Pulse of Oriental Medicine: Alternative Medicine That Works for Regular Folks
Alternative Medicine That Works for Regular Folks








Antibiotics and Ephedra
by Brian Benjamin Carter, MSci, LAc

Brian is the founder of the Pulse of Oriental Medicine. He teaches at the Pacific College of Oriental Medicine and maintains a private acupuncture and herbal practice in San Diego, California, and is the author of Powerful Body, Peaceful Mind: How to Heal Yourself with Foods, Herbs, and Acupressure.


I am currently taking antibiotics for a slight case of bronchitis (Zithromax). After taking a single dose (a pill) of ephedra while on the antibiotic, I experienced rapid heart rate, the shakes, and extreme nervousness.

I have never experienced anything like this before on ephedra (I take it on average of maybe once every 2 weeks), and so I'm wondering if the side effects had anything to do with my antibiotics.

Could you let me know what you think?

Great question- two thoughts-

Macrolides and Alkaloids

#1, azithromycin (zithromax) can increase levels of alkaloids among other things... ephedrine (the constituent of ephedra that helps with respiration, etc.) is an alkaloid. Macrolides like azithromycin can inhibit your liver's ability to metabolize herbs. So, this interaction made it as if you had taken a higher dosage of ephedra.

Ephedra and the Sympathetic Nervous System

Ephedrine works much like other asthma meds (e.g. albuterol) in that it stimulates the sympathetic nervous system. This is the "fight or flight" mode of the nervous system. That's why you experienced those side effects.

The best thing would be to avoid the ephedra until the azithromycin is out of your system, which would be 68 hours after you stop taking it.

Predicting Drug Herb Interactions

I would tell you to consult your doc or herbalist before you combine herbs and drugs in the future, but they are unlikely to know... check out my drug herb interaction article, and watch for another one explaining how you can find out this kind of interaction ahead of time.

Another Thought - Qi Deficiency

#2 - When you have a disease like bronchitis, your qi is depleted (you're tired and your immune system isn't as strong)... an herb like ephredra can be hard to deal with at a time like that. Chinese herbs are almost always taken in combination with other chinese herbs... in this case, some strengthening herbs and herbs that moderate the toxicity of ephedra could have been used in a formula.

That plus the drug-herb interaction is likely what caused your discomfort.

All the Controversy About Ma Huang (Ephedra)

Ma Huang has gotten a bad rap in the press- mostly because most people use it for the wrong things! Unethical supplement companies have marketed it for use in "energy" and weight loss products. However, Ma Huang is traditional used for asthma, coughing, and wheezing. In small doses, especially as part of a traditional chinese herbal formula, it is an important and safe medicine.

You won't get great results if you take one self-prescribed herb at the time. To get the best out of herbs, request the guidance of a trained professional- most acupuncturists have this kind of training. To find one, check our "Resources for Finding Acupuncurists and Herbalists" article.

All the best!

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