Toxicology Litigation Support
The Ephedra alkaloids are based on a chemical class of enantiomers which are structurally similar to amphetamines and metamphetamines. As such, they act in a similar way on adrenergic receptors and, not surprisingly, they are thought to be addictive. Nutritional supplements and cold remedies containing Ephedra alkaloids are thought to cause peak elevations in blood pressure and hemorrhagic strokes in susceptible individuals. Dr. Parent has written an expert report on the causal relationship between the use of Ephedra alkaloids and hemorrhagic stroke in which he employs the Hill Criteria to meet the requirements of Daubert. A report and selected references are provided below.
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Dulloo, A. G. and Miller, D. S., Ephedrine, caffeine and aspirin: “over-the-counter drugs” that interact to stimulate thermogenesis in the obese. Nutrition, 5(1), 7-9 (1989).
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Gallagher, J. P. and Shinnick-Gallagher, P., Ephedrine and neuromuscular transmission, in vivo. Neuropharmacology, 18(10), 749-754 (1979).
Goodhue, A., Bartel, R. L. and Smith, N. B., Exacerbation of psychosis by phenylpropanolamine. American Journal of Psychiatry, 157(6), 1021-1022 (2000).
Gurley, B. J., Wang, P. and Gardner, S. F., Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (Ma-huang) as determined by high performance liquid chromatography. Journal of Pharmaceutical Sciences, 87(12), 1547-1553 (1998).
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Karch, S. B., Ma huang and the ephedra alkaloids. In: Toxicology and Clinical Pharmacology of Herbal Products. Cupp, M. J. (ed). Humana Press, Inc., Totowa, New Jersey, 11-30 (2000).
Karch, S. B., Comments on “ma huang toxicity” letter by Dr. Theoharides. Journal of Clinical Psychopharmacology, 19(2), 196-199 (1999).
Kumarnsit, E., Harnyuttanakorn, P., Meksuriyen, D., Govitrapong, P., Baldwin, B. A., Kotchabhakdi, N. and Casalotti, S. O., Pseudoephedrine, a sympathomimetic agent, induces Fos-like immunoreactivity in rat nucleus accumbens and striatum. Neuropharmacology, 38(9), 1381-1387 (1999).
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Mourand, I., Ducrocq, X., Lacour, J. C., Taillandier, L., Anxionnat, R. and Weber, M., Acute reversible cerebral arteritis associated with parenteral ephedrine use. Cerebrovascular Disease, 9(6), 355-357 (1999).
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Ooms, T. G., Khan, S. A. and Means, C., Suspected caffeine and ephedrine toxicosis resulting from ingestion of an herbal supplement containing guarana and ma huang in dogs: 47 cases (1997-1999). Journal of the American Veterinary Medical Association, 218(2), 225-229 (2001).
Palmer, M. E. Haller, C., McKinney, P. E., Klein-Schwartz, W., Tschirgi, A., Smolinske, S. C., Woolf, A., Sprague, B. M., Ko, R., Everson, G., Nelson, L. S., Dodd-Butera, T., Bartlett, W.D ., Landzberg, B. R., Adverse events associated with dietary supplements: an observational study. Lancet, 361(9352), 101-106 (2003).
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Theoharides, T. C., Sudden death of a healthy college student related to ephedrine toxicity from a ma huang-containing drink. Journal of Clinical Psychopharmacology, 17(5), 437-439 (1997).
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White, L. M., Gardner, S. F., Gurley, B. J., Mark, M. A., Wang, P. L. and Estes, M., Pharmacokinetics and cardiovascular effects of ma-huang (ephedra sinica) in mormotensive adults. Journal of Clinical Pharmacology, 37, 116-122 (1997).
Young, R., Bondarev, M. and Glennon, R. A., An examination of isomeric phenylpropanolamines in (-)ephedrine-trained rats. Drug and Alcohol Dependence, 57(1), 1-6 (1999).
Zahn, K. A., Li, R. L. and Purssell, R. A., Cardiovascular toxicity after ingestion of “herbal ecstacy”. Journal of Emergency Medicine, 17, 289-291 (1999).
Toxicology Notes and Literature
Toxicology Litigation Support
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