Editorial

Establishing Causality from Case Reports: Was Ephedra to Blame?

Authors: Stephen 0 Bent, MD

Abstract

Ephedra has a long history of being associated with severe cardiovascular events, often in young, healthy patients. The Food and Drug Administration (FDA), which officially banned the sale of ephedra products in April 2004, had issued warnings about it dating back to September 1994.1 Numerous case reports have documented adverse events in persons taking ephedra,2–5 including myocardial infarction, stroke, and death. In the largest published case series, Haller and Benowitz2 reviewed 140 adverse event reports involving ephedra and found that 31% were definitely or probably related to the supplement and another 31% were possibly related. The report by Moawad et al6in this issue of the Southern Medical Journal is the first published report of an association between ephedra and posterior reversible encephalopathy syndrome (PRES), a neurologic event that is believed to be precipitated by a rapid rise in systemic blood pressure.

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References

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