Ma-huang strikes again: ephedrine nephrolithiasis

Am J Kidney Dis. 1998 Jul;32(1):153-9. doi: 10.1053/ajkd.1998.v32.pm9669437.


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 identify the chemical structure of our patient's stone, as well as other similar stones from Louis Herring, as containing ephedrine, norephedrine, and pseudoephedrine.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Drugs, Chinese Herbal / administration & dosage
  • Drugs, Chinese Herbal / adverse effects*
  • Ephedra sinica*
  • Ephedrine / administration & dosage
  • Ephedrine / adverse effects*
  • Gas Chromatography-Mass Spectrometry
  • Humans
  • Kidney Calculi / chemically induced*
  • Kidney Calculi / chemistry
  • Male
  • Plant Preparations


  • Drugs, Chinese Herbal
  • Plant Preparations
  • Ephedrae herba
  • Ephedrine