Evaluation of the Stimulant Content of Dietary Supplements Marketed as "Ephedra-Free"

Background: With the removal of stimulant herb ephe-dra from the market, dietary supplement manufacturers are coming out with many ephedra-free products. Some of these products appear to simply replace ephedra with stimulants by another name. Objective: To determine the stimulant content of dietary supplements marketed as ephedra-free. Design: Survey of the ingredients of dietary supplements that are stated as "ephedra-free" in the label or promotional material. Results: Out of 36 products marketed as ephedra-free, 32 (89%) contained a methylxanthine such as caffeine or theobromine, 21 (58%) contained the stimulant synephrine, and 20 (56%) contained both a methylxanthine and synephrine. Limitations: The results of this evaluation pertain only to products discovered through Internet and database searching. Conclusions: Most dietary supplement makers have substituted stimulants by a different name for ephedra in their "ephedra-free" products. Patients need to be advised that ephedra-free products are not necessarily stimulant free and may present a significant risk.