Re: Ephedra/ephedrine-exacerbated psychosis and Health Canada

The well-written case report on ephedra-exacerbated psychosis by Drs Bates and MacEwan [BCMJ 2012;54:465-467] provides another example of an adverse reaction to ephedra/ephedrine.

On 4 June 1997 the US Food and Drug Administration (FDA) first proposed some restrictions on the sale of dietary supplements containing ephed­rine alkaloids. This was followed by a complete ban in the US by the FDA in 2004 due to serious cardiovascular, central nervous system, and psychiatric adverse reactions, as well as deaths. After the US Supreme Court declined to hear the appeal from the manufacturer in 2007, dietary supplements containing ephedrine alkaloids were banned from the US market.

A resolution proposed by the Al­ternative Therapies and Allied Health Committee “to make the recent voluntary recall by Health Canada on certain natural health products containing ephedra/ephedrine compulsory” was passed at the 2002 BCMA Annual Meeting.

Health Canada intermittently issues stop-sale orders on dietary supplements that exceed the limits of its partial ban.[1] However, the current natural health product compliance guide on ephedra/ephedrine issued by Health Canada Natural Health Products Directorate is not more restrictive than those imposed by the US FDA 1997 proposal, some 15 years earlier.

For the health of Canadians, Health Canada should seriously consider a total ban on the sale of ephedra/ephedrine, similar to that of the US FDA, which was supported by the US Supreme Court. A total ban would prevent adverse reactions, especially in more vulnerable populations as noted by the authors. 
—H.C. George Wong, MD


1.    Wong HCG. Ephedrine: FDA and Health Canada. BCMJ 2011;53:262-263.

H.C. George Wong, MD, FRCPC. Re: Ephedra/ephedrine-exacerbated psychosis and Health Canada. BCMJ, Vol. 54, No. 10, December, 2012, Page(s) 493 - Letters.

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