ephedrine + hydroxyzine + theophylline

The combination drug ephedrine + hydroxyzine + theophylline was historically used for treating asthma and related respiratory conditions. This fixed-dose combination was marketed under the brand name Marax, among others, but is no longer manufactured in the US due to safety concerns and limited efficacy compared to individual components. ## Composition and Mechanism This combination contains three active ingredients that work through different mechanisms: 1. **Theophylline** - A bronchodilator that acts as an adenosine receptor antagonist, relaxing smooth muscle in the airways 2. **Ephedrine** - A sympathomimetic agent that functions as a norepinephrine releasing agent, providing bronchodilation 3. **Hydroxyzine** - An antihistamine that helps reduce allergic responses and may have mild anxiolytic effects ## Clinical Use and Effectiveness Clinical studies showed that while the combination was used to treat chronic asthma, it offered no significant advantage over theophylline alone[1][5]. In fact, the combination was associated with more adverse effects, including insomnia, nervousness, and gastrointestinal complaints[1]. Some research indicated that hydroxyzine's addition might have helped reduce side effects in some patients who couldn't tolerate the ephedrine-theophylline combination alone[5]. ## Safety Profile The combination has numerous potential drug interactions - 865 known drug interactions in total, with 154 classified as major, 685 as moderate, and 26 as minor[2]. It also has 21 disease interactions and 3 alcohol/food interactions[2]. Common side effects include: - Nausea and vomiting - Dry mouth - Stomach discomfort - Anxiety and restlessness - Headache - Increased heart rate - Insomnia - Drowsiness[9] ## Historical Context This combination was first studied for asthma treatment in the mid-20th century. The FDA eventually withdrew approval for combinations containing theophylline, ephedrine sulfate, and hydroxyzine hydrochloride[3]. Fixed-dose combinations of theophylline and ephedrine were largely abandoned after the 1970s as they did not allow for proper dose titration in asthma therapy due to ephedrine's toxicity[7]. The combination is no longer manufactured in the US, particularly after the FDA withdrew approval for ephedra-containing products[8].

Brand names

Marax