Ipecac
Also known as: Ipecac, Syrup of Ipecac, Emetine, Cephaeline, Ipecacuanha
Overview
Ipecac is derived from the dried roots of the *Carapichea ipecacuanha* plant. It has been traditionally used as an emetic to induce vomiting. The active alkaloids, primarily emetine and cephaeline, are responsible for its emetic and toxic effects. Historically, ipecac was used to induce vomiting after suspected poisoning. However, its clinical use has declined sharply due to safety concerns and limited evidence of efficacy. Modern systematic reviews and clinical guidelines generally do not support its routine use. While emetine, a component of ipecac, has shown some antiviral activity in vitro, this is distinct from the use of ipecac syrup as an emetic and is not clinically established for human use. The use of ipecac is now largely discouraged in favor of safer and more effective methods of poison management.
Benefits
The primary effect of ipecac is to induce vomiting, typically within 15-21 minutes after oral administration. However, studies show that it only recovers a variable amount of ingested substances, ranging from 28-50% in some studies. This incomplete removal of toxins raises concerns about its efficacy. While emetine, an alkaloid found in ipecac, has demonstrated antiviral activity in laboratory settings, this benefit is not related to ipecac's emetic properties and is not clinically relevant for human use. Due to its limited efficacy and potential for adverse effects, ipecac is no longer routinely recommended for any specific population or condition.
How it works
Ipecac induces vomiting primarily by stimulating the chemoreceptor trigger zone in the brain, which then activates the vomiting reflex. Emetine, one of the active alkaloids, plays a key role in this process. Additionally, emetine can have direct toxic effects on cardiac and skeletal muscle at higher doses. The drug is rapidly absorbed when taken orally, leading to a quick onset of emesis. However, this rapid absorption also raises concerns about systemic toxicity in cases of overdose. The mechanism involves central nervous system receptors involved in emesis.
Side effects
Ipecac use is associated with several potential side effects, ranging from common to rare but serious. Common side effects include nausea, prolonged vomiting, and abdominal cramps. Uncommon side effects (occurring in 1-5% of users) may include diarrhea and dizziness. Rare but serious side effects (<1%) include cardiotoxicity, muscle weakness, and arrhythmias. Due to the risk of aspiration, ipecac is contraindicated in unconscious patients and in cases of corrosive or hydrocarbon ingestion. It is also not recommended for children or pregnant women due to safety concerns. Potential drug interactions, especially with other cardiotoxic drugs, should be considered. Overall, the safety concerns associated with ipecac have led to the discontinuation of its routine use.
Dosage
Historically, the recommended dosage of syrup of ipecac was 15-30 mL for adults. However, due to safety concerns, current guidelines do not recommend its use. If ipecac is administered, it should be a single dose, as repeated doses are not advised. It should be given as soon as possible after ingestion of the toxin, ideally within 30 minutes, to maximize potential benefit. Ipecac is available in oral syrup form, which facilitates rapid absorption and onset of emesis. There is no current recommended maximum safe dose due to the risk of toxicity and the availability of safer alternatives.
FAQs
Is ipecac safe to use at home for poisoning?
No, current guidelines recommend against home use due to safety risks, questionable efficacy, and the availability of safer alternatives.
Can ipecac remove all poisons from the stomach?
No, recovery of ingested substances is variable and often incomplete, ranging from 28-50% in studies. It does not guarantee complete removal of toxins.
When should ipecac be administered?
If used, ipecac should only be administered under medical supervision and within 30 minutes of ingestion, considering the risks and benefits.
Why is ipecac no longer recommended?
Due to safety concerns, lack of evidence for improved outcomes, and the risk of complications such as aspiration pneumonia and cardiotoxicity.
Is vomiting always beneficial after poisoning?
Not necessarily; vomiting can cause harm depending on the substance ingested, especially corrosives or hydrocarbons, increasing the risk of aspiration.
Research Sources
- https://www.ncbi.nlm.nih.gov/books/NBK448075/ – This resource provides general information about ipecac, including its historical use as an emetic. It also touches on the risks associated with its use, which have led to its decline in popularity.
- https://www.webmd.com/vitamins/ai/ingredientmono-157/ipecac – WebMD notes that ipecac was historically used for poisoning but is no longer recommended due to a lack of evidence for improved outcomes and potential adverse effects. These adverse effects include aspiration pneumonia and cardiotoxicity.
- https://www.rxlist.com/supplements/ipecac.htm – RxList provides similar information, stating that ipecac is no longer recommended for routine use in poisoning cases. This is due to the potential for adverse effects and the lack of evidence supporting improved outcomes.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7760625/ – This pharmacological review discusses emetine, the active alkaloid in ipecac, and highlights its potent antiviral properties in vitro and in animal studies. However, emetine's toxicity limits its clinical use, and this antiviral activity is separate from ipecac syrup's emetic use.
- https://www.clintox.org/wp-content/uploads/2016/04/Position-Statement-Ipecac-Syrup-1.pdf – A systematic review summarized data from emergency department studies showing that ipecac-induced emesis recovered only 28-50% of ingested markers, with large variability and incomplete vomitus collection. The review concluded that ipecac has limited efficacy in toxin removal and variable onset time, leading to recommendations against routine use.