When used as directed for poisoning, Ipecac causes severe nausea, vomiting and intestinal spasms. If too much ipecac is taken, dizziness, rapid heartbeat and palpitations may occur. It has been reported that people with bulimia abuse ipecac by taking it frequently to induce vomiting and develop severe muscle or heart damage and, in some cases, die.10, 11 Because emetine is slowly eliminated from the body, the amounts can build up with repeated use and cause damage later on. Ipecac should not be used during pregnancy or lactation. For years, parents have been told to keep ipecac syrup at home. This medicine has been used to induce a child to vomit after swallowing poison. Well, your doctor doesn`t tell you to keep it. Poison control does not tell you to use it. You can not even buy Ipecac in the pharmacy. It is NOT necessary to store ipecac syrup in your home. Ipecac irritates the gastric mucosa and chemically stimulates the CRTZ (chemoreceptor trigger zone) in the medulla oblongata of the central nervous system to cause near-instantaneous vomiting. Historically, this was the reason for its recommendation in the treatment of poisons taken orally.
However, over time, clinical research began to question this practice. Ipecac syrup was subsequently shown to be inferior to activated charcoal to reduce absorption in case of toxic ingestion. Its use often delays more effective decontamination methods. [3] [4] Ipecac syrup is no longer available for over-the-counter or prescription use. However, there are various unregulated formulations of Ipecacuanha. In the 1950s, ipecac syrup was considered superior to gastric lavage and was the standard for treating toxic ingestion. It was available in one-ounce bottles and became the mainstay of home treatment of child poisoning. It was approved for over-the-counter sale by the U.S. Food and Drug Administration in 1965. In 1989, the American Academy of Pediatrics recommended that every household keep a bottle in case of an emergency. [7] To induce vomiting after ingesting something toxic (after consultation with poison control centres or emergency departments), adults are generally advised to take 15 to 30 ml of ipecac syrup followed by 3 to 4 glasses of water.9 Children aged 1 to 12 years should take 15 ml of ipecac syrup followed by 1 to 2 glasses of water.
Children under 1 year of age should be given 5-10 ml of syrup followed by half to 1 glass of water. The poisoned subject should be kept moving after taking Ipecac and the head should be kept straight. It can take up to 30 minutes for vomiting to occur. A second application of 15 ml followed by extra water may be used if vomiting does not occur after 30 minutes. If vomiting still does not occur after the second application, it is best to immediately go to the nearest hospital to pump the ipecac from the stomach and get additional help for the initial poisoning. Milk or soft drinks should not be replaced with water after taking Ipecac, as they may interfere with the absorption and effectiveness of Ipecac. Activated carbon also impairs the absorption and efficiency of ipecac. Charcoal should only be administered after the ipecac has caused vomiting. Ipecac should never be used to induce vomiting of corrosive toxins such as gasoline, acids or bleach. Ipecac tincture and liquid extract are much stronger than ipecac syrup. Ipecac tincture or liquid extract should never be taken in the above amounts for ipecac syrup. In 1965, the FDA approved the sale of up to one ounce of ipecac syrup without a prescription.
At the time of approval, its use was recommended by the AAP, AAPCC, AMA, and the FDA Medical Advisory Board as a method to induce vomiting “for prompt first aid at home under medical supervision” for use in cases of accidental poisoning. [2] Ipecac has very little accepted medical use in toxicology. When administering a non-corrosive, non-volatile substance that, if absorbed and metabolized, may be harmful within the first few minutes of oral ingestion, Ipecac may remove an indeterminate amount of the ingested substance by vomiting. The amount withdrawn is very vague. [6] Ipecac syrup (/ˈɪpɪkæk), commonly known as ipecac, is a drug that was once widely used as an expectorant (at low doses) and as a fast-acting emetic (at higher doses). It is extracted from the dried rhizome and roots of the Ipecacuanha plant (Carapichea ipecacuanha), from which it takes its name. It is no longer used in medicine. Original article: www.mayoclinic.org/drugs-supplements/ipecac-syrup-oral-route/side-effects/drg-20064363 Ipecac is rarely useful for most poisonings. It is not effective to remove significant amounts of ingested poisons unless it is released within the first few minutes after ingestion; Even then, the results are inconsistent and unpredictable. Its effect of uncontrolled vomiting delays other oral antidotes (e.g., activated charcoal) by one to two hours.
Given the risks associated with aspiration, an appropriately controlled airway is paramount. If the patient shows signs of toxicity, including sedation or inability to maintain their airways, there is not only a risk of aspiration of vomited material; It will almost certainly be ineffective since the drug is already absorbed. [6] Ipecac has been used by people with bulimia nervosa as a weight loss agent through induced vomiting. It is believed that repeated application in this way causes damage to the heart and muscles, which can ultimately lead to the death of the user. [7] The abuse of ipecac was blamed for the death of singer Karen Carpenter in 1983. [8] It has also been used as a remedy for Münchausen syndrome by proxy. [9] It is very important that you take this medication only as directed. Do not take more or more often than recommended on the label, unless otherwise directed. If too much ipecac is used, it can damage the heart and other muscles and even lead to death.
Ipecac has a low risk of serious toxicity. “Considering that more than 3 million patients received therapeutic doses of ipecac in the 14 years from 1983 to 1996, ipecac appears to have a high margin of safety. Potential complications from the therapeutic use of ipecac are well documented, but serious sequelae are rare. An important issue is that the use of Ipecac can delay the administration of activated charcoal by one to two hours. (p. 5, AACT Notice 2013, above.) In particular, rapidly induced violent vomiting by ipecac has been considered an important frontal treatment for orally ingested toxins for many years. However, subsequent studies (including a full meta-study from 2005) showed that gastric lavage produced by Ipecac is much less effective at lowering total body venom concentrations than the adsorption effect of oral activated charcoal (which is effective throughout the gastrointestinal tract and is often associated with whole-bowel lavage). Ipecac also has a low risk of overdose (as it is itself a mild poison) and a high risk of esophagitis and aspiration pneumonia when used to purify corrosive poisons. The American Society of Health-System Pharmacists (ASHP), which has long been replaced by more effective drugs (including in vomiting function), now advises that “ipecac syrup is no longer recommended for routine treatment of outpatient use of drugs or other chemicals.” [1] The American Academy of Pediatrics recommends that ipecac syrup should NOT be stored at home.
Similarly, the American Association of Poison Control Centers no longer recommends that parents keep ipecac syrup at home. The U.S. Food and Drug Administration is considering a recommendation from one of its expert panels to make ipecac syrup a prescription drug. To date, the FDA has not responded to the panel`s recommendation. Poison Control does not recommend that parents store ipecac syrup at home. In fact, ipecac syrup is no longer produced. Do not keep a bottle of ipecac that has been opened. Ipecac can evaporate over time.
It is better to replace it with a new one. Nurses, pharmacists and clinicians should be aware that Ipecac is no longer available for the treatment of medical conditions. There have been concerns about the toxicity of this agent. While the drug has enjoyed daily use in the past, its therapeutic benefits have also been questioned. Therefore, nurses who receive a prescription for Ipecac from a physician should consult with the pharmacist, especially one with toxicology training, before administering the drug to the patient. Pharmacists should also be vigilant when receiving a prescription for Ipecac and contact the prescribing physician to dissuade them from giving this medication to the patient. In cases where ipecac is even considered, a toxicologist should be consulted. Only an interprofessional team approach to care can prevent the use of Ipecac in most cases and take more appropriate steps to align patient care for optimal outcomes. [Level 5] After decades of using ipecac for poisoning, researchers have reviewed all the evidence for ipecac syrup. They agreed that ipecac syrup reliably causes vomiting.