Ephedrine hydrochloride | Sympathomimetic drug

The molecular formula of ephedrine hydrochloride is C10H15NO.HCl. Its molecular weight is 201.7. The CAS registry number of ephedrine hydrochloride is 50-98-6. Ephedrine belongs to a group of medicines called sympathomimetics. Sympathomimetic drugs affect the part of your nervous system that works automatically. Ephedrine Injection is used to relieve low blood pressure during spinal or epidural anaesthesia. It raises blood pressure by temporarily reducing the blood supply to small blood vessels.
Colourless crystals or a white, crystalline powder; odourless.



Chemical name. (-)-Ephedrine hydrochloride; [R-(R*, S*)]-α-[1-(methylamino) ethyl] benzenemethanol hydrochloride; CAS Reg. No. 50-98-6.




Description. Colourless crystals or a white, crystalline powder; odourless.

Solubility. Soluble in 4 parts of water; soluble in ethanol (~750 g/l) TS; practically insoluble in ether R.

Storage. Ephedrine hydrochloride should be kept in a well-closed container, protected from light.

Additional information. Ephedrine hydrochloride darkens on exposure to light.

Contraindications


  • Ephedrine is contraindicated in closed angle glaucoma, since ephedrine may exacerbate the condition.
  • Ephedrine is contraindicated in patients with pheochromocytoma, since severe hypertension may result.
  • Ephedrine is contraindicated in patients with asymmetric septal hypertrophy (idiopathic hypertrophic subaortic stenosis) since the obstruction may increase as myocardial contractility improves.
  • Ephedrine is contraindicated in patients undergoing therapy with monoamine oxidase inhibitors (MAO inhibitors), or within 14 days of ceasing such therapy, since MAO inhibitors may prolong and intensify the cardiac and pressor effects of ephedrine.
  • Ephedrine is contraindicated in patients using linezolid.

Use in pregnancy (Category A)

A Pregnancy Category A drug is defined by the Australian Drug Evaluation Committee as ‘Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed’.

Ephedrine may accelerate the foetal heart rate when used to control maternal hypotension during spinal anaesthesia for delivery. Ephedrine Hydrochloride Injection should not be used if the maternal blood pressure is greater than 130/80 Hg.

Ephedrine has been shown to cross the placenta and undergo early metabolism and/or redistribution in the foetus. Ephedrine has been associated with an increased risk of mild metabolic acidosis with increased umbilical plasma concentrations of lactate, glucose, epinephrine, and norepinephrine and greater UV PCO2.

Despite the transplacental passage of ephedrine and notable effects on the cord blood pH; it is uncertain whether this has the potential to affect clinical outcome on the neonate. Other studies have not demonstrated significant effects on neonatal outcomes.

Use in lactation

Ephedrine is distributed into breast milk, and therefore Ephedrine Hydrochloride Injection is not recommended for use during lactation because of the risk of adverse effects in the infant. Therefore, the risk and the benefit of using ephedrine should be avoided or used with caution, and administered to a breast-feeding woman only if necessary.

Dose and method of administration

Ephedrine Hydrochloride injection is administered by the intravenous route.

Adults and Elderly
Ephedrine should be administrated in the lowest effective dose. A 3mg/mL solution should be given as a slow intravenous injection of 3 to 7.5 mg (maximum 10 mg), repeated as needed every 3 - 4 minutes to a maximum of 30 mg. A lack of efficacy after 30 mg should lead to reconsideration of the choice of therapeutic agent.

Children
Ephedrine Hydrochloride is not recommended for use in this patient population.

Possible side effects

If you get any of the following side effects, stop taking this medicine and seek urgent medical advice straight away:
• Difficulty in breathing
• Abnormal heart rhythm;
• Palpitations, high blood pressure, fast heartbeat, or
• Pain over the heart, slow heartbeat, low blood pressure;
• Heart failure (cardiac arrest);
• bleeding in the brain;
• Build-up of a fluid within the lungs (pulmonary oedema);
• increased pressure in the eye (glaucoma)
• Difficulty in passing urine
Other side effects that you may experience while taking this medicine are:
Common (may affect up to 1 in 10 people):
• Confusion, feeling worried, depression;
• Nervousness, irritability, restlessness, weakness, sleeping problems, headache, sweating
• Shortness of breath;
• Nausea, vomiting.



Reference
https://www.drugs.com/ephedrine.html
https://www.rxlist.com/ephedrine-drug.htm
https://pubchem.ncbi.nlm.nih.gov/compound/Ephedrine
https://www.drugbank.ca/drugs/DB01364
https://examine.com/supplements/ephedrine/
https://www.medicinenet.com/ephedrine-oral/article.htm
https://www.medicines.org.uk/emc/product/2577/smpc

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