Principal Findings:

Pooled placebo controlled trials using ephedrine (n = 4), ephedrine + caffeine (n = 12), ephedra (n = 1), and ephedra + herbs with caffeine (n = 4) yielded estimates of weight loss of 0.6kg per month more than placebo. The confidence intervals were wide and none of the individual preparations was significantly better than placebo. At 4 months, ephedrine was associated with an average 11% weight loss. Weight loss with ephedrine + caffeine for 2 to 4 months was 1kg per month better than placebo (95%CI 0.7 to 1.3). A study comparing ephedrine + caffeine to dexfenfluramine showed no difference at 15 weeks. Safety data from 50 trials yielded a 2.2 to 3.6 fold increase in odds of psychiatric, autonomic, gastrointestinal complaints, and palpitations. From the cases reported to the FDA and manufacturers, there were 4 deaths, 5 MI’s, 11 CVA’s, 4 seizures, and 8 psychiatric cases, and about ½ of the events occurred in persons less than 30 years old. There was insufficient data to draw conclusions about event rates less than 1 per 1000. There was inadequate data to draw conclusions regarding the effect of ephedrine on athletic performance. However, ephedrine + caffeine demonstrated a 20-30% increase in athletic performance in 6 placebo controlled trials without an effect on oxygen consumption or time to exhaustion on exercise testing.