Dosage and Limitations of Sympathomimetics
Since the 1970s, many studies have examined the effects of ephedrine alone, or in combination with caffeine. The majority of these studies looked at the optimal dose for weight loss (ephedrine 20mg+caffeine 200mg). However, none of the studies were randomized with over 6 months of follow-up and sufficient population size. For these reasons, FDA did not approve E+C as an anti-obesity medication. Some scholars claimed that the weight loss effect of E+C formulation was due to appetite suppression rather than increased metabolism and heat generation.
Side Effects and Precautions of Sympathomimetic Drugs
Considering the E+C’s mechanism of action, cardiovascular side effects are expected. However, according to a 2003 study by Shekelle et al., the most common side effects are psychiatric such as hyperthymia, anxiety, restlessness, and depression, followed by autonomic nervous disorders such as mild convulsion and insomnia, as well as cardiovascular side effects such as palpitation and hypertension. In obese patients with hypertension responding well to previous therapy, an increased systolic pressure is seen in the early phase but it normalizes after four week and drops after eight weeks of therapy. Diabetic patients also tend to experience a rise in various markers, which normalize after 8 weeks of treatment. Therefore, the use of E+C is not too limited in obese patients with a controlled metabolic disorder.
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However, caution should be given to using E+C in patients with poorly controlled diabetes or hypertension. As it is used off-label, if clear benefits are not expected, it is advisable to not use the drug at all.
The plant Ephedra sinica Stapf. which contains ephedrine alkaloids is one of the most common herbal ingredients in oriental anti-obesity medicine. Therefore, it is also important to check the history of previous oriental medication and related symptoms. Discontinue medication or start at a very low dose if palpitation, orthostatic hypotension, severe insomnia and hypertension develop from treatment.
Advise the patient to not concurrently use oriental medication for weight loss along with E+C. The recently released oriental medicine called “Bang Pung Tong Seong San” contains similar ingredients and should not be used concurrently with E+C. Considering its mechanism of action, E+C should not be used concurrently with asthma medication such as theophylline.
-To be continued
