Ephedra (Ma Huang) and Other Herbal Ingredients Banned or Restricted for Safety
Ephedra (ma huang) was banned from US dietary supplements in 2004 over serious heart and brain harms. See what the FDA found, what trials showed, and other restricted herbal ingredients.
Content last updated . This page has not been medically reviewed.
Safety first. Supplements can cause side effects and interact with medicines. Read mushroom safety and interactions before you use any mushroom product.
Safety first. The US National Center for Complementary and Integrative Health (NCCIH) says ephedra, even in relatively low doses and for a short time, has been linked to high blood pressure, heart attack, seizure, stroke and psychosis. [1] It is considered unsafe in pregnancy, while breastfeeding and for children. [1] In the US, call 911 for chest pain, trouble breathing, fainting, signs of a stroke or a seizure. For a possible poisoning, Poison Help is 1-800-222-1222.
What ephedra and ma huang are
Ephedra is a low evergreen shrub. The herb usually comes from the stem and branches of Ephedra sinica Stapf (family Ephedraceae), known in Chinese medicine as ma huang. [1][2] Its stimulant compounds are called ephedrine alkaloids. [1]The FDA's 2004 rule lists "ma huang", "Ephedra", "Chinese Ephedra" and "epitonin" as names for the botanical ingredients, mainly from Ephedra sinica, E. equisetina, E. intermedia var. tibetica and E. distachya. [3] It adds that other plants, such as Sida cordifolia and Pinellia ternata, also contain ephedrine alkaloids. [3] The same rule says some common names, such as "Mormon tea", refer to North American Ephedra species that do not contain ephedrine alkaloids but have been misused to label ingredients that do. [3] A label name alone does not tell you which plant or which compounds are in a product.
Traditional use
This is tradition, not proof. NCCIH says ephedra has a long history of medicinal use in China and India for colds, fever, headaches, congestion, coughing and wheezing. [1] For the traditional formula and its safety, see Ma Huang Tang and ephedra safety.What the US regulator did
On 11 February 2004 the FDA published a final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk of illness or injury. [3] The rule took effect on April 12, 2004. [3] NCCIH describes this as a ban on the sale of such supplements in the United States. [1] The rule says it does not apply to conventional food products that contain ephedrine alkaloids. [3] Comments sent to the FDA argued that ephedrine alkaloids in Chinese herbal formulas should be treated differently from weight-loss products. [3] How that was resolved is not described in the parts of the rule we read. Rules in other countries are not described in the sources we read.What research showed before the ban
Ephedra was sold for weight loss, energy and athletic performance. [3]| Use | What the source found | Strength of evidence | Population and form |
|---|---|---|---|
| Weight loss | A JAMA meta-analysis (2003) found ephedrine and ephedra gave modest short-term weight loss, about 0.9 kg a month more than placebo, and no data on long-term weight loss. [4] The FDA said it knew of no well-designed study showing an effect beyond 6 months. [3] | Modest short-term effect; long-term insufficient evidence | Adult trials of ephedrine or ephedra, often with caffeine |
| Athletic performance | No trials of ephedra and athletic performance were found. [4] | Insufficient evidence | Adults |
| Safety | The same analysis found higher odds of psychiatric, autonomic or stomach and bowel symptoms and heart palpitations. [4] NCCIH says the weight benefit was judged insufficient to outweigh the serious risks. [1] | Evidence of harm | Adults in trials and case reports |
Almost no new research in people has been done since the ban. [1]
Other ingredients described as banned or restricted
The sources we read describe these restrictions. Each has its own page.| Ingredient | What the sources say | Read more |
|---|---|---|
| Comfrey, taken by mouth | LactMed says the FDA banned the sale of oral comfrey products in the US. [5] The EU herbal committee's 2014 statement says the FDA advised manufacturers in 2001 to remove Symphytum products. [6] | More about Comfrey, taken by mouth → |
| Yohimbe | NCCIH says yohimbe supplements have been restricted or banned in many countries. [7] | More about Yohimbe → |
| Aristolochic acid herbs | A 2008 review says botanicals known or suspected to contain it were no longer permitted in many countries, yet were still sold online. [8] | More about Aristolochic acid herbs → |
| Weight-loss products with hidden drugs | A 2025 review found synthetic adulteration ranged from 0% to 100% across studies, with sibutramine the most common adulterant. [9] | More about Weight-loss products with hidden drugs → |
For a broader list, see banned and restricted ingredients.
Who should ask first
NCCIH says it is not possible to say who is at greatest risk today, that people with cardiovascular disease have been considered at higher risk, and that ephedra might interact with other stimulants such as caffeine. [1] Ask a pharmacist or clinician about any stimulant product, and see how herbs and medicines interact. Tell the surgical team about every herbal product before a procedure. [10] Check labels and quality using quality testing and certifications. Report a reaction through side effects and reporting. Weight goals are covered in weight-loss supplements and fat burners.Frequently asked questions
Is ephedra legal?
In the US, the FDA's rule declared dietary supplements containing ephedrine alkaloids adulterated, effective April 12, 2004, which NCCIH describes as a ban on their sale. [3][1] Rules in other countries are not described in the sources we read.
Did ephedra work for weight loss?
Trials showed modest short-term weight loss, about 0.9 kg a month more than placebo, with no long-term data. [4] NCCIH says this benefit did not outweigh the serious risks. [1]
Is bitter orange a safe replacement for ephedra?
Not shown. Bitter orange products became popular as ephedra alternatives, and NCCIH says bitter orange has not been clearly shown to help any health purpose. [11] See bitter orange and yohimbe.
Is the plant itself harmless if it is not in a supplement?
Proper evidence not found in the sources we read for the risk of the whole plant used in other ways. The sources describe harms from ephedrine alkaloids in supplements. [1][3] Ask a pharmacist or clinician.
What should I do if I took an ephedra product and feel unwell?
Call 911 for chest pain, trouble breathing, fainting, stroke signs or a seizure. For other symptoms call Poison Help at 1-800-222-1222 or a clinician. Do not stop or change a prescribed medicine without asking the prescriber or pharmacist.
References
- NCCIH, Ephedra: Usefulness and Safety (US NIH). Read 2026-10-23.
- GBIF Backbone Taxonomy, Ephedra sinica match record. Read 2026-10-23.
- FDA, Final Rule Declaring Dietary Supplements Containing Ephedrine Alkaloids Adulterated, Federal Register, 11 Feb 2004 (69 FR 6788). Read 2026-10-23.
- Shekelle PG et al., Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 2003. Read 2026-10-23.
- LactMed (US NLM), Comfrey. Read 2026-10-23.
- EMA/HMPC, Public statement on the use of herbal medicinal products containing toxic, unsaturated pyrrolizidine alkaloids (PAs), final, adopted 24 November 2014 (EMA/HMPC/893108/2011). Read 2026-10-23.
- NCCIH, Yohimbe (US NIH). Read 2026-10-23.
- Debelle FD et al., Aristolochic acid nephropathy: a worldwide problem. Kidney International 2008. Read 2026-10-23.
- Systematic review and meta-analysis of pharmaceutical adulteration in weight-loss natural products. Frontiers in Pharmacology 2025. Read 2026-10-23.
- NCCIH, Using Dietary Supplements Wisely (US NIH). Read 2026-10-23.
- NCCIH, Bitter Orange (US NIH). Read 2026-10-23.