Ipecac Side Effects

Some side effects of ipecac may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to ipecac: oral syrup

Along with its needed effects, ipecac may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur while taking ipecac:

• Diarrhea
• fast or irregular heartbeat
• nausea or vomiting (continuing more than 30 minutes)
• stomach cramps or pain
• troubled breathing
• unusual tiredness or weakness
• weakness, aching, and stiffness of muscles, especially those of the neck, arms, and legs

For Healthcare Professionals

Applies to ipecac: oral syrup

General

Chronic ipecac abuse has occurred, particularly in patients with eating disorders (anorexia or bulemia). Chronic diarrhea, vomiting, colitis, muscle weakness, lethargy, hypothermia, impaired peripheral vascular circulation, elevated plasma CPK concentrations, cardiomyopathy, fever, hepatic and renal dysfunction, dental abnormalities, and interstitial edema have been reported.

Cardiovascular

Each 30 mL of ipecac contains approximately 21 mg of emetine. An acute lethal dose is estimated to be less than or equal to 20 mg/kg of emetine. Emetine is slowly eliminated by the kidney (detectable in the urine 40 to 60 days after short term amebicide therapy) and accumulation occurs with chronic use.

Cardiovascular side effects have included tachycardia, palpitations, prolonged QT and PR intervals, inverted T waves, ST segment abnormalities, decreased cardiac output, and hypotension. Vascular accidents or hemorrhage due to emesis-induced blood pressure increases have occurred in patients with cardiovascular dysfunction. Accumulation of the emetine alkaloid during chronic ingestion has resulted in toxic myopathy. Fatalities have occurred.

Musculoskeletal

Musculoskeletal side effects have included skeletal muscle toxicity due to emetine accumulation with chronic dosing. Reversible myopathy with symptoms of weakness and stiffness has occurred.

Gastrointestinal

Gastrointestinal side effects have included protracted vomiting (< 5%), diarrhea (16% to 26% in one case series), anorexia, and esophagitis. Esophageal Mallory-Weiss tears, strictures and ulcerations have also been reported.

Nervous system

Nervous system side effects have included drowsiness (20%), lethargy, and irritability.

Metabolic

Metabolic alterations such as electrolyte imbalance and dehydration have occurred with repeat vomiting during acute therapy and with chronic administration.

Respiratory

Respiratory effects occurring during emesis have included aspiration pneumonitis, pneumomediastinum, and retropneumoperitoneum.

Dermatologic

Dermatologic side effects have included rash or dry skin during chronic use of ipecac.

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