Syrup of ipecac

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"Ipecac" redirects here. For other uses, see Ipecac (disambiguation).
Syrup of ipecac
Flask for tincture of ipecac (ipecac roots and rhizomes dissolved in alcohol, which is watered down and sweetened to make syrup of ipecac)
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Syrup of ipecac (

emetic (in higher doses). It is obtained from the dried rhizome and roots of the ipecacuanha plant (Carapichea ipecacuanha
), from which it derives its name. It is no longer regularly used in medicine.

In particular, the rapidly induced

corrosive poisons. Having long been replaced (even in the emetic role) by more effective medications, the American Society of Health-System Pharmacists (ASHP) now advises that "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals."[1]

Ipecac is commonly made from alcohol extraction of the plants Cephaelis acuminata and Cephaelis ipecacuanha. The extract is commonly mixed with glycerin, sugar (syrup), and methylparaben. The active ingredients are plant alkaloids, cephaeline, and methyl-cephaeline (emetine)[2]

Use

Ipecac plant

Ipecac was used in cough mixtures as an

emetic from the 18th until the early 20th century.[citation needed] For instance, ipecac and opium were used to produce Dover's powder, which was used in syrup form.[citation needed
]

In 1965, the

American Association of Poison Control Centers, American Medical Association, and the FDA's medical advisory board as a method to induce vomiting "for quick first-aid use in the home, under medical supervision", for use in cases of accidental poisoning.[3]

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.[4] Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons,[5] because of a lack of 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.[6] When dealing with poisoning cases in the hospital, it became difficult to obtain a differential diagnosis when syrup of ipecac had been administered, as this can add further symptoms.

A 2005 review by a

side effects, such as lethargy, can be confused with the poison's effects, complicating diagnosis. The use of ipecac may also delay the use of other treatments (e.g., activated charcoal, whole bowel irrigation, or oral antidotes) or make them less effective.[7]

Misuse

Ipecac has been used by people with bulimia nervosa as a means to achieve weight loss through induced 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.[8] Misuse of ipecac has been blamed for the death of singer

Münchausen syndrome by proxy.[10]

Mechanism of action

The actions of ipecac are mainly those of major

mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.[citation needed
]

Discontinuation

Ipecac has been found to have minimal health benefits, and is ultimately ineffective at purging the body of poisonous substances. It was initially discontinued due to production costs and lack of raw materials. As the ASHP advises: "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals." Humco and Paddock Laboratories, the last two companies to continue manufacturing ipecac syrup, both stopped production in 2010.[11]

A heavily cited position statement outlines critical details of its effectiveness:

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 is 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.[12]

See also

References

  1. ^ "Ipecac Syrup". Discontinued Drug Bulletin. Archived from the original on 2014-12-16. Retrieved 2014-12-16.
  2. PMID 28846272
    .
  3. ^ Galton L (1966-01-09). "New Lifesaver For Your Medicine Chest". Parade. Retrieved 2015-06-04.
  4. PMID 14595067
    .
  5. S2CID 218865551
    .
  6. PMID 10191436
    .
  7. PMID 15732439
    .
  8. PMID 16109351
    .
  9. ^ Schmidt R (24 October 2010). "Karen Carpenter's tragic story". The Guardian.
  10. PMID 14595066
    .
  11. ^ "Ipecac Syrup". Discontinued Drug Bulletin.
  12. PMID 9482425
    .

External links
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