Efficacy and safety of ephedra-containing oral medications: a systematic review, meta-analysis, and exploratory dose-response analysis for weight reduction.

Introduction: Despite the widespread use of ephedra in various forms, including food supplements and herbal prescriptions, comprehensive studies reviewing its efficacy and safety across different countries are lacking.

Methods: We systematically searched 5 electronic databases and conducted a meta-analysis of 16 randomized controlled trials (RCTs) on ephedra-containing oral medications (EOMs), performing a dose-response analysis for weight loss.

Results: The meta-analysis results revealed a statistically significant reduction in the body mass index (BMI) (MD: 1.5 kg/m2; 95% CI: -2.46 to -0.54) and secondary outcomes like body weight (BW) and waist circumference (WC). The dose-response analysis indicated a correlation between ephedra and weight reduction. The safety analysis showed no significant difference in adverse effects between the treatment and control groups (RR = 0.99, 95% CI = 0.80 ∼ 1.21, and p = 0.90).

Discussion: In conclusion, EOMs demonstrated effectiveness in promoting weight loss, and the dose-response analysis indicated a correlation between ephedra and weight reduction. However, additional research is necessary due to the limited number of studies and inconsistent results among the assessment criteria. Moreover, if prescribed by traditional medicine physicians within the permissible daily ephedrine dosage range of 150 mg set by the Food and Drug Administration (FDA) and monitored by healthcare professionals, the risk of severe adverse events is likely to be minimal.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=387895, identifier CRD42023387895.