ephedrine (Rx)

Brand and Other Names:Akovaz, Corphedra, more...Emerphed, Rezipres
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution, as sulfate

  • 50mg/mL (Akovaz, Corphedra, generics)
  • 50mg/10mL (5mg/mL) (Emerphed); equivalent to ephedrine base 3.8mg/mL

injectable solution, as hydrochloride (Rezipres)

  • 47mg/mL; equivalent to ephedrine base 38mg/mL
  • 47mg/5mL (9.4mg/mL); equivalent to ephedrine base 7.7mg/mL
  • 23.5mg/5mL (4.7mg/mL); equivalent to ephedrine base 3.8mg/mL

Hypotension

Indicated for treatment of clinically important hypotension occurring in the setting of anesthesia

Akovaz, Corphedra, Emerphed, generics

  • Initial dose: 5-10 mg IV bolus
  • Administer additional boluses as needed, not to exceed a total cumulative dosage of 50 mg
  • Titrate dosage according to blood pressure (BP) goal

Rezipres

  • Initial dose: 4.7-9.4 mg IV bolus
  • Administer additional boluses as needed, not to exceed a total cumulative dosage of 47 mg
  • Titrate dosage according to blood pressure goal

Dosage Modifications

Renal impairment

  • Ephedrine and its metabolite are excreted in urine
  • Patients with renal impairment may have an increase in elimination half-life, which may slow the elimination, prolong the effects, and increase the risk of adverse reactions of ephedrine
  • Carefully monitor these patients after initial bolus dose for adverse reactions

Dosing Considerations

Premixed formulations (Emerphed, Rezipres 4.7 mg/mL)

  • Do NOT dilute before use

Safety and efficacy not established

Start at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy

Drug is substantially excreted by the kidney, and the risk of adverse reactions may be greater with impaired renal function

Because elderly patients are more likely to have decreased renal function, carefully select dose and consider monitoring renal function

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Interactions

Interaction Checker

and ephedrine

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            Contraindicated (9)

            • iobenguane I 123

              ephedrine decreases effects of iobenguane I 123 by receptor binding competition. Contraindicated. If clinically appropriate, discontinue drugs that compete for NE receptor sites for at least 5 half-lives; may cause false-negative imaging results.

            • isocarboxazid

              isocarboxazid increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • linezolid

              linezolid increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • phenelzine

              phenelzine increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • procarbazine

              procarbazine increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • rasagiline

              rasagiline increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • selegiline

              selegiline increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • selegiline transdermal

              selegiline transdermal increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            • tranylcypromine

              tranylcypromine increases effects of ephedrine by pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Serious - Use Alternative (28)

            • amitriptyline

              amitriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • amoxapine

              amoxapine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • cabergoline

              cabergoline, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • clomipramine

              clomipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • desflurane

              desflurane increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • desipramine

              desipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • dihydroergotamine

              dihydroergotamine, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • doxapram

              doxapram increases effects of ephedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

            • doxepin

              doxepin, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • ergoloid mesylates

              ergoloid mesylates, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ergotamine

              ergotamine, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • ether

              ether increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • imipramine

              imipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • iobenguane I 131

              ephedrine will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

            • isoflurane

              isoflurane increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • ketamine

              ketamine, ephedrine. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Intraoperative use of ephedrine and ketamine should be used cautiously and is contraindicated in situations where increased blood pressure would be hazardous (eg, hypertension, stroke, head trauma, intracranial bleeding).

            • lofepramine

              lofepramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • maprotiline

              maprotiline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • methoxyflurane

              methoxyflurane increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • methylergonovine

              methylergonovine, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Additive vasospasm; risk of hypertension.

            • nortriptyline

              nortriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • ozanimod

              ozanimod increases toxicity of ephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Avoid or Use Alternate Drug. Because the active metabolite of ozanimod inhibits MAO-B in vitro, there is a potential for serious adverse reactions, including hypertensive crisis. Therefore, coadministration of ozanimod with drugs that can increase norepinephrine or serotonin is not recommended. Monitor for hypertension with concomitant use.

            • protriptyline

              protriptyline, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • sevoflurane

              sevoflurane increases toxicity of ephedrine by Mechanism: unknown. Avoid or Use Alternate Drug. Risk of V tach, HTN.

            • trazodone

              trazodone, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • trimipramine

              trimipramine, ephedrine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.

            • yohimbe

              yohimbe, ephedrine. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of acute hypertensive episode.

            Monitor Closely (249)

            • acebutolol

              acebutolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              acebutolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • aceclofenac

              aceclofenac increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acemetacin

              acemetacin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • acetazolamide

              acetazolamide will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • albuterol

              albuterol and ephedrine both decrease serum potassium. Use Caution/Monitor.

              albuterol and ephedrine both decrease sedation. Use Caution/Monitor.

              albuterol and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • alfentanil

              alfentanil increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • alprazolam

              alprazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aluminum hydroxide

              aluminum hydroxide will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • amiloride

              amiloride increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • amitriptyline

              amitriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              amitriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • amobarbital

              amobarbital increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • amoxapine

              amoxapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              amoxapine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • arformoterol

              arformoterol and ephedrine both decrease serum potassium. Use Caution/Monitor.

              arformoterol and ephedrine both decrease sedation. Use Caution/Monitor.

              arformoterol and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • aripiprazole

              aripiprazole increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • armodafinil

              ephedrine and armodafinil both decrease sedation. Use Caution/Monitor.

            • aspirin

              aspirin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • aspirin rectal

              aspirin rectal increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • atenolol

              atenolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              atenolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • atomoxetine

              atomoxetine, ephedrine. Other (see comment). Use Caution/Monitor. Comment: Due to the potential for increases in blood pressure and heart rate, atomoxetine should be used cautiously.

            • azelastine

              azelastine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • belladonna and opium

              belladonna and opium increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bendroflumethiazide

              ephedrine and bendroflumethiazide both decrease serum potassium. Use Caution/Monitor.

            • benperidol

              benperidol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • benzphetamine

              ephedrine and benzphetamine both decrease sedation. Use Caution/Monitor.

              ephedrine and benzphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • betaxolol

              betaxolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              betaxolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • bisoprolol

              bisoprolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              bisoprolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • bretylium

              bretylium increases effects of ephedrine by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Modify Therapy/Monitor Closely. If catecholamines are administered to treat systolic BP <75 mmHg, a dilute solution should be employed and blood pressure monitored closely. Bretylium causes an initial norepinephrine release and may enhance catecholamine pressor effects.

            • bromocriptine

              bromocriptine, ephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Hypertension, V tach.

            • brompheniramine

              brompheniramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • bumetanide

              ephedrine and bumetanide both decrease serum potassium. Use Caution/Monitor.

            • buprenorphine buccal

              buprenorphine buccal increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butabarbital

              butabarbital increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butalbital

              butalbital increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • butorphanol

              butorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • caffeine

              ephedrine and caffeine both decrease sedation. Use Caution/Monitor.

            • calcium carbonate

              calcium carbonate will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • carbenoxolone

              ephedrine and carbenoxolone both decrease serum potassium. Use Caution/Monitor.

            • carbinoxamine

              carbinoxamine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • carvedilol

              carvedilol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              carvedilol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • celecoxib

              celecoxib increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • celiprolol

              celiprolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              celiprolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • chloral hydrate

              chloral hydrate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlordiazepoxide

              chlordiazepoxide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorothiazide

              ephedrine and chlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • chlorpheniramine

              chlorpheniramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              chlorpromazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • chlorthalidone

              ephedrine and chlorthalidone both decrease serum potassium. Use Caution/Monitor.

            • choline magnesium trisalicylate

              choline magnesium trisalicylate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • cinnarizine

              cinnarizine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clemastine

              clemastine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clomipramine

              clomipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              clomipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • clonazepam

              clonazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clorazepate

              clorazepate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • clozapine

              clozapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • codeine

              codeine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclizine

              cyclizine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • cyclopenthiazide

              ephedrine and cyclopenthiazide both decrease serum potassium. Use Caution/Monitor.

            • cyproheptadine

              cyproheptadine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • deflazacort

              ephedrine and deflazacort both decrease serum potassium. Use Caution/Monitor.

            • desipramine

              desipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              desipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • dexchlorpheniramine

              dexchlorpheniramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexfenfluramine

              ephedrine and dexfenfluramine both decrease sedation. Use Caution/Monitor.

              ephedrine and dexfenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dexmedetomidine

              dexmedetomidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dexmethylphenidate

              ephedrine and dexmethylphenidate both decrease sedation. Use Caution/Monitor.

              ephedrine and dexmethylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextroamphetamine

              ephedrine and dextroamphetamine both decrease sedation. Use Caution/Monitor.

              ephedrine and dextroamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dextromoramide

              dextromoramide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diamorphine

              diamorphine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diclofenac

              diclofenac increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diethylpropion

              ephedrine and diethylpropion both decrease sedation. Use Caution/Monitor.

              ephedrine and diethylpropion both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • difenoxin hcl

              difenoxin hcl increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diflunisal

              diflunisal increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • digoxin

              digoxin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dimenhydrinate

              dimenhydrinate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenhydramine

              diphenhydramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • diphenoxylate hcl

              diphenoxylate hcl increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dipipanone

              dipipanone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • dobutamine

              dobutamine and ephedrine both decrease serum potassium. Use Caution/Monitor.

              dobutamine and ephedrine both decrease sedation. Use Caution/Monitor.

              dobutamine and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopamine

              ephedrine and dopamine both decrease sedation. Use Caution/Monitor.

              ephedrine and dopamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • dopexamine

              dopexamine and ephedrine both decrease serum potassium. Use Caution/Monitor.

              dopexamine and ephedrine both decrease sedation. Use Caution/Monitor.

              dopexamine and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              dopexamine, ephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • doxepin

              doxepin increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              doxepin increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • droperidol

              droperidol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • drospirenone

              drospirenone increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • droxidopa

              ephedrine and droxidopa both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. May increase risk for supine hypertension

            • epinephrine

              ephedrine and epinephrine both decrease serum potassium. Use Caution/Monitor.

              ephedrine and epinephrine both decrease sedation. Use Caution/Monitor.

              ephedrine and epinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, epinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • epinephrine inhaled

              ephedrine, epinephrine inhaled. Either increases effects of the other by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • epinephrine racemic

              ephedrine and epinephrine racemic both decrease serum potassium. Use Caution/Monitor.

              ephedrine and epinephrine racemic both decrease sedation. Use Caution/Monitor.

              ephedrine and epinephrine racemic both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • esmolol

              esmolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              esmolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • estazolam

              estazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ethacrynic acid

              ephedrine and ethacrynic acid both decrease serum potassium. Use Caution/Monitor.

            • ethanol

              ethanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • etodolac

              etodolac increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fenfluramine

              ephedrine and fenfluramine both decrease sedation. Use Caution/Monitor.

              ephedrine and fenfluramine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, fenfluramine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • fenoprofen

              fenoprofen increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • fluphenazine

              fluphenazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              fluphenazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • flurazepam

              flurazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • flurbiprofen

              flurbiprofen increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • formoterol

              ephedrine and formoterol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and formoterol both decrease sedation. Use Caution/Monitor.

              ephedrine and formoterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • furosemide

              ephedrine and furosemide both decrease serum potassium. Use Caution/Monitor.

            • gentamicin

              ephedrine and gentamicin both decrease serum potassium. Use Caution/Monitor.

            • green tea

              green tea increases effects of ephedrine by pharmacodynamic synergism. Use Caution/Monitor. Due to caffeine content. Combination may increase CNS stimulatory effects due to caffeine in green tea.

            • haloperidol

              haloperidol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydralazine

              hydralazine, ephedrine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Sympathomimetics can antagonize the activity of some antihypertensive agents.

            • hydrochlorothiazide

              ephedrine and hydrochlorothiazide both decrease serum potassium. Use Caution/Monitor.

            • hydromorphone

              hydromorphone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • hydroxyzine

              hydroxyzine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen

              ibuprofen increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ibuprofen IV

              ibuprofen IV increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • iloperidone

              iloperidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • imipramine

              imipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              imipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • indacaterol, inhaled

              ephedrine increases effects of indacaterol, inhaled by Other (see comment). Use Caution/Monitor. Comment: If additional adrenergic drugs are to be administered by any route, they should be used with caution because the sympathetic effects of indacaterol may be potentiated.

            • indapamide

              ephedrine and indapamide both decrease serum potassium. Use Caution/Monitor.

            • indomethacin

              indomethacin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • insulin degludec

              ephedrine decreases effects of insulin degludec by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin degludec/insulin aspart

              ephedrine decreases effects of insulin degludec/insulin aspart by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • insulin inhaled

              ephedrine decreases effects of insulin inhaled by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Sympathomimetics increase blood glucose by stimulating alpha and beta receptors; this action results in increased hepatic glucose production, glycogenolysis, and decreased insulin secretion.

            • isoproterenol

              ephedrine and isoproterenol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and isoproterenol both decrease sedation. Use Caution/Monitor.

              ephedrine and isoproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, isoproterenol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • ketoprofen

              ketoprofen increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac

              ketorolac increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ketorolac intranasal

              ketorolac intranasal increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

            • ketotifen, ophthalmic

              ketotifen, ophthalmic increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • labetalol

              labetalol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              labetalol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • levalbuterol

              ephedrine and levalbuterol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and levalbuterol both decrease sedation. Use Caution/Monitor.

              ephedrine and levalbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • levorphanol

              levorphanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lisdexamfetamine

              ephedrine and lisdexamfetamine both decrease sedation. Use Caution/Monitor.

              ephedrine and lisdexamfetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • lofepramine

              lofepramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              lofepramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • lofexidine

              lofexidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loprazolam

              loprazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lorazepam

              lorazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lormetazepam

              lormetazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • lornoxicam

              lornoxicam increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine

              loxapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • loxapine inhaled

              loxapine inhaled increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • maprotiline

              maprotiline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              maprotiline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • marijuana

              marijuana increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meclofenamate

              meclofenamate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • mefenamic acid

              mefenamic acid increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • melatonin

              melatonin increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meloxicam

              meloxicam increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meperidine

              meperidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • meprobamate

              meprobamate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • metaproterenol

              ephedrine and metaproterenol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and metaproterenol both decrease sedation. Use Caution/Monitor.

              ephedrine and metaproterenol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methadone

              methadone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • methamphetamine

              ephedrine and methamphetamine both decrease sedation. Use Caution/Monitor.

              ephedrine and methamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, methamphetamine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • methyclothiazide

              ephedrine and methyclothiazide both decrease serum potassium. Use Caution/Monitor.

            • methyldopa

              methyldopa increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • methylenedioxymethamphetamine

              ephedrine and methylenedioxymethamphetamine both decrease sedation. Use Caution/Monitor.

              ephedrine and methylenedioxymethamphetamine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • methylphenidate

              ephedrine and methylphenidate both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • metolazone

              ephedrine and metolazone both decrease serum potassium. Use Caution/Monitor.

            • metoprolol

              metoprolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              metoprolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • midazolam

              midazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • midodrine

              ephedrine and midodrine both decrease sedation. Use Caution/Monitor.

              ephedrine and midodrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, midodrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • mirtazapine

              mirtazapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • modafinil

              ephedrine and modafinil both decrease sedation. Use Caution/Monitor.

            • morphine

              morphine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • motherwort

              motherwort increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • moxonidine

              moxonidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabilone

              nabilone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nabumetone

              nabumetone increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nadolol

              nadolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nadolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • nalbuphine

              nalbuphine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • naproxen

              naproxen increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • nateglinide

              ephedrine decreases effects of nateglinide by pharmacodynamic antagonism. Use Caution/Monitor. Coadministration may reduce nateglinide's hypoglycemic action.

            • nebivolol

              nebivolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nebivolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • norepinephrine

              ephedrine and norepinephrine both decrease serum potassium. Use Caution/Monitor.

              ephedrine and norepinephrine both decrease sedation. Use Caution/Monitor.

              ephedrine and norepinephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, norepinephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • nortriptyline

              nortriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              nortriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • olanzapine

              olanzapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • olodaterol inhaled

              ephedrine and olodaterol inhaled both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Caution with coadministration of adrenergic drugs by any route because of additive sympathetic effects

            • opium tincture

              opium tincture increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxaprozin

              oxaprozin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxazepam

              oxazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxycodone

              oxycodone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxymetazoline topical

              oxymetazoline topical and ephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • oxymorphone

              oxymorphone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • oxytocin

              oxytocin increases effects of ephedrine by pharmacodynamic synergism. Use Caution/Monitor.

            • paliperidone

              paliperidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • papaveretum

              papaveretum increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • parecoxib

              parecoxib increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • penbutolol

              penbutolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              penbutolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • pentazocine

              pentazocine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pentobarbital

              pentobarbital increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • perphenazine

              perphenazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              perphenazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • phendimetrazine

              ephedrine and phendimetrazine both decrease sedation. Use Caution/Monitor.

              ephedrine and phendimetrazine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, phendimetrazine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • phenobarbital

              phenobarbital increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • phenoxybenzamine

              phenoxybenzamine, ephedrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phentermine

              ephedrine and phentermine both decrease sedation. Use Caution/Monitor.

              ephedrine and phentermine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, phentermine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • phentolamine

              phentolamine, ephedrine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Hypotension, tachycardia.

            • phenylephrine

              ephedrine and phenylephrine both decrease sedation. Use Caution/Monitor.

              ephedrine and phenylephrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, phenylephrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • phenylephrine PO

              ephedrine and phenylephrine PO both decrease sedation. Use Caution/Monitor.

              ephedrine and phenylephrine PO both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, phenylephrine PO. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • pholcodine

              pholcodine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pimozide

              pimozide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • pindolol

              pindolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              pindolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • pirbuterol

              ephedrine and pirbuterol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and pirbuterol both decrease sedation. Use Caution/Monitor.

              ephedrine and pirbuterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • piroxicam

              piroxicam increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • potassium acid phosphate

              potassium acid phosphate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium chloride

              potassium chloride increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • potassium citrate

              potassium citrate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • primidone

              primidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • prochlorperazine

              prochlorperazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              prochlorperazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promazine

              promazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • promethazine

              promethazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              promethazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • propranolol

              propranolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              propranolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • propylhexedrine

              ephedrine and propylhexedrine both decrease sedation. Use Caution/Monitor.

              ephedrine and propylhexedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, propylhexedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • protriptyline

              protriptyline increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              protriptyline increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • pseudoephedrine

              ephedrine and pseudoephedrine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, pseudoephedrine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • quazepam

              quazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • quetiapine

              quetiapine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • risperidone

              risperidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sacubitril/valsartan

              sacubitril/valsartan increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salicylates (non-asa)

              salicylates (non-asa) increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • salmeterol

              ephedrine and salmeterol both decrease serum potassium. Use Caution/Monitor.

              ephedrine and salmeterol both decrease sedation. Use Caution/Monitor.

              ephedrine and salmeterol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • salsalate

              salsalate increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • scullcap

              scullcap increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • secobarbital

              secobarbital increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • shepherd's purse

              shepherd's purse increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sodium bicarbonate

              sodium bicarbonate will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • sodium citrate/citric acid

              sodium citrate/citric acid will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • sodium lactate

              sodium lactate will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

              ephedrine and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

            • solriamfetol

              ephedrine and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • sotalol

              sotalol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              sotalol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • spironolactone

              spironolactone increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • succinylcholine

              succinylcholine increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sufentanil

              sufentanil increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulfasalazine

              sulfasalazine increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • sulindac

              sulindac increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tapentadol

              tapentadol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • temazepam

              temazepam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • terbutaline

              ephedrine and terbutaline both decrease serum potassium. Use Caution/Monitor.

              ephedrine and terbutaline both decrease sedation. Use Caution/Monitor.

              ephedrine and terbutaline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • thioridazine

              thioridazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              thioridazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • thiothixene

              thiothixene increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • timolol

              timolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              timolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

            • tolfenamic acid

              tolfenamic acid increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolmetin

              tolmetin increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • tolvaptan

              tolvaptan increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • topiramate

              topiramate increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • torsemide

              ephedrine and torsemide both decrease serum potassium. Use Caution/Monitor.

            • tramadol

              tramadol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trazodone

              trazodone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              trazodone increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • triamterene

              triamterene increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.

            • triazolam

              triazolam increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • triclofos

              triclofos increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • trifluoperazine

              trifluoperazine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              trifluoperazine, ephedrine. Mechanism: unknown. Use Caution/Monitor. Risk of cardiac arrhythmia or sudden death, more likely w/thioridazine than other phenothiazines. Interaction more likely in certain predisposed pts. only.

            • trimipramine

              trimipramine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              trimipramine increases effects of ephedrine by unknown mechanism. Use Caution/Monitor.

            • triprolidine

              triprolidine increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • xylometazoline

              ephedrine and xylometazoline both decrease sedation. Use Caution/Monitor.

              ephedrine and xylometazoline both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              ephedrine, xylometazoline. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • yohimbine

              ephedrine and yohimbine both decrease sedation. Use Caution/Monitor.

              ephedrine and yohimbine both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

            • ziconotide

              ziconotide increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            • ziprasidone

              ziprasidone increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

            Minor (16)

            • bendroflumethiazide

              ephedrine, bendroflumethiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • bumetanide

              ephedrine, bumetanide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorothiazide

              ephedrine, chlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • chlorthalidone

              ephedrine, chlorthalidone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • cyclopenthiazide

              ephedrine, cyclopenthiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • desmopressin

              desmopressin increases effects of ephedrine by pharmacodynamic synergism. Minor/Significance Unknown.

            • ethacrynic acid

              ephedrine, ethacrynic acid. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • eucalyptus

              eucalyptus increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • furosemide

              ephedrine, furosemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • hydrochlorothiazide

              ephedrine, hydrochlorothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • indapamide

              ephedrine, indapamide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • methyclothiazide

              ephedrine, methyclothiazide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • metolazone

              ephedrine, metolazone. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

            • noni juice

              noni juice increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • sage

              sage increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Minor/Significance Unknown.

            • torsemide

              ephedrine, torsemide. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Hypokalemia.

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            Adverse Effects

            Frequency Not Defined

            Gastrointestinal disorders: Nausea, vomiting

            Cardiac disorders: Tachycardia, palpitations (thumping heart), reactive hypertension, bradycardia, ventricular ectopics, heart rhythm/rate variability

            Nervous system disorders: Dizziness

            Psychiatric disorders: Restlessness

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            Warnings

            Contraindications

            None

            Cautions

            Serious postpartum hypertension and stroke reported with coadministration of a vasopressor (ie, methoxamine, phenylephrine, ephedrine) and an oxytocic (ie, methylergonovine, ergonovine); monitor BP if patient has received both ephedrine and an oxytocic

            Repeated administration may cause tachyphylaxis; an alternative vasopressor may be needed to mitigate unresponsiveness to treatment

            An increased incidence of hypertension has occurred when used for prevention compared with treatment of hypotension

            Drug interaction overview

            • Oxytocin and oxytocic drugs
              • Carefully monitor BP
              • Coadministration of a vasopressor and an oxytocic cause serious postpartum hypertension; some patients experienced a stroke
            • Drugs that augment vasopressor effects of ephedrine
              • Carefully monitor BP
              • Clonidine, propofol, monoamine oxidase inhibitors (MAOIs), atropine may augment the vasopressor effects of ephedrine
            • Drugs that antagonize vasopressor effects of ephedrine
              • Carefully monitor BP
              • Alpha-adrenergic antagonists, beta-adrenergic receptor antagonists, reserpine, or quinidine may antagonize the vasopressor effects of ephedrine
            • Rocuronium
              • Be aware of interaction
              • Ephedrine may reduce onset time of neuromuscular blockade when used for intubation with rocuronium if administered simultaneously with anesthetic induction
            • Epidural anesthesia
              • Monitor and treat according to clinical practice
              • Ephedrine may decrease the efficacy of epidural blockage by hastening the regression of sensory analgesia
            • Theophylline
              • Monitor for worsening symptoms and manage symptoms according to clinical practice
              • Ephedrine may increase the frequency of nausea, nervousness, and insomnia
            • Cardiac glycosides
              • Carefully monitor
              • Coadministration with a cardiac glycoside (eg, digoxin) may increase the risk of arrhythmias
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            Pregnancy & Lactation

            Pregnancy

            Available data of use in pregnant females have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes

            Animal data

            • Decreased fetal body weights were observed when pregnant rats were administered IV bolus doses of 60 mg/kg ephedrine sulfate (12 times the maximum recommended human dose (MRHD) based on body surface area [BSA]) from gestation day (GD) 6-17; dose was associated with evidence of maternal toxicity (decreased body weight of dams and abnormal head movements)
            • Decreased fetal survival and fetal body weights were observed in presence of maternal toxicity after normotensive pregnant rats were administered 60 mg/kg IV ephedrine sulfate (12x the MRHD of 50 mg/day based on BSA) from GD 6 through Lactation Day 20

            Clinical considerations

            • Untreated hypotension associated with spinal anesthesia for cesarean section is associated with increase in maternal nausea and vomiting
            • Decreased uterine blood flow due to maternal hypotension may result in fetal bradycardia and acidosis
            • Fetal/neonatal adverse reactions
              • Cases of potential metabolic acidosis in newborns at delivery with maternal ephedrine exposure have been reported in the literature
              • These reports describe umbilical artery pH of ≤7.2 at the time of delivery
              • Monitor newborn for signs and symptoms of metabolic acidosis
              • Monitoring of infant’s acid-base status is warranted to ensure that an episode of acidosis is acute and reversible

            Lactation

            A single published case report indicates that ephedrine is present in human milk

            No information is available on its effects on breastfed infants or on milk production

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Sympathomimetic amine that directly acts as an agonist at alpha- and beta­adrenergic receptors and indirectly causes the release of norepinephrine from sympathetic neurons

            Resulting pharmacodynamic effects include increased heart rate, BP, cardiac output, and variable increases in peripheral resistance

            Stimulates alpha-adrenergic receptors of smooth muscle cells in the bladder (increases resistance to urinary outflow)

            Activation of beta-adrenergic receptors in the lungs promotes bronchodilation

            Distribution

            Crosses the placental barrier

            Metabolism

            Publications studying pharmacokinetics of oral (-)-ephedrine support that (-)-ephedrine is metabolized into norephedrine; however, metabolic pathway is unknown

            Elimination

            Half-life: 6 hr (oral)

            Excretion: Urine (ephedrine and its metabolites)

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            Administration

            IV Compatibilities

            0.9% NaCl

            D5W

            IV Preparation

            Visually inspect parenteral drug products for particulate matter and discoloration before preparation and administration

            Dilution requirements before administration

            • Products vary regarding requirement for dilution
            • Products requiring dilution
              • 50 mg/mL (Akovaz, Corphedra, generics)
              • 47 mg/mL (Rezipres)
              • 9.4 mg/mL (Rezipres): Can use as provided or may be diluted
            • Do not dilute
              • 5 mg/mL (Emerphed)
              • 4.7 mg/mL (Rezipres)
              • 9.4 mg/mL (Rezipres): Can use as provided or may be diluted

            Rezipres

            • 47 mg/mL
              • Withdraw 1 mL of 47 mg/mL ampule and dilute with 9 mL of D5W or 0.9% NaCl to yield 4.7 mg/mL
              • Withdraw an appropriate dose of the diluted 4.7-mg/mL solution prior to administration
            • 9.4 mg/mL
              • Withdraw 5 mL of 9.4-mg/mL ampule and dilute with 5 mL of D5W or 0.9% NaCl to yield 4.7 mg/mL
              • Withdraw an appropriate dose of the diluted 4.7-mg/mL solution prior to administration

            Akovaz, Corphedra, generics

            • Withdraw 1 mL of 50 mg/mL ampule and dilute with 9 mL of D5W or 0.9% NaCl to yield 5 mg/mL
            • Withdraw an appropriate dose of the diluted 5-mg/mL solution prior to administration

            IV Administration

            Administer prepared diluted solutions or undiluted drug as IV bolus

            Formulations for direct IV bolus administration

            • Emerphed (ephedrine sulfate 5 mg/mL)
            • Rezipres (ephedrine HCl 4.7 mg/mL and 9.7 mg/mL)

            Storage

            All formulations are single dose only; discard any unused portion

            Akovaz, Corphedra, Emerphed, generics

            • Vial stoppers are not manufactured with natural rubber latex
            • Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
            • Protect from light, store in carton until time of use

            Rezipres

            • Store at 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)
            • Diluted solutions: Discard after >4 hr at room temperature or >24 hr under refrigerated conditions
            • For single-dose only; discard any unused portion
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            Images

            No images available for this drug.
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            Patient Handout

            Patient Education
            ephedrine oral

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.