A patient with manic depressive illness, borderline psychosis and some abuse of alcohol has taken e

Fråga: A patient with manic depressive illness, borderline psychosis and some abuse of alcohol has taken ephedrine in doses of up to 20 x 20 mg daily during periods of depression. Occasionally he has suffered periods of confusion while taking ephedrine. Is there any risk of developing psychotic reactions while taking ephedrine? Is there any risk of addiction? What is known about the mechanism of action of ephedrine with respect to its influence on mood?

Sammanfattning: Paranoid psychosis, delusions and hallucinations may follow ephedrine overdosage, and there is a risk of developing dependence. The mechanisms involved in the reinforcing and euphorogenic effects of ephedrine are not well understood.

Svar: Whitehouse and Duncan (1) described paranoid psychosis in a 59-year-old man with schizoid personality who developed auditory hallucinations 24 hours after intake of a 360 mg dose of ephedrine (the oral dose of ephedrine varies from 15 to 50 mg per day (2)). In addition, these authors discussed about 20 case reports of psychosis associated with ephedrine use, and described this adverse effect as follows: "The typical clinical picture is a paranoid psychosis with delusions and auditory hallucinations in a setting of clear consciousness". This adverse reaction was reported to be dose-dependent, although the psychic effects of ephedrine may depend on the mental state and personality of the individual, i.e., patients with borderline personalities or affective disorders are particularly at risk (3).

Tolerance with dependence have been reported in association with prolonged administration of ephedrine (4,5)

The CNS effects of ephedrine are similar to those of amphetamine but are considerably less marked (2). In the case of amphetamine, its reinforcing and euphorogenic effects appear to involve the actions of catecholamines in the CNS, notably those of dopamine which facilitates self-stimulation of "reward" areas of the brain. However, the primary mechanism of this effect remains obscure (6). 1 Whitehouse AM, Duncan JM: Ephedrine psychosis rediscovered. Br J Psychiatr 1987; 150: 258-261

2 Goodman and Gilman, The pharmacological basis of therapeutics. 1985; 7th ed: 169-180
3 Lambert MT: Paranoid psychoses after abuse of proprietary cold remedies. Br J Psychiatr 1987; 151: 548-550
4 Martindale, The extra pharmacopoeia. 1989; 29th ed: 11
5 Pugh CR, Howie SM: Dependence on pseudopehedrine. Br J Psychiatry 1986; 149: 798

6 Goodman and Gilman, The pharmacological basis of therapeutics. 1985; 7th ed: 550-554