On December 30, 2003, the Food and Drug Administration (FDA) said it would be taking ephedra off the market. This was because there have been so many problems with the product causing heart problems and strokes. In the coming weeks, the FDA will make a final statement and ephedra will no longer be sold. Questions are now coming up about the safety of many other herbal products.

The market is full of “ephedra-free” products that claim to be safer. The products claim to have “safer” ingredients such as bitter orange and guarana. The question everyone needs to ask now is “Are these herbals any safer than ephedra?” Many of these products might still have the same dangerous side effects. Just like ephedra, they could increase your blood pressure and heart rate.

One of the most common herbals that works like ephedra is bitter orange (also called the Seville orange). Bitter orange is used as a flavoring agent in such products as orange marmalade, orange candies and orange liqueurs. The amount in these products is normally not high enough to be harmful. However, it is also used in many energy drinks and diet pills. These products might contain enough bitter orange to cause serious side effects. Bitter orange could be harmful to some people for two reasons.

• Bitter orange contains synephrine, which has some of the same side effects as ephedra.
• Bitter orange may interact with some medicines and cause dangerous side effects. There is an enzyme in bitter orange that causes this interaction.

You should always read labels carefully. Always talk to a doctor or pharmacist about any products that are not familiar to you. The following are some good questions to ask your pharmacist about herbal products.

• Will this product interfere with any of my prescription medicines?
• Will it affect any foods, vitamins or over-the-counter (OTC) medicines I take?
• Will this product affect any of my current health problems?
• Will I have any side effects from this product?
• How much of the product should I take?

If you have any side effects from an herbal product, you should stop taking it, and tell your doctor or pharmacist right away. If possible, use only one pharmacy. This makes it possible for your pharmacist to keep a list of all the medicines you are taking and tell you if there may be a problem. Remember to tell your pharmacist about all the OTC and herbal products you are taking. If a doctor gives you a new medicine, ask the pharmacist if it will interact with anything you are already taking.

Ephedra will soon be gone from store shelves. The FDA is also planning to study the safety of other herbal products. Until then, read product labels and ask questions to make sure you do not take an herbal product that might be just as dangerous as ephedra.