Drugs List

Therapeutic Indications

Uses

Reversible airways obstruction

Unlicensed Uses

Neuropathic oedema

Contraindications

Children under 6 months
Within 2 weeks of discontinuing MAOIs
Breastfeeding
Hypertension
Phaeochromocytoma
Pregnancy
Thyrotoxicosis

Precautions and Warnings

Elderly
Benign prostatic hyperplasia
Cardiac arrhythmias
Diabetes mellitus
Galactosaemia
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Hyperthyroidism
Ischaemic heart disease
Lactose intolerance
Narrow angle glaucoma
Renal impairment

Not all available brands are licensed for all age groups
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Some formulations contain lactose
Tolerance and dependence may occur

Pregnancy and Lactation

Pregnancy

Ephedrine hydrochloride is contraindicated in pregnancy.

Ephedrine-like drugs are teratogenic in some animal species, but human teratogenicity has not been established.

Significant increases in foetal heart rate and beat-to-beat variability may occur, but these effects may be the result of normal reflexes following hypotension-associated bradycardia. The presence of ephedrine in the foetal circulation is probably a major cause of the foetal heart rate changes.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Ephedrine hydrochloride is contraindicated in breastfeeding.

Ephedrine hydrochloride is excreted in breast milk. Irritability and sleep disturbances have been reported in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anxiety
Arrhythmias
Cold extremities
Dependence
Dry mouth
Headache
Hypertension
Insomnia
Myocardial infarction
Nausea
Restlessness
Tachycardia
Tolerance
Tremor
Urinary retention

Presentation

Oral formulations of ephedrine hydrochloride

Drugs List

Therapeutic Indications

Uses

Reversible airways obstruction

Unlicensed Uses

Neuropathic oedema

Dosage

Adults

Elderly

Children

Contraindications

Children under 6 months
Within 2 weeks of discontinuing MAOIs
Breastfeeding
Hypertension
Phaeochromocytoma
Pregnancy
Thyrotoxicosis

Precautions and Warnings

Elderly
Benign prostatic hyperplasia
Cardiac arrhythmias
Diabetes mellitus
Galactosaemia
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
Hyperthyroidism
Ischaemic heart disease
Lactose intolerance
Narrow angle glaucoma
Renal impairment

Not all available brands are licensed for all age groups
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Some formulations contain lactose
Tolerance and dependence may occur

Pregnancy and Lactation

Pregnancy

Ephedrine hydrochloride is contraindicated in pregnancy.

Ephedrine-like drugs are teratogenic in some animal species, but human teratogenicity has not been established.

Significant increases in foetal heart rate and beat-to-beat variability may occur, but these effects may be the result of normal reflexes following hypotension-associated bradycardia. The presence of ephedrine in the foetal circulation is probably a major cause of the foetal heart rate changes.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Ephedrine hydrochloride is contraindicated in breastfeeding.

Ephedrine hydrochloride is excreted in breast milk. Irritability and sleep disturbances have been reported in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Anxiety
Arrhythmias
Cold extremities
Dependence
Dry mouth
Headache
Hypertension
Insomnia
Myocardial infarction
Nausea
Restlessness
Tachycardia
Tolerance
Tremor
Urinary retention

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2014

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com [Accessed on 2.07.14].

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications https://www.medicinescomplete.com [Accessed on 2.07.14].

Summary of Product Characteristics: Cam Mixture. Cambridge Healthcare Supplies Ltd. Revised January 2014.

Summary of Product Characteristics: Ephedrine Hydrochloride 15 mg and 30 mg tablets. Wockhardt UK Ltd. Revised March 2007.