What is Ipecac?
Also known as Psychotria ipecacuanha, ipecac is a small, perennial tropical plant that is native to the humid forests of Bolivia and Brazil where large plantations have been established to commercialize the collection of ipecac root. Much of the root crop continues to be harvested from the wild, particularly in South America. India also is an important producer of ipecac. At maturity, the roots have a dark brown or red covering, bitter taste, and musty odor.
Cephalelis ipecacuanha, C. acuminata
Ipecac also is known as ipecacuanha, golden root, Rio ipecac or Brazilian ipecac, Matto Grosso ipecac, and Costa Rica ipecac.
What is it used for?
Brazilian Indians valued ipecac as a remedy for dysentery, and this information was brought to Europe by Portuguese missionaries. The dried root and rhizome are the source of the medicinally useful products. Ipecac has been widely used in syrup form as a potent and effective emetic. Ipecac powder had been used to induce sweating at the onset of influenza, and small amounts of the extract have been incorporated into cough syrups as expectorants. Emetine, derived from the root, has been used for more than a century to treat dysentery.
Ipecac induces vomiting by an irritant action on the intestinal mucosa and produces reflex vomiting and diarrhea. It also exerts a central emetic action. Emetine, one of its principle active components, primarily has a central action on the chemoreceptor trigger zone. The syrup induces vomiting in 15 to 60 minutes and is most effective when accompanied by fluid intake.
Debate surrounds the use of ipecac. One study found no apparent benefit when syrup of ipecac was used in the home, although there may be a benefit in certain poisonings. This remains to be proven.
Ipecac should be administered to an alert, conscious person who has ingested a potentially toxic amount of a poison. Do not administer ipecac to someone who has ingested either a corrosive substance or hydrocarbon with a high aspiration potential (eg, gasoline).
Maximum benefit can be expected in those patients who take ipecac soon after poison ingestion.
Emetine, a component of ipecac, also has amebicidal components. While ipecac is not effective against amebic dysentery, it may be useful for amebic abscesses and hepatitis. Emetine injected intramuscularly is distributed systemically.
What is the recommended dosage?
In syrup form, which contains 123 to 157 mg of total alkaloids per 100 mL, ipecac has been used to induce vomiting. The usual dose range for the syrup is 10 to 30 mL, yielding a dose of alkaloids of 12 to 48 mg. Do not confuse the syrup with the fluid extract of ipecac, which is 14 times stronger. Cumulative toxicity requires administration of emetine for amebic dysentery in low doses for a short time with intervals of several weeks before further treatment.
Do not administer ipecac when a patient has a decreased level of consciousness or has ingested either a corrosive substance of hydrocarbon (eg, gasoline) with a high aspiration potential.
Documented adverse effects include uterine stimulation. Avoid use.
None well documented.
Repeated exposure to powdered ipecac may cause rhinitis or asthma. Emetine may irritate skin if applied topically. Diarrhea, lethargy, drowsiness, and prolonged vomiting may occur.
Ipecac extracts may be highly toxic and should not be confused with syrup of ipecac. Emetine is a cardiotoxin and has been associated with serious cardiotoxicity.