Syrup of ipecac
Encyclopedia
Syrup of ipecac commonly referred to as ipecac, is derived from the dried rhizome
and root
s of the ipecacuanha plant, and is a well known emetic (substance used to induce vomiting
).
s of ipecac root. The rest is composed of glycerin, sugar syrup, and methylparaben
. 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.
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 poison
ing. 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, its 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 antidote
s.
as a means to achieve weight loss
through induced defensive vomiting
. Repeated use in this manner is believed to cause damage to the heart and muscles, which can ultimately result in the user's death.
Misuse of ipecac has been blamed for the death of well-known singer Karen Carpenter
in 1983. It has also been used as an agent for Münchausen syndrome by proxy
.
s, 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.
A position statement cited several times outlines critical details of its effectiveness, including this direct quote: "In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential."
Rhizome
In botany and dendrology, a rhizome is a characteristically horizontal stem of a plant that is usually found underground, often sending out roots and shoots from its nodes...
and root
Root
In vascular plants, the root is the organ of a plant that typically lies below the surface of the soil. This is not always the case, however, since a root can also be aerial or aerating . Furthermore, a stem normally occurring below ground is not exceptional either...
s of the ipecacuanha plant, and is a well known emetic (substance used to induce vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
).
Preparation
The commercial preparation of ipecac consists of 1/14 of a alcoholic extract of the roots and rhizomeRhizome
In botany and dendrology, a rhizome is a characteristically horizontal stem of a plant that is usually found underground, often sending out roots and shoots from its nodes...
s of ipecac root. The rest is composed of glycerin, sugar syrup, and methylparaben
Methylparaben
Methylparaben, also methyl paraben, one of the parabens, is a preservative with the chemical formula CH3. It is the methyl ester of p-hydroxybenzoic acid.-Occurrence:...
. 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 opiumOpium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...
were used to produce Dover's powder
Dover's powder
Dover's powder was a traditional medicine against cold and fever. It is no longer in use in modern medicine, but may have been in use at least through the 1960s.A 1958 source describes Dover's Powder as follows:...
, 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 poison
Poison
In the context of biology, poisons are substances that can cause disturbances to organisms, usually by chemical reaction or other activity on the molecular scale, when a sufficient quantity is absorbed by an organism....
ing. Current guidelines from the American Academy of Pediatrics
American Academy of Pediatrics
The American Academy of Pediatrics is the major professional association of pediatricians in the United States. The AAP was founded in 1930 by 35 pediatricians to address pediatric healthcare standards. It currently has 60,000 members in primary care and sub-specialist areas...
, 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
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
. The study suggested that indications for use of ipecac syrup were rare, and patients should be treated by more effective and safer means. Additionally, its potential side effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, such as lethargy, can be confused with the poison’s effects, complicating diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
. Ipecac may also delay the administration or reduce the effectiveness of other treatments, such as activated charcoal, whole bowel irrigation
Whole bowel irrigation
Whole bowel irrigation is a medical process involving the rapid administration of large volumes of an osmotically balanced polyethylene glycol solution , either orally or via a nasogastric tube, to flush out the entire gastrointestinal tract.-History:Whole bowel irrigation was originally developed...
, or oral antidote
Antidote
An antidote is a substance which can counteract a form of poisoning. The term ultimately derives from the Greek αντιδιδοναι antididonai, "given against"....
s.
Misuse
Ipecac has been used by individuals with bulimia nervosaBulimia nervosa
Bulimia nervosa is an eating disorder characterized by binge eating and purging or consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the food consumed, usually by purging and/or by laxative, diuretics or excessive exercise. Bulimia nervosa is...
as a means to achieve weight loss
Weight loss
Weight loss, in the context of medicine, health or physical fitness, is a reduction of the total body mass, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue...
through induced defensive vomiting
Defensive vomiting
Defensive vomiting is a symptom of anorexia nervosa and bulimia nervosa in which a person who has drastically over-eaten vomits as a reaction to an excess of food which the body is not prepared to handle...
. Repeated use in this manner is believed to cause damage to the heart and muscles, which can ultimately result in the user's death.
Misuse of ipecac has been blamed for the death of well-known singer Karen Carpenter
Karen Carpenter
Karen Anne Carpenter was an American singer and drummer. She and her brother, Richard, formed the 1970s duo The Carpenters. She was a drummer of exceptional skill, but she is best remembered for her vocal performances of idealistic romantic ballads of true love...
in 1983. It has also been used as an agent for Münchausen syndrome by proxy
Munchausen syndrome by proxy
Münchausen syndrome by proxy is a label for a pattern of behavior in which care-givers deliberately exaggerate, fabricate, and/or induce physical, psychological, behavioral, and/or mental health problems in others. Other experts classified MSbP as a mental illness...
.
Mechanism of action
The actions of ipecac are mainly those of its major alkaloidAlkaloid
Alkaloids are a group of naturally occurring chemical compounds that contain mostly basic nitrogen atoms. This group also includes some related compounds with neutral and even weakly acidic properties. Also some synthetic compounds of similar structure are attributed to alkaloids...
s, emetine
Emetine
Emetine is a drug used as both an anti-protozoal and to induce vomiting. It is produced from the ipecac root.-Early emetine-based preparations:Early use of emetine was in the form of oral administration of the extract of ipecac root, or ipecacuanha...
(methylcephaeline) and cephaeline
Cephaeline
Cephaeline is an alkaloid chemical that induces vomiting by stimulating the stomach lining. It is found in commercial products such as syrup of ipecac...
. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone
Chemoreceptor trigger zone
The chemoreceptor trigger zone , is an area of the medulla that receives inputs from blood-borne drugs or hormones, and communicates with the vomiting center, to initiate vomiting. The CTZ is close to the area postrema on the floor of the fourth ventricle and is outside of the blood-brain barrier...
to induce vomiting.
Discontinuation
Ipecac has been found to have minimal health benefits, and ultimately ineffective at purging the body of poisonous substances, and as such global production of the syrup has been stopped. As the ASHP puts it, "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals".A position statement cited several times outlines critical details of its effectiveness, including this direct quote: "In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There are insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential."