- Syrup of ipecac
Syrup of ipecac commonly referred to as simply Ipecac is derived from the dried
rhizomeand roots of the ipecacuanhaplant and is a well-known emetic(substance used to induce vomiting).
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 mucosaand centrally by stimulating the medullary chemoreceptor trigger zoneto induce vomiting. Syrup of ipecac is still used to induce vomiting.
Ipecac was used in cough mixtures as an
expectorantand from the 18th until the early 20th century. Ipecac and opiumwere used to produce Dover's powder, which was used in syrup form. Pediatriciansonce recommended Ipecac be kept in the home as a ready emetic for use in cases of accidental poisoning. [citation|author = Committee on Injury, Violence, and Poison Prevention|title = Office-Based Counseling for Injury Prevention|journal = Pediatrics|volume = 94|number = 4|pages = 566–567|year = 1994|url = http://pediatrics.aappublications.org/cgi/reprint/94/4/566.pdf] 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. [citation|author = Committee on Injury, Violence, and Poison Prevention|title = Poison Treatment in the Home|journal = Pediatrics|volume = 112|number = 5|pages = 1182–1185|doi = 10.1542/peds.112.5.1182|year = 2003|url = http://pediatrics.aappublications.org/cgi/content/full/112/5/1182|pmid = 14595067] Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons. [cite journal|last1 = Manoguerra|first1 = A S|last2 = Krenzelok|first2 = E P|last3 = McGuigan|first3 = M|last4 = Lheureux|first4 = P|year = 2004|title = AACT/EAPCCT position paper: ipecac syrup|journal = Clinical Toxicology|volume = 42|pages = 133–43|doi = 10.1081/CLT-120037421|author = Toxicology, American Academy of Clinical] , because:
# There has been 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 charcoaland/or antidotes.
# The effects of the Ipecac itself can be mistaken for the effects of the poisoning.
# Accidental overdose of Ipecac can result when administered in the home. [citation|title = Gastric decontamination—a view for the millennium|last = Bateman|first = D N|journal =
British Medical Journal|volume = 16|number = 2|pages = 84|year = 1999|publisher = BAEM|url = http://emj.bmj.com/cgi/content/abstract/16/2/84|pmid = 10191436]
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’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. [citation|title = Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons|last1 = Manoguerra|first1 = A S|last2 = Cobaugh|first2 = D J|journal = Clinical Toxicology|volume = 43|number = 1|pages = 1–10|year = 2005|url = http://www.informaworld.com/smpp/content~content=a713719870~db=all|doi = 10.1081/CLT-200046735|author = Manoguerra, Anthony]
Ipecac has been used by individuals with
bulimia nervosaas a means to achieve weight lossthrough induced defensive vomiting. Repeated abuse is believed to cause damage to the heart, which can ultimately result in the user's death. [citation|last = Silber|first = T J|year = 2005|title = Ipecac syrup abuse, morbidity, and mortality: Isn’t it time to repeal its over-the-counter status?|journal = Journal of Adolescent Health|volume = 37|issue = 3|pages = 256–260|url = http://linkinghub.elsevier.com/retrieve/pii/S1054139X05001126|accessdate = 2008-05-02|doi = 10.1016/j.jadohealth.2004.08.022]
* [http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202605.html MedlinePlus Drug Information]
* [http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/5/1182 AAP policy on Poison Treatment in the Home]
* [http://www.gwdocs.com/health/eHA-eHA_Content_C-Generic_Content_Page_Template_1131123674555.html Chemical Poisoning and Syrup of Ipecac]
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