EPHEDRINE Drug Class: CNS stimulant Ephedrine is a naturally occuring central nervous system stimulant obtained from the plant _Ephedra equisetina_. It is now also produced by chemical synthesis, the synthetic product being marketed in the form of its salt, ephedrine sulfate; it occurs as a white crystalline powder with a bitter taste, soluble in water and very soluble in alcohol. Ephedrine is closely related in structure to methamphetamine, although its CNS actions are much less potent and also longer-acting than those of the amphetamines. Its peripheral stimulant actions are similar to but less powerful than those of epinephrine (also called adrenaline), a hormone produced in the body by the adrenal glands. Ephedrine has moderately potent bronchial muscle relaxant properties, and therefore is used for symptomatic relief in milder cases of asthmatic attack; it is also used to reduce the risk of acute attacks in the treatment of chronic asthma. The typical adult dose range is 30-60 mg taken orally, three to four times per day, in the form of tablets. Ephedrine in the form of nose drops is also widely used to relieve nasal congestion associated with upper respitory tract illnesses. It is also used to treat low blood pressure, because it constricts blood vessels and stimulates certain actions of the heart. Common side effects are qualitatively similar to those produced by amphetamines and are generally milder. Higher doses (overdose) can cause restlessness and anxiety, dizziness, insomnia, tremor, rapid pulse, sweating, respiratory difficulties, confusion, hallucinations, delerium, and (very infrequently) convulsions. The most dangerous symptoms of overdose are abnormally high blood pressure and rapid, irregular heartbeat. A dose of ephedrine only two to three times the theraputic maximum can cause a significant increase in blood pressure. The elderly are particularly sensitive to overdose, and there have been a few deaths among such patients. Finally, a number of instances of psychosis, clinically similar to amphetamine psychosis, have resulted from chronic high-dose abuse; other effects of chronic abuse have not been adequately studied. Tolerance develops to the main effects of ephedrine; however, temporary abstinence restores sensitivity.
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