Monday, July 26, 2010

Syrup of Ipecac

Syrup of ipecac, commonly referred to as Ipecac, is derived from the dried rhizome and roots of the ipecacuanha plant and is a well known emetic (substance used to induce vomiting).

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.

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’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.

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