Syrup Of Ipecac

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Oct 19

Mechanism of action

The actions of Ipecac are mainly those of its major alkaloids, emetine (methylcephaeline) and cephaeline. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.

Poison Treatment

The commercial preparation of ipecac consists of 1/14th of fluedextractum of ipecac root. The rest is composed of glycerin and sugar syrup. Ipecac root itself is a poison but due to the normal strengths used and the inability of the patient to keep the solution ingested it is seldom fatal.

Use

Ipecac was used in cough mixtures as an expectorant or an emetic from the 18th until the early 20th century. Ipecac and opium were used to produce Dover's powder, which was used in syrup form. Ipecac syrup is still used to induce vomiting, though it is no longer widely recommended.

Pediatricians once recommended ipecac be kept in the home as a ready emetic for use in cases of accidental poisoning. Current guidelines from the American Academy of Pediatrics, however, strongly advise against this and in fact recommend the disposal of any syrup of Ipecac present in the home. Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons, because there has been no evidence that syrup of Ipecac actually helps improve the outcome in cases of poisoning. Moreover, accidental overdose of ipecac can result when administered in the home.

A 2005 review by an HRSA-funded scientific 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 potential side effects, such as lethargy, can be confused with the poison 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.

Abuse

Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss through induced defensive vomiting. Repeated abuse is believed to cause damage to the heart, which can ultimately result in the user's death. It has also been used as an agent for Mnchausen syndrome by proxy.

In Literature

In "Anne of Green Gables", by Lucy Montgomery, the protagonist Anne Shirley becomes a hero when she saves a neighbor's baby from croup by the administration of ipecac. The doctor, who arrives too late to be of much use, is effusive in his praise for the girl's actions. Anne says she learned how to deal with croup -- through the use of ipecac -- from her prior childcare experience. The book was written in the early 20th century and probably reflects the usage of the day.

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