Mechanism, Efficacy, and Safety of an Ephedrine, Caffeine, and Aspirin Combination in the Treatment of Obesity
The field of obesity management is coming to appreciate the efficacy of pharmacological treatments. For the past twenty years the thermogenic effects of sympathetic stimulation have been known and described. Recent studies have demonstrated that treating patients with a drug combination including the sympathomimetic ephedrine, the stimulant caffeine, and the analgesic aspirin (ECA combination) will stimulate thermogenesis and result in lowered weight but maintained muscle mass. This protein-sparing lipolysis has been attributed to the elevated levels of cAMP generated by the ECA combination. In rat studies, the mechanism of action has been well characterized in vitro and although there is some discrepancy in humans, a similar mechanism seems to be active. Randomized placebo-controlled trials have demonstrated the short-term efficacy of the ECA combination, but long-term studies are lacking. Most studies have also demonstrated the incidence of short-term side effects associated with excessive sympathetic stimulation, and have shown them to be transient and mild. Future studies should focus on the long-term efficacy of the ECA combination, and the effects of stopping treatment on the maintenance of fat loss.