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To the Editor:
In their recent article, Morgenstern et al. state that the “favored pathophysiologic basis for an association between Ephedra and hemorrhagic stroke is enhanced catecholaminergic effects leading to sharp blood pressure spikes.”1 The statement presumes a connection that has never been established.
The authors provide only one reference: an uncontrolled, open label, pharmacokinetic study of eight volunteers given 20 mg of Ephedra alkaloids and 200 mg of caffeine. On average, a 14-mm rise in systolic blood pressure occurred.2 This study comes from a group that has previously recorded elevations of a similar magnitude when caffeine is administered without ephedrine.3
The authors’ reliance upon one uncontrolled study is puzzling, especially when nearly 60 placebo-controlled clinical trials have measured the effects of ephedrine, ephedrine in combination with caffeine/aminophylline, and herbal Ephedra, alone and in combination (letters to Neurology are permitted only five citations, so only the …
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