Ephedrine

The verdict

Our read at a glance.

Whether a real but modest weight-loss effect justifies the cardiovascular risk that got the supplement form removed from the market.

The signal

Unlike most of this category, ephedrine has been studied properly. Randomized trials and meta-analyses of ephedrine, alone and with caffeine, show a real but modest increase in weight loss over placebo, on the order of a kilogram or so per month, alongside consistent increases in heart rate and blood pressure. It remains an approved drug in a different context entirely: injectable ephedrine is labelled for the treatment of clinically important hypotension in the setting of anaesthesia, and registered trials continue in that perioperative use.

The unknown

Nothing much about efficacy. The unresolved issue is individual cardiovascular susceptibility, since the serious events that drove the ban occurred in a small fraction of a very large number of users and could not be predicted in advance.

Our read

The honest fat-loss drug of this category: a real, replicated, small effect with a real, quantified cardiovascular cost. It is also the reason the supplement industry's self-regulation argument is hard to sustain, since the ban followed deaths rather than preceded them.