Med Sci Law. 2001 Oct; 41(4): 331-6.

Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol.

Tormey WP, Bruzzi A.

Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland.

A short-lasting episode of acute psychosis in a 32-year-old male which followed the consumption of alcohol, caffeine and 'vigueur fit' tablets containing ephedra alkaloids is reported. Less than two days after the event, a urine sample contained 22 microg/ml of ephedrine and 5 microg/ml of pseudoephedrine. Despite detailed pharmacological evidence being given at a jury trial, he was convicted of assault and trespass and was fined pounds sterling 16,000. An earlier incident involving misbehaviour on an aircraft again involving alcohol and ephedrine resulted in a conviction and a court order to provide twice weekly urine tests for alcohol for a period of six months. He stopped taking the alkaloid tablets after the second incident. There was no history of aberrant behaviour in this man outwith the period when taking these tablets. Ephedra alkaloids may cause psychosis and their effects can be exaggerated by interaction with caffeine and ethanol. To protect the public, the use of stimulant drugs in over-the-counter weight control programmes should be prescription only and the package insert should include a warning on the dangers of concomitant use of ethanol.