Ephedrine

Where Can You Buy Ephedrine Over-The-Counter Without a Prescription?

Ephedrine Over the CounterCan you buy diet pills with ephedrine over-the-counter anymore?

Since the ban of ephedrine alkaloids in ephedra-based products in 2004, it is no longer legal to sell weight loss supplements that contain this ingredient.

However, there are some preparations in which it remains legal to buy over-the-counter without a prescription in the United States and Canada.

This is controversial and there are many who claim that the ingredient should be banned for sale due to the risk of serious harmful side effects when it is misused.

When looking for over-the-counter ephedrine, be aware of safety issues. This is applicable to both medicinal items that still contain ephedrine, or those purchased online from warehouses.

Also note that ephedra fat burner supplements sold legally in the USA without a prescription no longer contain this banned alkaloid. Ephedra diet pills are still legal as per FDA regulations so long as they have this alkaloid removed.


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Why Is Ephedrine Banned in Many Countries?

Ephedrine over-the-counter products were incredibly popular in the 1980s and 1990s. Hundreds of weight-loss and energy producing products contained ephedrine as a primary ingredient.

However, due to increasing reports of side effects and adverse reactions, the US Food and Drug Administration (FDA) along with other government agencies and medical experts, started taking a closer look at how ephedrine, when used for weight loss or energy production, could be detrimental to health.

One of the considerations for the ban was the fact that adequate dosage recommendations could not be determined due to the fact that ephedra and ephedrine products contained so many ingredients. Individuals often combined caffeine or other stimulants with the product. This had an effect on both efficacy as well as potential for side effects.

Before it was banned, FDA recommendations were to take ephedrine over-the-counter at under a 150 mg dosage per day. A safe dose was determined to average 25 mg. Pseudoephedrine, another primary alkaloid in ephedra and found in ephedra products, was then approved, but not more in regard to dosage than 240 mg per day, with a safe dosage determined at 60 mg.

However, disagreements regarding dosage safety were prevalent among medical experts and researchers. Harvard and Columbia universities and medical schools determined that a person who is very overweight or obese would likely experience the greatest risk for side effects due to the comorbidity factors of high blood pressure (hypertension) as well as diabetes.

As an end result, in early 2004, the FDA announced that it would be prohibiting sales of any dietary supplements containing ephedra with its alkaloids. [1] According to Harvard Medical School, the banishment of products that contain ephedra and its alkaloids was one of the first in which the US FDA banned an herbal supplement.

The ultimate decision to ban ephedra at the time was due to the tens of thousands of adverse health effects reported to the agency at the time. [2] According to reports and studies, the primary objection to ephedra and ephedrine over-the-counter products at the time was the risk to cardiovascular issues including increased blood pressure, heart palpitations, and possible heart attacks.

It was claimed that over and above the thousands of complaints at the time, over 800 adverse and life-threatening reactions had been reported in those complaints. Some adverse events were described as seizures, strokes, heart attacks, and death. Other reports stated individuals experienced insomnia and some even developed psychosis.

At the time, the decision to ban ephedra containing alkaloids was controversial, and continues to be controversial. It is doubtful that the ban will ever be reversed due to increased knowledge of potential side effects and tendency of individuals to use ephedrine for weight loss, energy enhancement, or improve physical performance to misuse such products.

Historically, the ephedra plant and its alkaloids were used primarily to treat lung and breathing issues such as asthma, bronchitis, sinusitis, and so forth.

Not all countries have completely banned ephedrine from their over-the-counter products, so depending on geographical location, it may possible to find over-the-counter ephedrine, at least as a component in common asthma, cold, flu, and cough medicines.

Each of the above medicinal products comes with label instructions regarding dosage, recommendations for frequency of use, and warnings about overusing or misusing such products.

What Is Ephedrine and Its Mechanism of Action in the Body?

The primary mechanism of action of ephedrine is its behavior as a sympathomimetic amine. It has an influence over certain receptors in the body in response to certain stimulus.

One of the most common body responds to stimulus components is that of adrenaline, responsible primarily for triggering our human fight or flight response. This means accelerated heart rate, shutdown of nonessential body functions, and a surge of energy, among other behaviors.

In addition to this behavior, ephedrine also encourages the production of norepinephrine in the brain. Norepinephrine has an influence on adrenergic receptors in the body, otherwise known as sympathetic receptors because they affect receptors of the sympathetic nervous system. The sympathetic nervous system is responsible for functions in the body over which we have no control, such as:

  • Heart rate
  • Metabolism
  • Respiration
  • Digestion

Norepinephrine also has an influence on alpha, beta-one, and beta-two adrenergic receptors. Each of these receptors has an influence on body function.

For example, alpha receptors that are triggered or influenced by norepinephrine cause arteries in the body to constrict. This constriction increases blood pressure. This mechanism of action also increases the flow of blood that returns to the heart for oxygenation. However, athletes should be aware that blood vessels found in skeletal muscle don’t have or respond to these alpha receptors. This is because they are designed to maintain flow of blood from the heart for the delivery of nutrients and oxygen for energy, strength, and function.

Norepinephrine also has an influence on the heart muscle, where beta-one receptors are located. When triggered, these receptors accelerate heart rate and can increase the force of heart contractions. This is perceived by athletes and those looking for weight loss to also equate to increased metabolism and fat burn, but the two are not always linked together.

Finally, norepinephrine also stimulates beta-2 receptors, which are found in the lung airways. For this reason, ephedrine has long been a component to asthma bronchodilator products. This mechanism of action relieves the constricted airways often associated with an asthma attack. Increased oxygenation means more delivery of oxygen to muscles, enhancing stamina, endurance, and function.


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Where Can I Find Ephedrine OTC Products?

A number of ephedrine OTC products are still available, but not necessarily “over-the-counter”. In some countries around the world, ephedrine in allergy medications, cold and flu remedies, and cough medicines, can actually still be found without a prescription and sometimes on store shelves. Among the most common locations include:

  • Walmart
  • Walgreens
  • CVS
  • Rite-Aid

However, some products that contain ephedrine “over-the-counter” are actually located in the pharmacy holding area, even if the product doesn’t require a prescription. One of the most popular bronchial asthma products to contain ephedrine was, and is, in some countries, Bronkaid.

Over the years, some products containing ephedrine over-the-counter have been replaced with other components due to increased technology in development of drugs that provide the same effect without the number of side effects.

Another common combination of asthma medications that contain ephedrine over-the-counter include ephedrine and guaifenesin syrups. The milligram strength of ephedrine in cough and cold, flu, and asthma medications does not typically exceed 25 mg.

Another common asthma product that contains ephedrine over-the-counter is Primatene tablets. Primatene Mist, another nasal-inhalant form of the popular product, has been discontinued in the US, but is still available in other countries around the world.

The milligram strength of ephedrine over-the-counter products today is relatively low, averaging 12.5 mg and perhaps up to 25 mg, depending on product. A person would have to take higher than recommended dosages of the product for efficacy in weight loss.

For this reason, individuals often take products like Bronkaid, Primatene, or even Sudafed, with other stimulants including caffeine to enhance benefits. However, this is not recommended, as the more stimulants a person takes combined together, the greater the risk of side effects and adverse reactions.

Advancements in technology, as well as the increased knowledge of the manner in which a number of stimulative ingredients in dietary products affect the body through various mechanisms of action have garnered greater attention.

Legitimate dietary and weight loss supplement manufacturers today continue to research the efficacy of other ingredients that may provide the same results with drastically reduced potential for side effects or adverse reactions. However, illegal ephedrine diet pills can still be found, with one of the most common sources being China.

Diet Pills with Ephedrine Over-The-Counter – Are They Available?

It can be difficult to find diet pills with ephedrine over-the-counter today. In many cases, the ephedrine component of such products has been replaced with other stimulative ingredients including Bitter Orange (Citrus aurantium). However, in some cases, the substitutes for ephedrine can be deemed as potentially dangerous as the ephedrine component found in the original product.

Ephedrine diet pills and ephedrine OTC products are prevalently marketed online today, even though some of the products no longer contain the ephedra in them. They contain ephedra extract, which implies the ephedra with the alkaloids removed.

One major ephedra supplier markets one of its products as ephedrine in search parameters, but when the page is linked, they specify that their product is the “number one alternative to prescription ephedrine”.

Unfortunately, it can also be difficult to find actual ingredients on labels of some of these products without extensive searches online or even phone calls to the manufacturer.

Individuals may also find a number of sellers claiming to sell diet pills with ephedrine over-the-counter on websites like eBay. Clicking on some of these links takes the potential buyer to sellers offering fat burners, slimming diet pills, weight-loss products, and thermogenic fat burners.

When taking a look at one of these, the ingredients often read: caffeine, Citrus aurantium, green tea extract, and acetyl l-carnitine. No mention of ephedrine, or ephedra, nor ephedra extract.

What about Over-The-Counter Ephedrine for Weight Loss?

In the United States and other countries around the world, the potential of finding over-the-counter ephedrine for weight loss is slim, especially due to the fact that ephedrine in such products has been banned in many countries around the world for over a decade.

Substitutes and switched out ingredients may provide some benefit for weight loss for some individuals, but it’s the wording that catches the eye.

A number of studies prior to and following the ban of ephedrine from dietary supplements deemed that the actual use of over-the-counter ephedrine for weight loss was not as effective as otherwise claimed.

Research of medical studies and clinical trials in this aspect determined that none lasted longer than six months, and that the overall effect of ephedrine on weight loss averaged approximately 0 .9 kg per month more in weight loss than someone using a placebo in a clinical trial. [3]

A number of studies were also conducted on the efficacy of ephedrine for weight loss and athletic performance. Results? The test involved ephedrine used by itself, ephedrine with caffeine, and ephedrine combined with other stimulative products like Citrus aurantium (Bitter Orange).

A 2017 study deemed Bitter Orange, which contains p-synephrine – which is also very similar in nature to ephedrine and adrenaline – as one of the most common substitutes for the ephedrine in today’s “ephedrine” over the counter weight loss supplements.

The report mentions that over 30 studies involving humans have determined that the p-synephrine and other Bitter Orange extracts did not act as stimulants on the cardiovascular system at lower dosages, but the effects on humans has not yet been determined other than it can exhibit adrenergic receptor binding capabilities [4].

This behavior is much like ephedrine, which can have an influence on blood pressure, cardiac pumping capability, and similar effects as that of ephedrine on the sympathetic nervous system, i.e. functions in the body over which we have no control.

Legalities of Ephedrine in the US, Canada, and Australia

Legalities regarding ephedra, ephedrine, and other alkaloids of the ephedra plans differ around the world. Ephedra alkaloids, primarily ephedrine, were banned by the US Food and Drug Administration in 2004, due to the above-mentioned concerns regarding misuse, overuse, and abuse of the product.

Reported side effects and adverse reactions were not merely limited to those who misused the product, but some otherwise healthy, young individuals who used the products containing ephedra – and according to its instructions.

In Australia, the legal status of ephedrine can be found under the regulations mandated by the Australian Government Department of Health: Therapeutic Goods Administration. In Australia, ephedrine OTC is not typically found.

According to regulations set by the Office of Drug Control, ephedrine is deemed a controlled substance, and any use will require a prescription, most commonly as ephedrine is found in bronchodilator, other asthma, and some cold and flu medications.

While ephedrine “over-the-counter” does not necessarily require a prescription, in the US and other countries around the world, a person will have to obtain it by approaching the pharmacy counter rather than expecting to find it on store shelves in many locations.

In Canada, ephedrine is permitted in some medical preparations, but at a limited dosage. As with the United States and other countries, individuals may be required to show identification and sign for the medication containing limited dosage of ephedrine from pharmacy counters.

Canadian health agencies have warned that combinations of ephedrine with caffeine, even at low dosages, can contribute to adverse side effects. Canada’s Association of Food and Drug Officials have reported individuals experiencing cardiovascular events, even at low doses in regard to the milligram strength of the ephedrine in a product.

Consumers should be aware that ephedra extract continues to be legal in many countries, including the US, as the extract is not supposed to contain any of the ephedrine or other alkaloids of previous products.

In addition, not all ephedra plant species, from which ephedra extract may be found in today’s products, contain any ephedrine or its alkaloids. In this sense, legal ephedrine over-the-counter products are still available.

However, a number of websites still continue to sell ephedrine products, and are doing so illegally. Consumers should note that some of these products may be quite old, and the potential for some of them may even be left over from before the ban of 2004.

Individuals looking to purchase ephedrine “over-the-counter” from foreign sources should, as always, be aware of counterfeit products, lack of quality, and potential substitution of inactive or even dangerous components in such products.


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Side Effects Associated with Ephedrine

A number of side effects of them associated with ephedrine over the years. Among the most common, even at lower dosages, side effects less severe can include:

  • Tremors, most noted in the hands
  • A sense of jitteriness or extreme anxiousness (some describe the feeling is the skin crawling or jumping out of one’s skin)
  • Increased nervousness
  • Upset stomach, nausea, and some complain of vomiting
  • Headaches
  • Increased heart rate
  • Changes in attitude and mood

The half-life of ephedrine typically lasts one to three hours, although some individuals may feel its effects for as many as six hours. This not only depends on the milligram strength, but the frequency of use as well as combination with other stimulative ingredients or combinations, including caffeine.

In most cases, the above-mentioned side effects are temporary in nature and will fade as the half-life of the ephedrine declines.

However, a number of serious side effects and adverse reactions have been associated to ephedrine over-the-counter products, and former diet pills with ephedrine over-the-counter sales. It was for this reason that the products began to catch the attention of government agencies.

Increasing numbers of medical reports and journal articles began to relate situations such as:

  • Heart palpitations (when not treated or if occur frequently, can contribute to a number of cardiovascular issues that are associated with heart pumping function, effectiveness, and tempo)
  • Racing heart rate (tachycardia)
  • Irregular heart rate (arrhythmia)
  • Potential seizure
  • Strokes
  • Heart attack

The severe and adverse side effects were not relegated to older individuals or those with a diagnosed or undiagnosed medical condition. In some cases, they occurred in otherwise healthy and young individuals.

Even in medical scenarios, and when products like Primatene or Bronkaid are recommended and overseen by a physician, instructions for use are specific in regard to dosage and maximum dosage.

Warnings and precautions for use of Primatene tablets, even at a low milligram strength of ephedrine HCl at 12.5 mg (and 200 mg guaifenesin) are common. The product warns of possible adverse reactions such as tachycardia, insomnia, and seizures.

Patients are warned to avoid other caffeine containing products due to negative interactions. Precautions are listed on the package for individuals diagnosed with hypertension, any form of cardiac disease, diabetes or thyroid issues and more.

Combining any ephedrine over-the-counter product with other stimulants including caffeine, herbal products such as Citrus aurantium (Bitter Orange), Yohimbine, Yerba Mate, or caffeine anhydrous – a dry, powdered form of caffeine – can contribute to an increased risk of unexpected and unpleasant reactions.

Pregnant and nursing women are advised to stay away from any ephedrine product, and even use of ephedrine over-the-counter products such as cough medicine, without previous discussion with their obstetrician or pediatrician.

Conclusion

While it’s not particularly difficult to find ephedrine over-the-counter in some medicine products today, regulations continue to change. So too do import and export laws in countries around the world including the US, Canada, Australia, New Zealand, and the UK.

In some locations, pharmacists are required by law to keep a log of any products sold containing ephedrine. Be prepared to show identification. Most pharmacies around the world will not sell any product containing ephedrine to an individual under 18 years of age. In some cases, you may be required to sign for the product.

Diet pills with ephedrine over-the-counter products are rarely found today, at least legally, although online, a person may have more success.

A number of websites promote the sale of ephedrine, marketing their product as “pure ephedrine” or “identical to the original ephedra product” even though careful examination of ingredient labels deems such statements are misleading, if not outright false.

Before purchasing any over-the-counter ephedrine, look at the other ingredients, determine how each of those ingredients may affect the body, and pay attention to interactions and precautions, especially when combining the product with other stimulants including caffeine.

References
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