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Licensed to fill prescriptions for patients in RI, MA, CT, NJ, NH, FL, ME and PA. New York patients are served on a limited basis while nonresident registration is pending.
Prepared to a prescriber's order for one patient. Not FDA-approved.
Ephedrine is a sympathomimetic that raises blood pressure and opens airways, commonly compounded into oral capsules, troches, nasal drops and sterile injections.
Ephedrine is a sympathomimetic amine. It stimulates alpha and beta adrenergic receptors directly and, more importantly, indirectly by releasing norepinephrine from nerve endings, which raises blood pressure and heart rate and relaxes bronchial smooth muscle. Manufactured ephedrine sulfate injection (brands include Akovaz, Emerphed, Corphedra and Rezipres, plus generics) is FDA-approved for clinically important hypotension during anesthesia. Oral ephedrine is now sold mainly in a few over-the-counter fixed-dose combinations with guaifenesin for temporary relief of mild asthma symptoms. Separately, FDA has prohibited dietary supplements containing ephedrine alkaloids since 2004 because of an unreasonable risk of illness or injury; that rule concerns supplements, not prescription drugs. Prescribers order ephedrine compounded when they need an oral strength or form that is not manufactured, a nasal or topical preparation, or a sterile injection at a specific concentration. Compounded preparations are not FDA-approved and require a prescription.
The injection label lists no contraindications and no boxed warning, but StatPearls advises against use in acute hypertension or tachycardia and caution in ischemic heart disease, heart failure, aortic stenosis, urinary retention and prostate enlargement. The OTC oral leaflet says not to use it with high blood pressure, heart disease, irregular heartbeat, thyroid disease, diabetes or prostate-related urinary trouble, or within 14 days of an MAO inhibitor, which can cause a hypertensive crisis. Oxytocics such as methylergonovine, clonidine, propofol and atropine strengthen its pressor effect; beta blockers, alpha blockers and reserpine weaken it; it raises arrhythmia risk with digoxin. Repeated doses lose effect. Pregnancy: no birth defect signal; newborns exposed near delivery have shown metabolic acidosis. Breastfeeding: one case report found ephedrine in milk, and prolonged use of oral ephedrine products while nursing is discouraged. Common side effects are nausea, palpitations, headache, restlessness and insomnia. Talk to your prescriber or pharmacist about trouble urinating, a racing or irregular heartbeat, or symptoms that do not improve.
Ephedrine is a mixed-acting sympathomimetic: direct alpha and beta agonism plus indirect norepinephrine release and reuptake inhibition, which sustains heart rate rather than provoking reflex bradycardia as phenylephrine does. Oral bioavailability is about 88 percent with peak plasma concentration at about 1.8 hours, a large volume of distribution, metabolism to norephedrine, and renal excretion of parent and metabolite; oral half-life is about 6 hours and urinary excretion increases in acidic urine. Renal impairment prolongs effect. Ephedrine crosses the placenta. Labeled indication (ephedrine sulfate injection): clinically important hypotension in the setting of anesthesia, with tachyphylaxis and serious postpartum hypertension with oxytocics as the principal label warnings. Prescribers have ordered compounded ephedrine sulfate injection (IJPC published a sterile formulation in 2014) and oral ephedrine for off-label uses such as myasthenia gravis, where a 2016 placebo-controlled n-of-1 series in four patients reported a small, consistent improvement and the authors noted the mechanism is not well understood. Dosing is per prescriber. Monitor blood pressure, heart rate and pulse oximetry; the OTC oral leaflet advises against use in diabetes. Not a scheduled controlled substance; ephedrine and its salts are a DEA List I chemical (21 CFR 1310.02), with federal registration, recordkeeping and reporting rules for regulated transactions and state-level sales rules that vary. The FDA rule against ephedrine alkaloids in dietary supplements does not apply to prescription drug products.
Swallow the capsule whole with fluid. Do not crush, chew, divide or open it, and do not dissolve it in liquid, because that can release the full dose at once. Take it at the same times each day as your label directs. Slow release forms are not meant for feeding tubes; ask your pharmacist if you need a different form.
These are nonaqueous capsules, so a USP <795> default beyond-use date of up to 180 days usually applies. Store in a closed container at room temperature, away from heat, moisture and direct light, and out of reach of children. Discard after the beyond-use date on the label.
This formulation is compounded by Bayview Pharmacy on a prescriber's order for an individual patient. It is not an FDA-approved drug product, and the FDA has not evaluated it for safety, effectiveness, or manufacturing quality.
A valid prescription is required. Availability depends on Bayview's licensure in your state. This page is general information, not medical advice. Discuss your situation with a licensed healthcare provider.
Search by NCPDP 4106882, or by name and ZIP: Bayview Pharmacy, Warwick, RI 02886. Select it as the destination pharmacy and save it as a favorite. Click any value to copy it.
Compounded preparations have no NDC, so this formula will not appear in your EHR's drug search. Use your system's compound, non-formulary, or free-text prescription entry and name the preparation exactly as written in step 3. If your EHR forces you to pick a listed drug, pick the closest entry for the active ingredient and put the full formula in the prescription body (the Sig or directions field), not in Notes to Pharmacy.
Compounded preparations have no NDC and will not appear in your drug search. For EPCS to validate, select a drug entry your EHR recognizes as controlled, usually the bulk powder entry for the active ingredient (for example Ketamine (bulk) powder, not a branded product), then put the full formula from step 3 in the prescription body. A free-text entry that does not validate as controlled will be rejected by your EPCS module.
Quantity and directions are starting points for this dose form, not treatment recommendations. Dosing remains the prescriber's responsibility.
Transmit from your EHR. For this non-controlled preparation we also accept fax to (401) 284-4506 and phoned orders at (401) 284-4505. Order forms are on the formulation pages and in the prescriber portal.
Transmit with two-factor authentication through your EPCS-enabled EHR. No order form is offered for this preparation; e-prescribing guides for our controlled preparations are on the formulation pages.
Licensed to dispense in RI, MA, CT, NJ, NH, FL, ME, and PA; New York is served on a limited basis while nonresident registration is pending. Compounded preparations are not FDA-approved. A valid prescription is required. Full guide, including steps by EHR: How to e-prescribe to Bayview. Questions about this formula: call (401) 284-4505.
Take 1 capsule by mouth
