Syrup of ipecac
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Syrup of Ipecac (derived from the dried rhizome and roots of the Ipecacuanha plant), is an emetic—a substance used to induce vomiting. It is used in cases of accidental poisoning, and is perhaps the best-known emetic. Ipecac is also used in cough mixtures as an expectorant and from the 18th until the early 20th century, Ipecac and opium were used to produce Dover's powder, which was used in syrup form.
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Mechanism of action
The actions of Ipecac are mainly those of its major alkaloids, emetine (methylcephalin) and cephalin. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.[1]
Dosage
In children up to six months of age:
- Ipecac syrup should only be administered under the supervision of a physician
Children 6–12 months of age:
Children 1–12 years of age:
- 15 mL (1 tablespoon) preceded or followed by 120 to 240 mL (½ to 1 cup) of water
Adolescents and adults:
- 15 to 30 mL (1 to 2 tablespoon) followed immediately by 240 mL (1 cup) of water.
Vomiting typically happens within 15 to 20 minutes. If the patient has not vomited within 20 to 30 minutes, a second dose can be administered.[1] Saving the vomit is recommended for medical inspection.
Use
Though it has a long history of use, syrup of Ipecac has come under recent scrutiny.[1]
One recent scientific review (2005) by an expert panel concluded that vomiting alone does not reliably remove poisons from the stomach. The study suggested that indications for use of Ipecac syrup were rare and patients should be treated by more effective and safer means. Additionally, Ipecac’s potential side effects, such as lethargy, can be confused with the poison’s effects, complicating diagnosis. Ipecac may also delay the administration or reduce the effectiveness of other treatments such as activated charcoal, whole bowel irrigation, or oral antidotes.[1] The current first-line treatment for most ingested poisons is now activated charcoal, which operates much more quickly and effectively than Ipecac treatment.[1]
Although Ipecac was once recommended by pediatricians to be kept in the home, the current guidelines from the American Academy of Pediatrics recommends against keeping syrup of Ipecac in the home and in fact recommends disposal of any syrup of Ipecac present in the home.[1]
The reason for this new policy was:
- There was no evidence that syrup of Ipecac actually helps improve the outcome in cases of poisoning
- Administering syrup of Ipecac can delay administering more effective treatments, such as activated charcoal and/or antidotes
- Syrup of Ipecac can change neurologic status, and so the effects of the Ipecac can be mistaken for the effects of the poisoning
- Accidental overdose of Ipecac can result when administered in the home
- Universal availability of Ipecac in the home may have contributed to Ipecac abuse by bulimics and intentional misuse of Ipecac in cases of Munchausen syndrome by proxy.
Abuse
Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss. Repeated abuse is believed to cause damage to the heart, which can ultimately result in the user's death.[1] It can also destroy teeth due to long term contact with stomach acid, as what generally happens in bulimics. The death of singer Karen Carpenter in 1983 has been popularly attributed to her abuse of Ipecac for weight control.
