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Ipecac Side Effects

Medically reviewed by Drugs.com. Last updated on Mar 11, 2024.

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.[Ref]

Cardiovascular

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.[Ref]

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.[Ref]

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.[Ref]

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.[Ref]

Nervous system

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

Metabolic

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

Respiratory

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

Dermatologic

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

References

1. McClung HJ, Murray R, Braden NJ, Fyda J, Myers RP, Gutches L. Intentional ipecac poisoning in children. Am J Dis Child. 1988;142:637-9.

2. Sutphen JL, Saulsbury FT. Intentional ipecac poisoning: Munchausen syndrome by proxy. Pediatrics. 1988;82:453-6.

3. Berkner P, Kastner T, Skolnick L. Chronic ipecac poisoning in infancy: a case report. Pediatrics. 1988;82:384-6.

4. Friedman EJ. Death from ipecac intoxication in a patient with anorexia nervosa. Am J Psychiatry. 1984;141:702-3.

5. Klein-Schwartz W, Gorman RL, Oderda GM, Wedin GP, Saggar D. Ipecac use in the elderly: the unanswered question. Ann Emerg Med. 1984;13:1152-4.

6. Adler AG, Walinsky P, Krall RA, Cho SY. Death resulting from ipecac syrup poisoning. JAMA. 1980;243:1927-8.

7. Schiff RJ, Wurzel CL, Brunson SC, Kasloff I, Nussbaum MP, Frank SD. Death due to chronic syrup of ipecac use in a patient with bulimia. Pediatrics. 1986;78:412-6.

8. Friedman AG, Seime RJ, Roberts T, Fremouw WJ. Ipecac abuse: a serious complication in bulimia. Gen Hosp Psychiatry. 1987;9:225-8.

9. Dawson JA, Yager J. A case of abuse of syrup of ipecac resulting in death. J Am Coll Health. 1986;34:280-2.

10. Dresser LP, Massey EW, Johnson EE, Bossen E. Ipecac myopathy and cardiomyopathy. J Neurol Neurosurg Psychiatry. 1993;56:560-2.

11. Isner JM. Effects of ipecac on the heart. N Engl J Med. 1986;314:1253.

12. Mateer JE, Farrell BJ, Chou SS, Gutmann L. Reversible ipecac myopathy. Arch Neurol. 1985;42:188-90.

13. Brotman MC, Forbath N, Garfinkel PE, Humphrey JG. Myopathy due to ipecac syrup poisoning in a patient with anorexia nervosa. Can Med Assoc J. 1981;125:453-4.

14. Palmer EP, Guay AT. Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. N Engl J Med. 1985;313:1457-9.

15. Bennett HS, Spiro AJ, Pollack MA, Zucker P. Ipecac-induced myopathy simulating dermatomyositis. Neurology. 1982;32:91-4.

16. Rosenberg NL, Ringel SP. Myopathy from surreptitious ipecac ingestion. West J Med. 1986;145:386-8.

17. Siegel AJ. Effects of ipecac on the heart. N Engl J Med. 1986;314:1254.

18. Tandberg D, Liechty EJ, Fishbein D. Mallory-Weiss syndrome: an unusual complication of ipecac-induced emesis. Ann Emerg Med. 1981;10:521-3.

19. Nagao T, Ibayashi S, Fujii K, Sugimori H, Sadoshima S, Fujishima M. Treatment of warfarin-induced hair loss with ubidecarenone. Lancet. 1995;346:1104-5.

20. Persson CG. Ipecacuanha asthma: more lessons. Thorax. 1991;46:467-8.

21. Kulig K. Effects of ipecac on the heart. N Engl J Med. 1986;314:1254.

22. Spadaro A, Riccieri V, Siliscavalli A, Sensi F, Taccari E, Zoppini A. Comparison of cyclosporin a and methotrexate in the treatment of psoriatic arthritis: a one-year prospective study. Clin Exp Rheumatol. 1995;13:589-93.

Further information

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