedrine is also used to treat breathing problems (as a bronchodilator), nasal congestion (as a decongestant), myasthenia gravis, narcolepsy, menstrual problems (dysmenorrhea), or urine-control problems.

Ephedrine is available under the following different brand names: Akovaz, and Corphedra.

Dosage Forms and Strengths

Injectable Solution

• 50mg/mL (ephedrine sulfate [38mg/mL ephedrine base])

Dosage Considerations – Should be Given as Follows:

Hypotension

• Indicated for the treatment of clinically important hypotension occurring in the setting of anesthesia
• Initial dose: 5-10 mg intravenous (IV) bolus (must dilute)
• Administer additional boluses as needed, not to exceed a total cumulative dosage of 50 mg
• Adjust dosage according to the blood pressure goal

Dosing Considerations

• Pediatric: Safety and efficacy not established
• Geriatric: Start at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy
• Drug is substantially excreted by the kidney, and the risk of adverse reactions may be greater with impaired renal function
• Because elderly patients are more likely to have decreased renal function, carefully select dose and consider monitoring renal function

Side effects of ephedrine include:

• Anxiety
• Difficult or painful urination
• Dizziness
• Fast heart rate
• Headache
• Heart rhythm/rate variability
• Loss of appetite
• Nausea
• Nervousness
• Palpitations (thumping heart)
• Reactive high blood pressure (hypertension)
• Restlessness
• Slow heart rate
• Spinning sensation (vertigo)
• Sweating
• Trouble sleeping (insomnia)
• Ventricular ectopic beats
• Vomiting
• Weight loss

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe Interactions of ephedrine include:
  • iobenguane I 123
  • isocarboxazid
  • linezolid
  • phenelzine
  • procarbazine
  • rasagiline
  • selegiline
  • selegiline transdermal
  • tranylcypromine
• Ephedrine has serious interactions with at least 29 different drugs.
• Ephedrine has moderate interactions with at least 263 different drugs.
• Mild Interactions of ephedrine include:
  • bendroflumethiazide
  • bumetanide
  • chlorothiazide
  • chlorthalidone
  • cyclopenthiazide
  • desmopressin
  • ethacrynic acid
  • eucalyptus
  • furosemide
  • hydrochlorothiazide
  • indapamide
  • methyclothiazide
  • metolazone
  • noni juice
  • sage
  • torsemide
• Ephedrine has moderate interactions with at least 108 different drugs.
• Mild Interactions of ephedrine include:
  • amikacin
  • digoxin
  • dimenhydrinate
  • donepezil
  • galantamine
  • gentamicin
  • kanamycin
  • neomycin
  • netilmicin
  • paromomycin
  • streptomycin
  • tacrine
  • tobramycin

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

Warnings

This medication contains ephedrine. Do not take Akovaz or Corphedra if you are allergic to ephedrine or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• None

Effects of Drug Abuse

• None

Short-Term Effects

• See "What Are Side Effects Associated with Using Ephedrine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Ephedrine?"

Cautions

• Serious postpartum hypertension and stroke have been described with co-administration of a vasopressor (i.e., methoxamine, phenylephrine, ephedrine) and an oxytocic (i.e., methylergonovine, ergonovine); monitor blood pressure if patient has received both ephedrine and an oxytocic
• Repeated administration can result in tolerance and tachyphylaxis; an alternative vasopressor may be needed to mitigate unresponsiveness to treatment
• When used to prevent hypotension, ephedrine has been associated with an increased incidence of hypertension compared with when ephedrine is used to treat hypotension

Pregnancy and Lactation

Ephedrine crosses the placenta; it is used at delivery for prevention and/or treatment of maternal low blood pressure (hypotension) associated with spinal anesthesia.

Fetal/neonatal adverse reactions:

• Cases of potential metabolic acidosis in newborns at delivery with maternal ephedrine exposure have been reported in the literature
• These reports describe umbilical artery pH of 7.2 or greater at the time of delivery
• Monitor newborn for signs and symptoms of metabolic acidosis
• Monitoring of infant's acid-base status is warranted to ensure that an episode of acidosis is acute and reversible

It is unknown if ephedrine is excreted in breast milk; consult your doctor before breastfeeding.