Ephedrine is used to treat low blood pressure caused by spinal or epidural anesthesia. However, it is not very effective in managing hypotension resulting from shock, circulatory failure, or severe blood loss.

Ephedrine is a stimulant that belongs to the sympathomimetic class of drugs. It acts as both an alpha- and beta-adrenergic receptor agonist. Additionally, it promotes the release of norepinephrine, a potent natural alpha agonist. Its effects are similar to those of epinephrine (adrenaline), the body’s main adrenergic hormone, which also stimulates both alpha and beta receptors. When administered, ephedrine increases central nervous system activity and exerts stimulating effects on various target tissues.

To reverse hypotension induced by spinal or epidural anaesthesia 3 to 6 mg (or at most 9 mg) Ephedrine Hydrochloride is given by slow intravenous injection and repeated every 3 to 4 minutes as required; the maximum total dose is 30 mg. Ephedrine has also been given by intramuscular or subcutaneous injection.

Ephedrine may trigger a hypertensive crisis in patients taking monoamine oxidase inhibitors (MAOIs), including reversible MAO-A inhibitors. It should be avoided or used cautiously in patients undergoing anesthesia with agents such as cyclopropane, halothane, or other volatile anesthetics. There is an increased risk of cardiac arrhythmias when ephedrine is used with cardiac glycosides, quinidine, or tricyclic antidepressants. Additionally, the risk of excessive vasoconstriction or elevated blood pressure is higher when combined with ergot alkaloids or oxytocin.

Ephedrine is contraindicated in patients with coronary thrombosis. It should be used with caution in individuals with underlying heart conditions, cardiac failure, hyperthyroidism, hypertension, angina pectoris, or those receiving digitalis therapy.

Reported side effects of ephedrine include nausea, vomiting, and loss of appetite. Cardiovascular effects may include increased heart rate (tachycardia), sometimes slow heart rate (bradycardia), arrhythmias, chest pain (angina), and changes in blood pressure such as hypertension due to vasoconstriction or hypotension due to vasodilation. Other effects may include dizziness, flushing, shortness of breath (dyspnea), headache, anxiety, restlessness, confusion, psychotic reactions, insomnia, and tremors. It may also cause difficulty in urination or urinary retention, increased sweating, excessive salivation, and changes in blood glucose levels. In very rare cases, angle-closure glaucoma may occur.

Pregnancy: Ephedrine is classified as Pregnancy Category C. Animal studies have shown potential harmful effects on the fetus, and there are no adequate controlled studies in pregnant women. Therefore, it should only be used during pregnancy if the expected benefit outweighs the potential risk to the fetus.

Lactation: Ephedrine is excreted into breast milk. Due to the possibility of adverse effects in the nursing infant, its use is not recommended during breastfeeding.

Ephedrine should be used with caution in patients with hyperthyroidism, diabetes mellitus, ischemic heart disease, hypertension, renal impairment, or angle-closure glaucoma. In patients with an enlarged prostate, it may worsen urinary difficulties. During pregnancy and lactation, caution is advised. Parenteral use of ephedrine has been associated with increased fetal heart rate. In breastfeeding infants, irritability and sleep disturbances have been reported.

When given in sufficiently large doses, ephedrine gives rise to minor reactions in most patients, such as:

• Giddiness
• Headache
• Nausea, vomiting
• Sweating
• Palpitations
• Difficulty in micturition
• Tremors
• Anxiety, restlessness
• Insomnia

Note: Some patients may exhibit these symptoms even with the usual therapeutic dosage.

When ephedrine is administered in high doses, it may cause various adverse reactions in most patients. These include dizziness, headache, nausea, vomiting, sweating, palpitations, difficulty in urination, tremors, anxiety, restlessness, and insomnia. Some individuals may experience these effects even at normal therapeutic doses.

Other adrenoceptor stimulants, Vasoconstrictor/Venotonic

Store in a cool and dry place, away from light. Keep all medicines out of the reach of children.