Ma-Huang strikes again: Ephedrine nephrolithiasis

Thomas Powell, Fong Fu Hsu, John Turk, Keith Hruska

Research output: Contribution to journalArticlepeer-review

101 Scopus citations


Ephedrine and its metabolites are naturally occurring alkaloids that can be derived from evergreens worldwide and have been used as medicinals for hundreds of years. Because they have 'real' pharmacological alpha and beta catecholamine effects and are 'natural' products, the alternative medicine industry has popularized them for multiple uses, including asthma, weight loss, energy and sexual enhancement, and euphoria. Several recent reviews have documented the dangerous nature of using these 'drugs' unsupervised, including multiple deaths, and the FDA is currently reviewing ephedrine's use in the alternative medicine industry. We report a new toxicity, ephedrine nephrolithiasis, in a patient using an energy supplement, Ma-Huang extract, which contains ephedrine. Although previously not reported, the Louis C. Herring and Company kidney stone database show that this is an endemic complication of ephedrine with hundreds of previous episodes. Using gas chromatography (GC) mass spectrometry, we were able to positively identity the chemical structure of our patient's stone, as well as other similar atones from Louis Herring, as containing ephedrine, norephedrine, and pseudoephedrine.

Original languageEnglish
Pages (from-to)153-159
Number of pages7
JournalAmerican Journal of Kidney Diseases
Issue number1
StatePublished - Jul 1998


  • Ephedrine
  • Mass spectrometry
  • Pseudoephedrine nephrolithiasis


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