Ephedra: After the death of Baltimore Orioles pitcher Steve Bechler, it's pretty clear that ephedra is not a safe choice. But "many people don't even know they're taking it," says Gregory Thompson, PharmD, director of the Los Angeles Regional Drug Information Center at the University of Southern California. Often ephedra is listed by its botanical sources, which include ma huang, sida cordifolia and epitonin.
Illegal Stimulants (also known as uppers): Clobenzorex and fenproporex are drugs that suppress the appetite (anorectics) and, although illegal in the United States, are popular in Southern California and the Southwest, where they're available on the street. "The abuse of this stuff is rampant," says Thompson. Side effects include insomnia, irritability, aggressive behavior, stroke and cardiac arrhythmia.
Provigil: The latest buzz in the pharmaceutical industry surrounds this narcolepsy drug, which is also being prescribed off-label for fatigue caused by other medical conditions. Meanwhile, Provigil is being tested to see if it enhances alertness in military pilots and shift workers. Side effects include headache, nausea, anxiety and insomnia, and the drug appears to interact with medications such as birth control pills. Long-term side effects are unknown.
Caffeine: "Caffeine is probably the safest stimulant we know of," says Robert Basner, MD, director of the Sleep and Ventilatory Disorders Program at Columbia Presbyterian Medical Center. Even caffeine pills are fine for most people. But in the end, he stresses, "sleep is what you need to get more of."