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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.
See also
Algarot
References
^ Committee on Injury, Violence, and Poison Prevention (1994), "Office-Based Counseling for Injury Prevention", Pediatrics 94 (4): 566567, website
^ Committee on Injury, Violence, and Poison Prevention (1994), "Office-Based Counseling for Injury Prevention", Pediatrics 94 (4): 566567, website
^ Committee on Injury, Violence, and Poison Prevention (2003), "Poison Treatment in the Home", Pediatrics 112 (5): 11821185, doi:10.1542/peds.112.5.1182, PMID 14595067, website
^ Manoguerra, A S; Krenzelok, E P; McGuigan, M; Lheureux, P (2004). "AACT/EAPCCT position paper: ipecac syrup". Clinical Toxicology 42: 13343. doi:10.1081/CLT-120037421.
^ Bateman, D N (1999), "Gastric decontamination view for the millennium", British Medical Journal (BAEM) 16 (2): 84, doi:10.1136/emj.16.2.84, PMID 10191436, website
^ Manoguerra, A S; Cobaugh, D J (2005), "Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons", Clinical Toxicology 43 (1): 110, doi:10.1081/CLT-200046735, website
^ Silber, T J (2005), "Ipecac syrup abuse, morbidity, and mortality: Isn it time to repeal its over-the-counter status?", Journal of Adolescent Health 37 (3): 256260, doi:10.1016/j.jadohealth.2004.08.022, website retrieved 2008-05-02
^ Shannon M (November 2003). "The demise of ipecac". Pediatrics 112 (5): 11801. PMID 14595066.
External links
AAP policy on Poison Treatment in the Home
Chemical Poisoning and Syrup of Ipecac
v d e
Cough and cold preparations (R05)
Expectorants
Althea root Antimony pentasulfide Creosote Guaiacolsulfonate Guaifenesin Ipecacuanha (Syrup of ipecac) Levoverbenone Potassium iodide Senega Tyloxapol
Mucolytics
Acetylcysteine Ambroxol Bromhexine Carbocisteine Domiodol Dornase alfa Eprazinone Erdosteine Letosteine Mesna Neltenexine Sobrerol Stepronin Tiopronin
Cough suppressants
Opium alkaloids,
Opioids,
and derivatives
Acetyldihydrocodeine Benzylmorphine Codeine Dextromethorphan Heroin Dihydrocodeine Dimemorfan Droxypropine Ethylmorphine Hydrocodone Hydromorphone Isoaminile Laudanum Levomethadone Levopropoxyphene Methadone Nicocodeine Nicodicodeine Normethadone Noscapine Pholcodine Thebacon Tipepidine Zipeprol
Other
Benzonatate Benproperine Bibenzonium bromide Butamirate Clobutinol Clofedanol Cloperastine Diphenhydramine Dibunate Dimethoxanate Dropropizine Fedrilate Glaucine Levodropropizine Meprotixol Morclofone Nepinalone Oxolamine Oxeladin Pentoxyverine Pipazetate Prenoxdiazine Piperidione
v d e
Antidotes (V03AB)
Nervous system
Nerve agent / Organophosphate poisoning
Atropine# Biperiden Diazepam# Oximes (Pralidoxime, Obidoxime) see also Cholinesterase
Opioid overdose
Diprenorphine Doxapram Nalorphine Naloxone# Naltrexone Nalmefene
Barbiturate overdose
Bemegride Ethamivan
Benzodiazepine overdose
Cyprodenate Flumazenil
GHB overdose
Physostigmine SCH-50911
Reversal of neuromuscular blockade
Sugammadex
Cardiovascular
Heparin
Protamine#
Digoxin toxicity
Digoxin Immune Fab
Beta blocker
Glucagon
Other
Methanol / Ethylene glycol poisoning
Ethanol Fomepizole
Paracetamol toxicity (Acetaminophen)
Acetylcysteine# Glutathione Methionine#
Arsenic poisoning
Dimercaprol# Succimer
Cyanide poisoning
nitrite (Amyl nitrite, Sodium nitrite#) Sodium thiosulfate# 4-Dimethylaminophenol Hydroxocobalamin
Toxic metals (cadmium, mercury, lead, thallium)
Edetates Dimercaprol# Prussian blue
Hydrofluoric acid
Calcium gluconate#
Other
Prednisolone and promethazine oxidizing agent (potassium permanganate) iodine-131 (Potassium iodide) Methylthioninium chloride#
Emetic
Ipecacuanha (Syrup of ipecac) Copper sulfate
#WHO-EM. Withdrawn from market. CLINICAL TRIALS: hase III. Never to phase III
Categories: Drugboxes which contain changes to watched fields | EmeticsHidden categories: Drug pages needing a structure drawing
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