A test tube study demonstrated that the bronchodilating effects of salbutamol, a drug with similar actions in the lung to epinephrine, were significantly increased by the addition of forskolin, the active component of the herb Coleus forskohlii.¹ The results of this preliminary research suggest that the combination of forskolin and beta-agonists might provide an alternative to raising the doses of the beta-agonist drugs as they lose effectiveness. Until more is known, coleus should not be combined with epinephrine without the supervision of a doctor.

Ephedra is the plant from which the drug ephedrine was originally isolated. Epinephrine and ephedrine have similar effects and side effects.² Until 2004, ephedra—also called ma huang—was used in many herbal products, including supplements promoted for weight loss. While interactions between epinephrine and ephedra have not been reported, it seems likely that such interactions could occur. To prevent potential problems, people should not be taking both epinephrine and ephedra/ephedrine-containing products.

Epinephrine can increase blood pressure and heart rate.³ Caffeine, especially in large amounts, can also increase heart rate.⁴ When given with phenylpropanolamine, a drug with effects similar to epinephrine, caffeine has been shown to produce an additive increase in blood pressure.⁵ Caffeine is found in coffee, tea, soft drinks, chocolate, guaraná (Paullinia cupana), nonprescription drugs, and supplements containing caffeine or guaraná. While no interactions have been reported between epinephrine and caffeine, people using epinephrine can minimize the potential for interactions by limiting or avoiding caffeine.

Intravenous administration of epinephrine to human volunteers reduced plasma concentrations of vitamin C.⁶ Epinephrine and other “stress hormones” may reduce intracellular concentrations of potassium and magnesium.⁷ Although there are no clinical studies in humans, it seems reasonable that individuals using epinephrine should consume a diet high in vitamin C, potassium, and magnesium, or should consider supplementing with these nutrients.

Intravenous administration of epinephrine to human volunteers reduced plasma concentrations of vitamin C.⁸ Epinephrine and other “stress hormones” may reduce intracellular concentrations of potassium and magnesium.⁹ Although there are no clinical studies in humans, it seems reasonable that individuals using epinephrine should consume a diet high in vitamin C, potassium, and magnesium, or should consider supplementing with these nutrients.

Intravenous administration of epinephrine to human volunteers reduced plasma concentrations of vitamin C.¹⁰ Epinephrine and other “stress hormones” may reduce intracellular concentrations of potassium and magnesium.¹¹ Although there are no clinical studies in humans, it seems reasonable that individuals using epinephrine should consume a diet high in vitamin C, potassium, and magnesium, or should consider supplementing with these nutrients.