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Ephedra–Associated Cardiomyopathy

Clinical Pharmacist, Heart Failure/Transplant, Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, NJ

Ronald S Freudenberger, MD

Associate Professor; Director, Heart Failure and Transplant Cardiology Program, University of Medicine and Dentistry of New Jersey, New Brunswick

Reprints: Sarjita D Naik PharmD, Department of Pharmacy, Robert Wood Johnson University Hospital, One Robert Wood Johnson Place, PO Box 2601, New Brunswick, NJ 08903-2601, fax 732/937-8584, sarjita.naik{at}rwjuh.edu

OBJECTIVE: To report 2 cases of cardiomyopathy associated with use of dietary supplements containing ephedra.

CASE SUMMARIES: A 19-year-old white man presented to the emergency department (ED) complaining of exertional shortness of breath and episodic chest pain radiating to the left arm. Left heart catheterization revealed no significant coronary artery disease, a dilated left ventricle, and global hypokinesis. He was discharged home 5 days after admission on standard therapies for heart failure, but died 5 weeks later. A 21-year-old white man presented to the ED with recurrent chest pain and was diagnosed with myopericarditis. An echocardiogram showed global hypokinesis with an ejection fraction of 40–50%. He was treated for myopericarditis with standard therapies for heart failure. An objective causality assessment probability scale revealed that an adverse drug reaction was possible between cardiomyopathy and ephedra use in these 2 patients. Both of these cases have been reported to MedWatch.

DISCUSSION: Ephedrine is a potent sympathomimetic agent with direct and indirect effects on adrenergic receptors to cause increases in heart rate, blood pressure, cardiac output, and vascular resistance. The adverse effects of adrenergic stimulation are well known in cardiomyopathy, inducing direct and indirect myocyte toxicity.

CONCLUSIONS: It is well documented that ephedra, through its sympathomimetic effects, can cause a range of cardiovascular toxicities including myocarditis, arrhythmias, myocardial infarction, cardiac arrest, and sudden death.

Key Words: cardiomyopathy, dietary supplements, ephedra

Published Online, January 23, 2004. www.theannals.com, DOI 10.1345/aph.1D408

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