Derived from the dried rhizome and root of the plant, ephedra has been used as a medicinal herb for thousands of years in India, China and Japan. It is commonly consumed in low doses and in combination with other herbs to promote urination, to treat asthma, bronchitis and coughs. Ephedrine and pseudoephedrine, the major constituents, are non-selective sympathomimetic agents with both alpha and beta activities, and have direct as well as indirect central nervous system (CNS) stimulation effects, which account for the medicinal properties of the herb. In preclinical models, ephedra demonstrated antibacterial and anti-inflammatory properties ^{(1) (2) (3)}.

Although ephedra is widely promoted as a natural stimulant and as an appetite suppressant, a systematic review cited insufficient evidence to support its use for weight loss ⁽²¹⁾. Additional  preliminary data suggest an ephedrine alkaloids-free ephedra extract may be safer compared to ephedra extract, which causes adverse effects such as excitation, insomnia, and arrhythmias ^(19) (20), and a formula containing ephedra used alone or combined with NSAIDs reduced disease activity in active ankylosing spondylitis patients ⁽²³⁾.

Misuse and overdose of ephedra have resulted in heart attack, stroke, seizure, psychosis and death ⁽⁸⁾. The FDA has banned the sales of dietary supplements that contain ephedra because of their significant risk to human health ^(12) (13). However, a review of 51 websites found nearly 20% sold weight loss products that potentially violated the ban of ephedra alkaloids ⁽²⁴⁾.