Ephedra 245878 221187450 2008-06-23T12:38:50Z John Nevard 5585333 /* Effects and uses */ {{Otheruses4|the use of species of ''Ephedra'' in medicine|botanical information|Ephedra (genus)}} {{For|the prescription medication ephedrine|ephedrine}} {{globalize}} [[Image:EphedrineInBottles.jpg|thumb|Bottle of Ephedrine, an alkaloid found in Ephedra]] '''Ephedra''' refers to the plant ''[[Ephedra sinica]]''.<ref name=Gurley_1998>{{cite journal |author=Gurley B, Wang P, Gardner S |title=Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (Ma-huang) as determined by high performance liquid chromatography |journal=J Pharm Sci |volume=87 |issue=12 |pages=1547–53 |year=1998 |pmid=10189265 |doi=10.1021/js9801844}}</ref> ''E. sinica'', known in Chinese as '''ma huang''' ([[wikt:麻|麻]][[wikt:黃|黃]]; pinyin: má huáng), has been used in [[traditional Chinese medicine]] for 5,000 years for the treatment of [[asthma]] and [[hay fever]], as well as for the [[common cold]].<ref name=Abourashed_2003>{{cite journal |author=Abourashed E, El-Alfy A, Khan I, Walker L |title=Ephedra in perspective--a current review |journal=Phytother Res |volume=17 |issue=7 |pages=703–12 |year=2003 |pmid=12916063 |doi=10.1002/ptr.1337}}</ref> Several additional species belonging to the [[genus]] ''[[Ephedra (genus)|Ephedra]]'' have traditionally been used for a variety of medicinal purposes, and are a possible candidate for the [[Soma]] plant of [[Indo-Iranian]] religion.<ref>[http://www.iranica.com/articles/v11f6/v11f6059a.html#i Botany of Haoma], from [[Encyclopedia Iranica]]. Accessed [[March 15]] [[2007]].</ref> [[Native Americans in the United States|Native Americans]] and [[Mormon]] pioneers drank a tea brewed from an ''Ephedra,'' called '''Mormon Tea'''. In recent years, the safety of ephedra-containing [[dietary supplement]]s has been questioned by the [[United States]] [[Food and Drug Administration]] (FDA), the [[National Center for Complementary and Alternative Medicine]], and the medical community as a result of a high rate of serious side effects and ephedra-related deaths.<ref name=Haller_2000>{{cite journal |author=Haller C, Benowitz N |title=Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids |journal=N Engl J Med |volume=343 |issue=25 |pages=1833–8 |year=2000 |pmid=11117974 |doi=10.1056/NEJM200012213432502}}</ref><ref name=Bent_2003>{{cite journal |author=Bent S, Tiedt T, Odden M, Shlipak M |title=The relative safety of ephedra compared with other herbal products |journal=Ann Intern Med |volume=138 |issue=6 |pages=468–71 |year=2003 |pmid=12639079}}</ref><ref name="nccam">{{cite web | title = National Center for Complementary and Alternative Medicine Consumer Advisory on ephedra | date = 2004-10-01 | url = http://nccam.nih.gov/health/alerts/ephedra/consumeradvisory.htm | accessdate = 2007-02-13}} ]</ref><ref name="fdamain">{{cite web | title = Food and Drug Administration summary of actions regarding sale of ephedra supplements | url = http://www.fda.gov/oc/initiatives/ephedra/february2004/ | accessdate = 2007-02-13}}</ref><ref name="webmd">[http://www.webmd.com/hw/alternative_medicine/tp21143.asp WebMD page on ephedra supplements]. Accessed 7 Feb 2007.</ref> In response to accumulating evidence of adverse effects and deaths related to ephedra, the FDA banned the sale of ephedra-containing supplements on [[April 12]] [[2004]].<ref name="fdaban">[http://www.fda.gov/bbs/topics/NEWS/2004/NEW01050.html FDA Final Rule Banning Dietary Supplements With Ephedrine Alkaloids Becomes Effective]. Accessed from FDA website 7 Feb 2007.</ref> A suit by an ephedra manufacturer was upheld by a [[United States district court|Federal District Court]] judge in [[Utah]] on [[April 14]] [[2005]]. <ref>[http://www.mayoclinic.com/health/ephedra/NS_patient-ephedra "Ephedra", from MayoClinic.com]. Accessed 7 Feb 2007.</ref> The FDA appealed this ruling, and on [[August 17]] [[2006]] the [[U.S. Court of Appeals for the Tenth Circuit]] upheld the FDA's ban of ephedra.<ref name="fdaappeal">[http://www.fda.gov/bbs/topics/NEWS/2006/NEW01434.html FDA Statement on 10th Circuit Court's ruling to uphold ban of ephedra]</ref> The sale of ephedra-containing dietary supplements remains illegal in the United States due to evidence of adverse ephedra-related effects. ==Ephedra biochemistry== The [[alkaloid]]s [[ephedrine]] and [[pseudoephedrine]] are the active constituents of the plant. Pseudoephedrine is used in [[Over-the-counter drug|over-the-counter]] [[decongestants]]. Derivatives of ephedrine are used to treat [[hypotension|low blood pressure]], but alternatives with reduced cardiovascular risk have replaced it for treating [[asthma]]. Ephedrine is also considered a [[performance-enhancing drug]] and is prohibited in most competitive sports. Some species in the ''Ephedra'' genus have no alkaloid content and are therefore essentially inert; however, the most commonly used species, ''E. sinica'', has a total alkaloid content of 1–3% by dry weight. Ephedrine constitutes 40–90% of the alkaloid content, with the remainder consisting of pseudoephedrine and the demethylated forms of each compound.<ref>[http://www.hsph.harvard.edu/Organizations/DDIL/ephedrine.html Adverse Effects of Botanical and Non-Botanical Ephedrine Products], from the [[Harvard School of Public Health]]. Published 1997. Accessed 7 Feb 2007.</ref> ==Effects and uses== Ephedra is both a [[stimulant]] and a [[thermogenic]]; its biological effects are due to its ephedrine and pseudoephedrine content.<ref>{{cite journal |author=Abourashed E, El-Alfy A, Khan I, Walker L |title=Ephedra in perspective--a current review |journal=Phytother Res |volume=17 |issue=7 |pages=703–12 |year=2003 |pmid=12916063 |doi=10.1002/ptr.1337}}</ref> These compounds stimulate the brain, increase [[heart rate]], constrict blood vessels (increasing [[blood pressure]]), and expand bronchial tubes (making breathing easier). Their thermogenic properties cause an increase in metabolism, evidenced by an increase in body heat. In traditional [[Chinese herbology]], ''E. sinica'' is included in many herbal formulas used to treat cold and flu such as 麻黃湯 ''ma huang tang'' (ephedra decoction) or 麻杏石甘湯 ''ma xing shi gan tang'' (ephedra, apricot kernel, gypsum, and licorice decoction). Ephedra is used therapeutically as a [[diaphoretic]] to help expel exterior pathogens and regulate the proper functioning of the lungs.<ref>[http://www.holistic-online.com/Herbal-Med/_Herbs/h53.htm Ephedra, Mahuang, Ma Huang, desert tea, Mormon tea, American ephedra, Chinese ephedra, European ephedra, Pakistani ephedra, Ephedra sinica, Ephedra intermedia, Ephedra equisetina, Ephedra distacha, Ephedra trifurca<!-- Bot generated title -->]</ref> Ephedra is widely used by athletes,<ref>{{cite journal |author=Bents R, Marsh E |title=Patterns of ephedra and other stimulant use in collegiate hockey athletes |journal=Int J Sport Nutr Exerc Metab |volume=16 |issue=6 |pages=636–43 |year=2006 |pmid=17342884}}</ref> despite a lack of evidence that it enhances athletic performance.<ref>{{cite journal |author=Bohn A, Khodaee M, Schwenk T |title=Ephedrine and other stimulants as ergogenic aids |journal=Curr Sports Med Rep |volume=2 |issue=4 |pages=220–5 |year=2003 |pmid=12834578 |doi=10.1007/s11932-003-0009-2}}</ref><ref>{{cite journal |author=Calfee R, Fadale P |title=Popular ergogenic drugs and supplements in young athletes |journal=Pediatrics |volume=117 |issue=3 |pages=e577–89 |year=2006 |pmid=16510635 |doi=10.1542/peds.2005-1429}}</ref> Ephedra may also be used as a precursor in the illicit manufacture of [[methamphetamine]].<ref>{{cite journal |author=Barker W, Antia U |title=A study of the use of Ephedra in the manufacture of methamphetamine |journal=Forensic Sci Int |volume=166 |issue=2-3 |pages=102–9 |year=2007 |pmid=16707238 |doi=10.1016/j.forsciint.2006.04.005}}</ref> Ephedra has also been used for weight loss, sometimes in combination with [[aspirin]] and [[caffeine]]. Some studies have shown that ephedra, when taken in a regulated and supervised environment, is effective for marginal short-term weight loss (0.9kg/month more than the placebo), although it is unclear whether such weight loss is maintained.<ref>{{cite journal |author=Boozer C, Daly P, Homel P, Solomon J, Blanchard D, Nasser J, Strauss R, Meredith T |title=Herbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trial |journal=Int J Obes Relat Metab Disord |volume=26 |issue=5 |pages=593–604 |year=2002 |pmid=12032741 |doi=10.1038/sj.ijo.0802023}}</ref> However, several reports have documented the large number of [[adverse event]]s attributable to unregulated ephedra supplements.<ref>{{cite journal |author=Woolf A, Watson W, Smolinske S, Litovitz T |title=The severity of toxic reactions to ephedra: comparisons to other botanical products and national trends from 1993-2002 |journal=Clin Toxicol (Phila) |volume=43 |issue=5 |pages=347–55 |year=2005 |pmid=16235509}}</ref> [[Side effects]] of ephedra may include severe skin reactions, irritability, nervousness, dizziness, trembling, [[headache]], [[insomnia]], profuse perspiration, [[dehydration]], itchy scalp and skin, vomiting, [[hyperthermia]], [[arrhythmia|irregular heartbeat]], [[seizure]]s, [[myocardial infarction|heart attack]], [[stroke]], or [[death]].<ref>[http://www.mskcc.org/mskcc/html/69213.cfm Ephedra information] from [[Memorial Sloan-Kettering Cancer Center]]. Accessed [[April 11]] [[2007]].</ref> ==Purity and dosage== There are no formal requirements for [[standardization]] or [[quality control]] of dietary supplements in the United States, and the dosage of effective ingredients in supplements may vary widely from brand to brand or batch to batch.<ref name="salon">[http://archive.salon.com/health/feature/2000/06/07/ephedra/index.html "Swallowing Ephedra"], by Sharon Brownlee. Published online at [[Salon.com]] on [[June 7]] [[2000]]. Accessed 8 Feb 2007.</ref><ref>[http://dietary-supplements.info.nih.gov/factsheets/dietarysupplements.asp Dietary Supplements: Background Information]. From the Office of Dietary Supplements at the [[National Institutes of Health]]. Accessed 7 Feb 2007.</ref><ref>Herbal Rx: the promise and pitfalls. ''[[Consumer Reports]]'', 1999, pp 44–48.</ref> Studies of ephedra supplements have found significant discrepancies between the labeled dose and the actual amount of ephedra in the product. Significant variation in ephedrine alkaloid levels, by as much as 10-fold, was seen even from lot to lot within the same brand.<ref>{{cite journal |author=Haller C, Duan M, Benowitz N, Jacob P |title=Concentrations of ephedra alkaloids and caffeine in commercial dietary supplements |journal=J Anal Toxicol |volume=28 |issue=3 |pages=145–51 |year=2004 |pmid=15107143}}</ref><ref>{{cite journal |author=Gurley B, Gardner S, Hubbard M |title=Content versus label claims in ephedra-containing dietary supplements |journal=Am J Health Syst Pharm |volume=57 |issue=10 |pages=963–9 |year=2000 |pmid=10832496}}</ref> ==Safety and regulatory actions in the United States== Escalating concerns regarding the safety of ephedra supplements led the FDA to ban the sale of ephedra-containing supplements in the United States in 2004. This ban was challenged by supplement manufacturers and initially overturned, but ultimately upheld. ===Initial concerns and supplement industry response=== In 1997, in response to mounting concern over serious side effects of ephedra, the FDA proposed a ban on products containing 8 mg or more of ephedrine alkaloids and stricter labeling of low-dose ephedra supplements. The FDA also proposed that ephedra labels be required to disclose the health risks of ephedra, such as [[myocardial infarction|heart attack]], [[stroke]], or death.<ref>[http://www.cfsan.fda.gov/~lrd/fr97064a.html "Dietary Supplements Containing Ephedrine Alkaloids; Proposed Rule"], from the [[Federal Register]], [[June 4]] [[1997]]. Accessed 7 Feb 2007.</ref> In response, the supplement industry created a [[public relations]] group, the Ephedra Education Council, to oppose the changes, and commissioned a scientific review by a private consulting firm, which reported that ephedra was safe.<ref name="consumerreports">[http://www.consumerreports.org/cro/health-fitness/drugs-supplements/dangerous-supplements-504/overview/index.htm "Dangerous supplements: Still at large"], from ''[[Consumer Reports]]'' magazine. Published May 2004, accessed 7 Feb 2007.</ref> The Ephedra Education Council also attempted to block publication of a study confirming wide discrepancies between the labeled potency of supplements and the actual amount of ephedra in the product.<ref name="salon"/> During this time, [[Metabolife]], makers of the best-selling brand of ephedra supplement, had received over 14,000 complaints of adverse events associated with its product; these reports were not provided to the FDA.<ref name="consumerreports"/><ref>[http://www.usatoday.com/news/health/2002-08-15-ephedra_x.htm Criminal investigation sought for diet supplement seller], published in ''[[USA Today]]'' on [[August 15]] [[2002]]. Accessed [[April 10]] [[2007]].</ref> Co-founder of Metabolife, [[Michael J. Ellis]], has been sentenced to six months in Federal prison for his failure to report adverse effects from his company's products to the FDA.<ref>[http://www.10news.com/news/16554203/detail.html Metabolife Founder Sentenced For Lying To FDA]</ref> Senators [[Orrin Hatch]] and [[Tom Harkin]], authors of the Dietary Supplements Health and Education Act, questioned the scientific basis for the FDA's proposed labeling changes and suggested that the number of problems reported were insufficient to warrant regulatory action. At the time, Hatch's son was working for a firm hired to [[lobbying|lobby]] Congress and the FDA on behalf of ephedra manufacturers.<ref name="latimes">[http://pqasb.pqarchiver.com/latimes/access/300234371.html?dids=300234371:300234371&FMT=ABS&FMTS=ABS:FT&type=current&date=Mar+5%2C+2003&author=Chuck+Neubauer%2C+Judy+Pasternak+and+Richard+T.+Cooper&pub=Los+Angeles+Times&edition=&startpage=A.1&desc=The+Nation "Senator, His Son Get Boosts From Makers of Ephedra"], published in the [[Los Angeles Times]] on [[March 5]] [[2003]]. Purchase required to view full text. Accessed 7 Feb 2007.</ref> In addition to the activities of the Ephedra Education Council, Metabolife spent more than $4 million between 1998 and 2000 lobbying against state regulation of ephedra in Texas.<ref name="sciencewolfe">{{cite journal |author=Wolfe S |title=Medicine. Ephedra--scientific evidence versus money/politics |journal=Science |volume=300 |issue=5618 |pages=437 |year=2003 |pmid=12702860 |doi=10.1126/science.1081910}}</ref> ''[[Business Week]]'' reported that efforts to regulate ephedra and other potentially harmful supplements had been "beaten down by deep-pocketed industry lobbying."<ref name="bw">[http://www.businessweek.com/magazine/content/02_35/b3797051.htm "Diet Pills and Pols: A Dangerous Mix"], by Arlene Weintraub and John Carey. Published in ''[[Business Week]]'' on [[September 2]] [[2002]]. Accessed [[March 31]] [[2007]].</ref> Ultimately, in 2000, the FDA withdrew the proposed labeling changes and restrictions.<ref>[http://www.cfsan.fda.gov/~lrd/fr00043a.html "Dietary Supplements Containing Ephedrine Alkaloids; Withdrawal in Part"], from the [[Federal Register]], [[April 3]] [[2000]]. Accessed 7 Feb 2007.</ref> ===Additional evidence=== A review of ephedra-related adverse reactions, published in the ''[[New England Journal of Medicine]]'' in 2000, found a number of cases of [[sudden cardiac death]] or severe disability resulting from ephedra use, many of which occurred in young adults using ephedra in the labeled dosages.<ref name=Haller_2000 /> Subsequently, in response to pressure from the [[consumer advocacy]] group [[Public Citizen]],<ref name="bw"/> Metabolife was compelled by the [[United States Department of Justice|Department of Justice]] in 2002 to turn over reports of over 15,000 ephedra-related adverse events, ranging from [[insomnia]] to death, which the company had previously withheld from the FDA.<ref name="npr2002">[http://www.npr.org/templates/story/story.php?storyId=850679 "The Secret of Ephedra's Questionable Success"]. A report on "All Things Considered", [[National Public Radio]], [[November 22]] [[2002]]. Accessed 7 Feb 2007.</ref><ref name="consumerreports"/> Use of ephedra was considered to have possibly contributed to the death of [[Minnesota Vikings]] [[offensive lineman]] [[Korey Stringer]] from [[heatstroke]] in 2001.<ref name="stringer">[http://sportsillustrated.cnn.com/football/news/2003/02/25/stringer_ephedra_ap/ Vikings: Stringer's use of ephedra contributed to death], published online by ''[[Sports Illustrated]]'' on [[February 25]] [[2003]]. Accessed [[March 15]] [[2007]].</ref> ===Death of Steve Bechler=== [[Steve Bechler]], a [[pitcher (baseball)|pitcher]] for the [[Baltimore Orioles]], died of complications from heatstroke following a [[spring training]] workout on [[February 17]] [[2003]]. The [[medical examiner]] found that ephedra toxicity played a "significant role" in Bechler's sudden death.<ref>[http://www.usatoday.com/sports/baseball/al/orioles/2003-03-13-bechler-exam_x.htm "Medical examiner: Ephedra a factor in Bechler death"], from [[USA Today]], published [[March 13]] [[2003]]. Accessed 7 Feb 2007.</ref> Following Bechler's death, the FDA re-opened its efforts to regulate ephedra use. According to Bruce Silverglade, legal director for the [[Center for Science in the Public Interest]], "All of a sudden [after Bechler's death] Congress dropped objections to an ephedra ban and started demanding the FDA act."<ref name="consumerreports"/> Senator [[Orrin Hatch]], who in 1999 had helped block the FDA's attempts to regulate ephedra, said in March 2003 that "...it has been obvious to even the most casual observer that problems exist," and called FDA action to regulate ephedra "long overdue."<ref name="latimes"/> Given Hatch's prior defense of ephedra, ''[[Time (magazine)|Time]]'' described his statement as "a dazzling display of hypocrisy."<ref>[http://www.time.com/time/columnist/jaroff/article/0,9565,429341,00.html "It's Time To Rethink Ephedra Regulation"], by Leon Jaroff. Published in ''[[Time (magazine)|Time]]'' on [[March 5]] [[2003]]. Accessed [[March 31]] [[2007]].</ref> ===Ephedra banned=== In response to renewed calls for the regulation of ephedra, the FDA commissioned a large [[meta-analysis]] of ephedra's safety and efficacy by the [[RAND Corporation]]. This study found that while ephedra promoted modest short-term weight loss, there was no evidence that it was effective for long-term weight loss or performance enhancement. The use of ephedra in this study was associated with significant gastrointestinal, psychiatric, and [[autonomic nervous system|autonomic]] side effects.<ref name="rand">{{cite journal |author=Shekelle P, Hardy M, Morton S, Maglione M, Mojica W, Suttorp M, Rhodes S, Jungvig L, Gagné J |title=Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis |journal=JAMA |volume=289 |issue=12 |pages=1537–45 |year=2003 |pmid=12672771 |doi=10.1001/jama.289.12.1537}}</ref> Almost simultaneously, a study in ''[[Annals of Internal Medicine]]'' found that ephedra was 100 to 700 times more likely to cause a significant adverse reaction than other commonly used supplements such as [[kava]] or [[Ginkgo biloba]].<ref name=Bent_2003/> On [[December 30]] [[2003]], the FDA issued a [[press release]] recommending that consumers stop buying and using ephedra, and indicating its intention to ban the sale of ephedra-containing supplements.<ref>[http://www.fda.gov/oc/initiatives/ephedra/december2003/ "FDA Announces Plans to Prohibit Sales of Dietary Supplements Containing Ephedra"]: Press release from the FDA website, issued [[December 30]] [[2003]], accessed 7 Feb 2007.</ref> Subsequently, on [[April 12]] [[2004]], the FDA issued a final rule banning the sale of ephedra-containing dietary supplements. [[Tommy Thompson]], the [[Secretary of Health and Human Services]], stated that "...These products pose unacceptable health risks, and any consumers who are still using them should stop immediately."<ref name="fdaban"/> ===Legal challenges=== Nutraceutical Corporation, a supplement manufacturer based in [[Park City, Utah]], challenged the legality of the FDA's ban of ephedra as exceeding the authority given the agency by the Dietary Health Supplements and Education Act. Nutraceutical Corporation stated that they did not intend to start marketing ephedra, but were concerned about the scope of the FDA's regulatory action. Judge Tena Campbell of the Utah [[Federal District Court]] ruled that the FDA had not proven that low doses of ephedra were unsafe, although she also noted that studies to address the safety of low-dose ephedra would be [[medical ethics|unethical]]. Nevertheless, her ruling overturned the ban on the sale of ephedra in the state of Utah, and called into question whether the ban could be enforced anywhere in the United States.<ref name="nytimes">[http://query.nytimes.com/gst/fullpage.html?res=9C04E0DF113EF936A25757C0A9639C8B63&sec=health&pagewanted=print "Judge's Decision Lifts Ban On Sale of Ephedra in Utah"], from the ''[[New York Times]]'', published [[April 15]] [[2005]]. Accessed 7 Feb 2007.</ref> The ruling was appealed to the [[U.S. Court of Appeals for the Tenth Circuit]] in [[Denver, Colorado]]. On [[August 17]] [[2006]], the Appeals Court upheld the FDA's ban of ephedra, finding that the 133,000-page administrative record compiled by the FDA supported the agency's finding that ephedra posed an unreasonable risk to consumers.<ref name="fdaappeal"/> Nutraceutical Corp. filed a petition for a [[writ of certiorari]] seeking a rehearing on the ban of ephedra; however, on [[May 14]] [[2007]] the [[United States Supreme Court]] declined to hear this petition. The sale of ephedra-containing dietary supplements remains illegal in the United States.<ref name="fdamain"/> ==Use in sports== Ephedrine is listed as a [[Doping (sport)|banned substance]] by both the [[International Olympic Committee]] and the [[World Anti-Doping Agency]].<ref>{{PDFlink|[http://www.wada-ama.org/rtecontent/document/Prohibited_List_2006_EN_FR_SP.pdf World Anti-Doping Agency Prohibited List, 2006].|1.50&nbsp;[[Mebibyte|MiB]]<!-- application/pdf, 1577958 bytes -->}} Accessed [[March 15]] [[2007]].</ref> The U.S. [[National Football League]] banned players from using ephedra as a dietary supplement in 2001 after the death of [[Minnesota Vikings]] [[offensive tackle]] [[Korey Stringer]]; ephedra was found in Stringer's locker and lawyers for the team contend that it contributed to his death.<ref name="stringer"/><ref name="sauerbrun">[http://www.denverpost.com/sports/ci_4022235%20Todd%20Sauerbrun Sauerbrun fails test: Broncos punter faces suspension for use of ephedra], by Bill Williamson. Published in the ''[[Denver Post]]'' on [[July 6]] [[2006]]. Accessed [[March 15]] [[2007]].</ref> The substance is also banned by the [[National Basketball Association]].<ref name="nytimes"/> Nonetheless, ephedra remains widely used by athletes; a 2006 survey of collegiate hockey players found that nearly half had used ephedra in the belief it would enhance athletic performance.<ref>{{cite journal |author=Bents R, Marsh E |title=Patterns of ephedra and other stimulant use in collegiate hockey athletes |journal=Int J Sport Nutr Exerc Metab |volume=16 |issue=6 |pages=636–43 |year=2006 |pmid=17342884}}</ref> ===Prominent cases of ephedra use=== In the 1994 [[Football World Cup|FIFA World Cup]], the [[Argentina|Argentine]] footballer [[Diego Maradona|Diego Armando Maradona]] tested positive for ephedrine.<ref>[http://news.bbc.co.uk/sport2/hi/football/3639425.stm "Maradona's fall from grace"], by John May. From the [[BBC]], published [[April 19]] [[2004]]. Accessed [[March 15]] [[2007]].</ref> The [[Japan]]ese [[motorcycle]] racer [[Noriyuki Haga]] tested positive for it in 2000, being disqualified from two races and banned from two more as a result.<ref>[http://www.motorcycledaily.com/24may00hagasaga.html "Haga Saga"], by Dirck Edge. From motorcycledaily.com, [[May 24]] [[2000]]. Accessed [[March 15]] [[2007]].</ref> NFL [[Punter (football position)|punter]] [[Todd Sauerbrun]] of the [[Denver Broncos]] was suspended for the first month of the 2006 season after testing positive for ephedra.<ref name="sauerbrun"/> ==See also== * [[Chinese medicine]] * [[Sida cordifolia]] * [[Pinellia]] * [[Synephrine]] ==References== <!-- --------------------------------------------------------------- See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a discussion of different citation methods and how to generate footnotes using the <ref> & </ref> tags and the {{Reflist}} template -------------------------------------------------------------------- --> {{Reflist|2}} ==External links== *[http://www.cfsan.fda.gov/~dms/ds-ephed.html United States FDA] links to actions *[http://www.fda.gov/oc/initiatives/ephedra/february2004/ FDA Rule] *[http://ods.od.nih.gov/factsheets/ephedraandephedrine.asp United States NIH Factsheet] regarding weight loss and athletic performance *[http://www.health.state.ny.us/regulations/task_force/docs/dietary_supplement_safety.pdf Dietary Supplements: Balancing Consumer Choice and Safety]. A report of the New York State Task Force on Life & the Law. [[Category:Dietary supplements]] [[Category:Herbal and fungal stimulants]] [[Category:Traditional Chinese medicine]] [[Category:Drugs in sport]] [[Category:Withdrawn drugs]] [[Category:Amphetamine alkaloids]] [[da:Efedrin]] [[de:Ephedrin]] [[es:Efedrina]] [[fr:Éphédrine]] [[it:Efedrina]] [[nl:Efedrine]] [[ja:エフェドリン]] [[pl:Efedryna]] [[pt:Efedrina]] [[ru:Эфедрин]] [[sk:Efedrín]] [[fi:Efedriini]] [[sv:Efedrin]] [[zh:麻黄]]