Disease relevance of PSEUDOEPHEDRINE

• DATA EXTRACTION: Two reviewers independently identified trials of efficacy and safety of ephedra and ephedrine on weight loss or athletic performance; disagreements were resolved by consensus [1].
• Ephedrine and pseudoephedrine may also cause hypertension, as well as tachyarrhythmias due to beta-adrenergic stimulation [2].
• Sixteen asthmatic children between the ages of 7 and 13 years, 13 of whom were receiving theophylline orally around-the-clock, were studied for eight weeks in double-blind manner to evaluate efficacy, toxicity, and development of tolerance to the combination of ephedrine sulfate and theophylline [3].
• The bronchodilator effect of carbuterol hydrochloride, a new adrenergic agonist, was compared with that of ephedrine sulfate in 12 patients with bronchial asthma [4].
• Fluorescein leakage: First sign of juvenile diabetic retinopathy [5].

Psychiatry related information on PSEUDOEPHEDRINE

• This combination has not previously been reported with ephedrine abuse although it is well known with amphetamine abuse [6].
• Two patients had fatal intracranial hemorrhages after ingesting unknown quantities of ephedrine; one of them had a history of drug abuse, and one lacked a history of ephedrine use or drug abuse [7].
• OBJECTIVES: To evaluate the efficacy of a combination of ephedrine and caffeine on smoking cessation rates, postcessation weight gain, and withdrawal symptoms and to examine changes in glycosylated hemoglobin (HbA1c) after smoking cessation [8].
• 1 Ephedrine (3.1-50 mg/kg) was given intraperitoneally to rats and was found to cause a marked increase in spontaneous locomotor activity [9].
• Ephedrine induced dose-related stereotyped behavior in rats [10].

High impact information on PSEUDOEPHEDRINE

• JAMA patient page. Ephedra and ephedrine [11].
• Over-the-counter stimulants (phenylpropanolamine hydrochloride, ephedrine, pseudoephedrine, caffeine) are used widely as decongestants, anorectic agents, amphetamine substitutes, and "legal stimulants." Toxic effects may result from overdose, drug interactions, or diseases that increase sensitivity to sympathomimetic agents [2].
• A comparative study of bronchodilator effects of carbuterol and ephedrine [4].
• Ephedrine and postoperative hyperamylasaemia in obstetrics [12].
• Phenylephrine or ephedrine maintained a normal blood-pressure on standing but caused supine hypertension [13].

Chemical compound and disease context of PSEUDOEPHEDRINE

• Pooled results for trials comparing placebo with ephedrine (n = 5), ephedrine and caffeine (n = 12), ephedra (n = 1), and ephedra and herbs containing caffeine (n = 4) yielded estimates of weight loss (more than placebo) of 0.6 (95% confidence interval, 0.2-1.0), 1.0 (0.7-1.3), 0.8 (0.4-1.2), and 1.0 (0.6-1.3) kg/mo, respectively [1].
• Phenylephrine or ephedrine had some beneficial effect, but since all these drugs influence standing pressure only at the expense of pronounced supine hypertension, alternative therapy must be sought [13].
• Ventricular tachycardia occurred in three patients treated with terbutaline and in one patient with ephedrine [14].
• Clonidine was associated with sedation and a fall in blood pressure of greater than 20 mm Hg in all patients, 1 patient required ephedrine to treat hypotension [15].
• Reduced adipsin expression in murine obesity: effect of age and treatment with the sympathomimetic-thermogenic drug mixture ephedrine and caffeine [16].

Biological context of PSEUDOEPHEDRINE

• The two strongest agonists, epinephrine and fenoterol, provoked 11-13-fold increases in the level of betaAR phosphorylation after just 1 min, whereas the weak agonists dobutamine and ephedrine caused only 3-4-fold increases, similar to levels induced by cAMP-dependent protein kinase activation with forskolin [17].
• RESULTS--While a strong statistical correlation was found over time, with minimal increases in mean arterial pressure and heart rate, pseudoephedrine administration did not result in statistically significant changes in any cardiovascular parameter [18].
• Aspirin as a promoter of ephedrine-induced thermogenesis: potential use in the treatment of obesity [19].
• In contrast, treatment with ephedrine alone caused losses of 14% in body weight and 42% in body fat, effects brought about mainly by a 10% increase in energy expenditure [20].
• After 4 and 12 wk of treatment ephedrine elicited a more sustained response, the extra oxygen consumption in the 3 h following ephedrine intake being 7.0 and 6.9 1, respectively [21].

Anatomical context of PSEUDOEPHEDRINE

• To assess the effects of ephedrine on cardiac autonomic control, baroreceptor reflex sensitivity (BRS), heart rate (HR) variability, HR response to acute myocardial ischemia, and resting catecholamines were measured before and after ephedrine [22].
• Ephedrine-induced intracerebral hemorrhage and central nervous system vasculitis [23].
• Therefore, ephedrine is not a direct beta-adrenergic agonist on human peripheral blood lymphocytes [24].
• The authors recorded visual analog pain score (VAPS), maternal blood pressure and heart rate, ephedrine requirements, and sedation at regular intervals and fetal heart rate tracings continuously [25].
• Coronary artery spasm after ephedrine in a patient with high spinal anesthesia [26].

Associations of PSEUDOEPHEDRINE with other chemical compounds

• On the other hand, intravenous norepinephrine and oral ephedrine blunted the CSM-induced drop in systolic pressure (CSM with norepinephrine, -19 +/- 12 mm Hg; CSM with ephedrine, -21 +/- 11 mm Hg; both p less than .01 vs atrioventricular sequential pacing alone) [27].
• Midodrine significantly increased both systolic (P < 0.001) and diastolic (P < 0.001) standing blood pressure over placebo (P < 0.001) and ephedrine (P < 0.05) [28].
• While urinary pH remained alkaline, renal excretion of pseudoephedrine and its metabolite, norpseudoephedrine, was directly correlated with the flow rate of urine in each subject [29].
• An additional increase of FEV above baseline of 23% for terbutaline and 12% for ephedrine was noted after daily medication [30].
• RESULTS: Herbal asthma self-treatment was reported by 46 (8%; 95% confidence interval [CI] 6% to 10%); coffee or black tea self-treatment by 36 (6%; 95% CI 4% to 8%), epinephrine or ephedrine OTC use by 36 (6%; 95% CI 4% to 8%), and any of the three practices by 98 subjects (16%; 95% CI 13% to 19%) [31].

Gene context of PSEUDOEPHEDRINE

• The initial levels (2 min) of a range of agonist-stimulated GRK site phosphorylations were correlated with their efficacy for activation of adenylyl cyclase, namely epinephrine > or = formoterol = fenoterol > terbutaline = zinterol = albuterol > salmeterol > dobutamine > or = ephedrine [32].
• Contribution of beta 3-adrenoceptor activation to ephedrine-induced thermogenesis in humans [33].
• DESIGN: Three doses (2.5, 5 and 10 mg) of nadolol were used to estimate what fraction of the thermogenic response to ephedrine (30 mg) remained after inhibition of beta 1- and beta 2-adrenoceptor mediated responses [33].
• For rhinosinusitis subjects, the amount of CGRP and VIP during attacks returned to baseline values following treatment with pseudoephedrine and relief of symptoms [34].
• Immunohistochemistry was used to determine the alteration of NMDA receptor density in rat hippocampus and dentate gyrus following acute and chronic pseudoephedrine administration [35].

Analytical, diagnostic and therapeutic context of PSEUDOEPHEDRINE

• Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis [1].
• CONCLUSIONS: Ephedrine and ephedra promote modest short-term weight loss (approximately 0.9 kg/mo more than placebo) in clinical trials [1].
• Intracerebral hemorrhage occurred in a 20-year-old man following self-administration of ephedrine [6].
• METHODS--Volunteers (N = 28) with controlled hypertension participated in a randomized, double-blind, placebo-controlled, crossover study that examined the cardiovascular effects of 120 mg of sustained-release pseudoephedrine taken on a twice daily basis [18].
• Self-medication with pseudoephedrine in a chronically depressed patient [36].

References