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Recently, ephedra preparations have been sold with misleading names alluding to the drug ecstasy (MDMA) (Blumenthal and King 1997). Several deaths have resulted from cardiac toxicity because hypertension and cardiac arrhythmia are chief problems with higher doses of ephedrine. Use of ephedra is thus contraindicated in people with existing high blood pressure. Cases have been reported of intracerebral hemorrhage and vasculitis in association with ephedrine (Forman et al. 1989; Kaye and Fainstat 1987; Wooten et al. 1983). The risk of cerebral hemorrhage is even greater when combining ephedrine with other catecholamine stimulants such as the over-the-counter stimulant phenyl-propanolamine (Stoessl et al. 1985). Pseudoephedrine may be safer than ephedrine in some respects (Porta et al. 1986). In a large sample (n > 100,000) of pseudoephedrine users, there were no reports of cerebrovascular disorders within 15 days after administration. The incidence of myocardial infarction, seizures, and neuropsychiatric disorders were no greater than base rates in the general population.

Other conditions in which ephedra is contraindicated are anxiety disorders, angle-closure glaucoma, prostate adenoma with residual urine volume, pheochromocytoma, and thyrotoxicosis (Gruenwald et al. 1998). Known medications that may interact adversely with ephedrine include heart glycosides, halothane, guanethidine, MAO inhibitors, secale alkaloids, and oxytocin. Addiction and Dependence

Use of ephedrine is sometimes associated with dependence (Gruber and Pope 1998). One study reported a high incidence of eating and body-image disorders among ephedrine users, but this is likely confounded by the fact that the sample consisted entirely of female weightlifters and is likely not to represent the greater population. Coca

History and Botany

Coca (Erythroxylon coca) is a small shrublike tree that grows to 5 m in height. The leaves are oval, green, and tough, growing 5 cm in length and 2.5 cm in width (Robbers et al. 1996; Gruenwald et al. 1998). The

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