Ephedrine vs. Synephrine: What to Choose and for Whom

If you are choosing a «fat burner» and are hesitating between a product with synephrine and «something stronger with ephedrine», this article is for you. The editors do not promise magical results, but explain for whom and under what conditions a supplement with p-synephrine may be acceptable, why ephedrine is not a tool for self-administration, and how not to make a mistake in choosing a product.

The Right Question Before Choosing

Before comparing ephedrine and synephrine, it is worth honestly answering the question: what problem do I want to solve? If the goal is to lose a few kilograms, energy balance plays the decisive role. No stimulant compensates for systematic overeating, and the total contribution of thermogenics to weight reduction, according to studies, is small.

If, however, it is a matter of obesity, especially with hypertension or disorders of glucose or lipid metabolism, the question is worth discussing with a physician. Modern medicine has drugs with a much stronger evidence base than any stimulants from the shelf of a sports store.

Finally, for athletes who compete, the first filter is anti-doping rules. Ephedrine is prohibited in competition above the threshold level, while synephrine is in the WADA Monitoring Program, that is, currently permitted.

Only after answering these questions can one talk about a choice. And, as we will see below, for an ordinary person the choice effectively comes down to whether it is worth adding a supplement with synephrine to the diet at all.

Ephedrine: Why It Is Not a Supplement

Ephedrine is a medicine and in many countries a controlled substance. In Ukraine it belongs to the precursors, the circulation of which is strictly regulated, so it is impossible to legally purchase it as a «fat burner». Products offered «with ephedra» or «with ephedrine» are either illegal or contain something entirely different from what is stated.

Even where ephedrine is available as a medicine, its cardiovascular and neurological risks make self-administration for weight loss unjustified. The meta-analysis by Shekelle et al. (2003) showed an increased risk of palpitations, psychiatric and autonomic symptoms, and an analysis of adverse events conducted by Haller and Benowitz (2000) described strokes, heart attacks and cases of sudden death.

The people who most want a «strong» effect — those who are overweight, have high blood pressure and are sedentary — at the same time belong to the group of highest cardiovascular risk. It is precisely for them that ephedrine is especially dangerous.

Therefore the editors' position is unambiguous: ephedrine is not an option for self-selection. Any use of it is possible only for medical indications and under a physician's supervision.

Synephrine: Who It May Suit

Supplements with bitter orange extract and p-synephrine are legally sold as dietary supplements. Reviews by Stohs and colleagues indicate that at the doses used in studies, pure p-synephrine in healthy adults did not significantly change heart rate and blood pressure. Most clinical works used on the order of a few dozen milligrams of p-synephrine per dose.

So a conditionally acceptable candidate may be a healthy adult without diseases of the heart, blood vessels or thyroid gland and without anxiety disorders, who has already established nutrition and training and understands that the effect of the supplement will be modest.

Practical recommendations for such people are simple. Follow the dose specified by the manufacturer and do not exceed it. Start with the minimum portion to assess tolerability. Do not take synephrine in the evening, so as not to disrupt sleep. Take into account all the caffeine over the day — from coffee, energy drinks, pre-workout complexes.

• Take it in the first half of the day, separately from other stimulants.
• Take breaks and monitor your pulse and blood pressure if you have the opportunity.
• Stop taking it in case of palpitations, chest pain, dizziness or severe restlessness.

One should not expect noticeable «fat burning» from synephrine. It is best regarded as a small addition to a calorie deficit, not as the main tool.

Who Should Not Take Any Stimulant

There are groups of people for whom neither ephedrine, nor synephrine, nor other thermogenic stimulants are recommended without a physician's approval. These include people with arterial hypertension, arrhythmias, coronary heart disease, a previous stroke, as well as hyperthyroidism, glaucoma, prostate adenoma with difficult urination.

Stimulants are contraindicated in pregnant and breastfeeding women, as well as in adolescents. Caution is needed for people with anxiety disorders, insomnia and panic attacks: even mild stimulants can worsen symptoms.

Drug interactions can also be dangerous. Stimulants must not be combined with monoamine oxidase inhibitors, and when taking antidepressants, ADHD medications, decongestants or blood pressure drugs a physician's consultation is needed.

Finally, for people with obesity and metabolic diseases it is more advisable to consult an endocrinologist: for them there are drugs with proven effectiveness and a controlled safety profile.

How to Choose a Product and Not Harm Yourself

If you have decided to try a supplement with synephrine, first study the label carefully. It is good when the manufacturer indicates not only the amount of bitter orange extract, but also the content of p-synephrine in milligrams. «Proprietary blends» without disclosing amounts do not allow you to assess how much active substance you are getting.

Pay attention to the presence of caffeine and other stimulants. Combined formulas with several stimulants have a higher risk of side effects, and it is precisely with them that most of the described cases of complications are associated.

Athletes should choose products that have passed independent testing for prohibited substances under programs such as Informed Sport or NSF Certified for Sport. This does not give an absolute guarantee, but significantly reduces the risk of accidental doping.

And lastly: buy supplements at trusted stores and from official distributors. Counterfeits and products of unknown origin may contain undeclared stimulants, in particular substances prohibited in many countries.

Editorial Conclusions

In a real choice ephedrine and synephrine are not equivalent options. Ephedrine is a controlled medicine with serious risks that should not be used on one's own. Synephrine is a legal supplement with a milder safety profile and modest evidence of effectiveness.

A supplement with synephrine may be an option for healthy adults who already control their nutrition and train, provided they follow the dose on the label and pay attention to total caffeine.

For people with diseases of the heart and blood vessels, pregnant women, adolescents and those who take medications, stimulants without a physician's consultation are not recommended.

We also recommend familiarizing yourself with our articles on safely combining caffeine with other supplements, on the risks of pre-workout complexes, and on the role of protein during weight loss.

References

1. Shekelle PG, Hardy ML, Morton SC, et al. Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA. 2003;289(12):1537–1545.
2. Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med. 2000;343(25):1833–1838.
3. Stohs SJ, Preuss HG, Shara M. The safety of Citrus aurantium (bitter orange) and its primary protoalkaloid p-synephrine. Phytother Res. 2011;25(10):1421–1428.
4. Stohs SJ, Preuss HG, Shara M. A review of the receptor-binding properties of p-synephrine as related to its pharmacological effects. Oxid Med Cell Longev. 2011;2011:482973.
5. Maughan RJ, Burke LM, Dvorak J, et al. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 2018;52(7):439–455.
6. World Anti-Doping Agency. Prohibited List та Monitoring Program. Montreal: WADA; актуальні редакції.