IPECAC

OTHER NAME(S):

Brazil Root, Brazilian Ipecac, Callicocca ipecacuanha, Cartagena Ipecac, Cephaelis acuminata, Cephaelis ipecacuanha, Ipéca, Ipéca du Brésil, Ipéca du Nicaragua, Ipéca du Panama, Ipecacuana, Ipécacuana, Ipecacuanha, Matto Grosso Ipecac, Nicaragua Ipecac, Panama Ipecac, Psychotria ipecacuanha, Racine Brésilienne, Rio Ipecac, Uragoga granatensis, Uragoga ipecacuanha.

Overview

Overview Information

Ipecac is a small shrub. It grows in parts of Central America and Brazil. The root is used to make medicine. Ipecac syrup is available both as a nonprescription product and as an FDA-approved prescription product. But using ipecac can be unsafe when used long-term or in large amounts.

Ipecac is most commonly used to cause vomiting after suspected poisoning. It is also used for croup, severe diarrhea, and cancer, but there is no good scientific evidence to support any of these uses.

How does it work?

Ipecac contains chemicals that irritate the digestive tract and trigger the brain to cause vomiting.

Uses

Uses & Effectiveness?

Possibly Ineffective for

  • Poisoning. In the past, ipecac syrup was commonly used to cause vomiting in people who ingested poison. But now it is no longer recommended. It doesn't seem to work better than activated charcoal, another agent used for poisoning. And ipecac syrup has also been linked to safety concerns.

Insufficient Evidence for

  • Thinning mucous to make coughing easier.
  • Bronchitis associated with croup.
  • Severe diarrhea caused by amoebic dysentery.
  • Loss of appetite.
  • Cancer.
  • Hepatitis, when given by IV.
  • Other conditions.
More evidence is needed to rate the effectiveness of ipecac for these uses.
Side Effects

Side Effects & Safety

When taken by mouth: Ipecac is POSSIBLY SAFE for most people when taken by mouth and used for a short time. It can cause nausea, vomiting, stomach irritation, dizziness, low blood pressure, shortness of breath, and a fast heartbeat. Ipecac is LIKELY UNSAFE when taken by mouth long-term or in large amounts. Misuse of ipecac can lead to serious poisoning, heart damage, and death. Signs of poisoning include difficulty breathing, digestive tract problems, abnormal heart rates, blood in the urine, convulsions, shock, coma, and death.

When applied to the skin: Ipecac is POSSIBLY UNSAFE when allowed to touch the skin. Ipecac contains emetine, which can irritate the skin.

When inhaled: Ipecac is POSSIBLY UNSAFE when inhaled. Ipecac contains emetine, which can irritate the respiratory tract.

When given by IV: Ipecac is LIKELY UNSAFE when injected at a dose of more than 1 gram. Misuse of ipecac can lead to serious poisoning and death. Signs of poisoning include digestive tract and brain and nerve problems, blood in the urine, and death.

Special Precautions & Warnings:

Pregnancy: It's LIKELY UNSAFE to use ipecac if you are pregnant. It might stimulate the uterus and cause a miscarriage.

Breast-feeding:There isn't enough reliable information to know if ipecac is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: Ipecac is POSSIBLY SAFE for children when used appropriately as a prescription product to induce vomiting. But the American Academy of Pediatrics' recommendation to keep a 1-ounce bottle of syrup of ipecac at home has recently been reversed. The new statement reads, "Syrup of ipecac should no longer be routinely used as a poison treatment intervention in the home." The thinking is that keeping ipecac at home hasn't been proven to save lives. Talk with your healthcare provider or poison control center about how to use ipecac correctly in cases of poisoning in children.

Ipecac is LIKELY UNSAFE when used in high doses or in children under the age of one year. Children are more sensitive than adults to the side effects of ipecac. Misuse of ipecac can lead to serious poisoning, heart damage, and death. Signs of poisoning include difficulty breathing, digestive tract problems, abnormal heart rates, blood in the urine, convulsions, shock, coma, and death.

Unconsciousness or certain kinds of poisonings: Ipecac should not be used in people who are unconscious or have been poisoned with certain chemicals including corrosives, petroleum products, strychnine, and others. Talk to your healthcare provider or poison control center about whether ipecac is appropriate to use in each case of suspected poisoning. If ipecac is used incorrectly, serious complications can arise including damage of the esophagus, pneumonia, and convulsions.

Digestive tract problems including ulcers, infections, or Crohn's disease: Ipecac can irritate the digestive tract. Don't use it if you have one of these conditions.

Heart disease: Ipecac can affect the heart. Don't use it if you have a heart condition.

Interactions

Interactions?

Major Interaction

Do not take this combination

!
  • Activated charcoal interacts with IPECAC

    Activated charcoal can bind up syrup of ipecac in the stomach. This decreases the effectiveness of syrup of ipecac.

Dosing

Dosing

The appropriate dose of ipecac depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for ipecac. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

View References

REFERENCES:

  • Olsen, K. M., Ma, F. H., Ackerman, B. H., and Stull, R. E. Low-volume whole bowel irrigation and salicylate absorption: a comparison with ipecac-charcoal. Pharmacotherapy 1993;13(3):229-232. View abstract.
  • Palmer, E. P. and Guay, A. T. Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. N.Engl.J.Med. 12-5-1985;313(23):1457-1459. View abstract.
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  • Saincher, A., Sitar, D. S., and Tenenbein, M. Efficacy of ipecac during the first hour after drug ingestion in human volunteers. J.Toxicol.Clin.Toxicol. 1997;35(6):609-615. View abstract.
  • Scharman, E. J., Hutzler, J. M., Rosencrance, J. G., and Tracy, T. S. Single dose pharmacokinetics of syrup of ipecac. Ther.Drug Monit. 2000;22(5):566-573. View abstract.
  • Schiff, R. J., Wurzel, C. L., Brunson, S. C., Kasloff, I., Nussbaum, M. P., and Frank, S. D. Death due to chronic syrup of ipecac use in a patient with bulimia. Pediatrics 1986;78(3):412-416. View abstract.
  • Schneider, D. J., Perez, A., Knilamus, T. E., Daniels, S. R., Bove, K. E., and Bonnell, H. Clinical and pathologic aspects of cardiomyopathy from ipecac administration in Munchausen's syndrome by proxy. Pediatrics 1996;97(6 Pt 1):902-906. View abstract.
  • Schofferman, J. A. A clinical comparison of syrup of ipecac and apomorphine use in adults. JACEP. 1976;5(1):22-25. View abstract.
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  • Stiell, I. G. Activated charcoal alone versus activated charcoal & ipecac. Ann.Emerg.Med. 1990;19(10):1202-1204. View abstract.
  • Tandberg, D. and Murphy, L. C. The knee-chest position does not improve the efficacy of ipecac-induced emesis. Am.J.Emerg.Med. 1989;7(3):267-270. View abstract.
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  • Tenenbein, M., Cohen, S., and Sitar, D. S. Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Ann.Emerg.Med. 1987;16(8):838-841. View abstract.
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  • Yamashita, M., Yamashita, M., and Azuma, J. Urinary excretion of ipecac alkaloids in human volunteers. Vet.Hum.Toxicol. 2002;44(5):257-259. View abstract.
  • Young, W. F., Jr. and Bivins, H. G. Evaluation of gastric emptying using radionuclides: gastric lavage versus ipecac-induced emesis. Ann.Emerg.Med. 1993;22(9):1423-1427. View abstract.
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  • Merigian, K. S., Woodard, M., Hedges, J. R., Roberts, J. R., Stuebing, R., and Rashkin, M. C. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg.Med 1990;8(6):479-483. View abstract.
  • Mofenson, H. C. and Caraccio, T. R. Benefits/risks of syrup of ipecac. Pediatrics 1986;77(4):551-552. View abstract.
  • Moldawsky, R. J. Myopathy and ipecac abuse in a bulimic patient. Psychosomatics 1985;26(5):448-449. View abstract.
  • Neuvonen, P. J., Vartiainen, M., and Tokola, O. Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur.J.Clin.Pharmacol. 1983;24(4):557-562. View abstract.
  • Auerbach, P. S., Osterloh, J., Braun, O., Hu, P., Geehr, E. C., Kizer, K. W., and McKinney, H. Efficacy of gastric emptying: gastric lavage versus emesis induced with ipecac. Ann.Emerg.Med. 1986;15(6):692-698. View abstract.
  • Bennett, H. S., Spiro, A. J., Pollack, M. A., and Zucker, P. Ipecac-induced myopathy simulating dermatomyositis. Neurology 1982;32(1):91-94. View abstract.
  • Bond, G. R. Home syrup of ipecac use does not reduce emergency department use or improve outcome. Pediatrics 2003;112(5):1061-1064. View abstract.
  • Bond, G. R., Requa, R. K., Krenzelok, E. P., Normann, S. A., Tendler, J. D., Morris, C. L., McCoy, D. J., Thompson, M. W., McCarthy, T., Roblez, J., and . Influence of time until emesis on the efficacy of decontamination using acetaminophen as a marker in a pediatric population. Ann.Emerg.Med 1993;22(9):1403-1407. View abstract.
  • Boxer, L., Anderson, F. P., and Rowe, D. S. Comparison of ipecac-induced emesis with gastric lavage in the treatment of acute salicylate ingestion. J.Pediatr. 1969;74(5):800-803. View abstract.
  • Brotman, M. C., Forbath, N., Garfinkel, P. E., and Humphrey, J. G. Myopathy due to ipecac syrup poisoning in a patient with anorexia nervosa. Can.Med.Assoc.J. 9-1-1981;125(5):453-454. View abstract.
  • Curtis, R. A., Barone, J., and Giacona, N. Efficacy of ipecac and activated charcoal/cathartic. Prevention of salicylate absorption in a simulated overdose. Arch.Intern.Med 1984;144(1):48-52. View abstract.
  • Day, L., Kelly, C., Reed, G., Andersen, J. M., and Keljo, J. M. Fatal cardiomyopathy: suspected child abuse by chronic ipecac administration. Vet.Hum.Toxicol. 1989;31(3):255-257. View abstract.
  • Freedman, G. E., Pasternak, S., and Krenzelok, E. P. A clinical trial using syrup of ipecac and activated charcoal concurrently. Ann.Emerg.Med. 1987;16(2):164-166. View abstract.
  • Friedman, A. G., Seime, R. J., Roberts, T., and Fremouw, W. J. Ipecac abuse: a serious complication in bulimia. Gen.Hosp.Psychiatry 1987;9(3):225-228. View abstract.
  • Friedman, E. J. Death from ipecac intoxication in a patient with anorexia nervosa. Am.J.Psychiatry 1984;141(5):702-703. View abstract.
  • Halbig, L., Gutmann, L., Goebel, H. H., Brick, J. F., and Schochet, S. Ultrastructural pathology in emetine-induced myopathy. Acta Neuropathol. 1988;75(6):577-582. View abstract.
  • Ho, P. C., Dweik, R., and Cohen, M. C. Rapidly reversible cardiomyopathy associated with chronic ipecac ingestion. Clin.Cardiol. 1998;21(10):780-783. View abstract.
  • Kendrick, D., Smith, S., Sutton, A., Watson, M., Coupland, C., Mulvaney, C., and Mason-Jones, A. Effect of education and safety equipment on poisoning-prevention practices and poisoning: systematic review, meta-analysis and meta-regression. Arch Dis.Child 2008;93(7):599-608. View abstract.
  • Klein-Schwartz, W., Gorman, R. L., Oderda, G. M., Wedin, G. P., and Saggar, D. Ipecac use in the elderly: the unanswered question. Ann.Emerg.Med. 1984;13(12):1152-1154. View abstract.
  • Knight, K. M. and Doucet, H. J. Gastric rupture and death caused by ipecac syrup. South.Med.J. 1987;80(6):786-787. View abstract.
  • Kornberg, A. E. and Dolgin, J. Pediatric ingestions: charcoal alone versus ipecac and charcoal. Ann.Emerg.Med 1991;20(6):648-651. View abstract.
  • Kulig, K., Bar-Or, D., Cantrill, S. V., Rosen, P., and Rumack, B. H. Management of acutely poisoned patients without gastric emptying. Ann.Emerg.Med 1985;14(6):562-567. View abstract.
  • Kuntzer, T., Bogousslavsky, J., Deruaz, J. P., Janzer, R., and Regli, F. Reversible emetine-induced myopathy with ECG abnormalities: a toxic myopathy. J Neurol. 1989;236(4):246-248. View abstract.
  • Lacomis, D. Case of the month. June 1996--anorexia nervosa. Brain Pathol. 1996;6(4):535-536. View abstract.
  • Lee, M. R. Ipecacuanha: the South American vomiting root. J R.Coll.Physicians Edinb. 2008;38(4):355-360. View abstract.
  • Lewis, R. K. and Paloucek, F. P. Assessment and treatment of acetaminophen overdose. Clin Pharm 1991;10(10):765-774. View abstract.
  • Litovitz, T., Clancy, C., Korberly, B., Temple, A. R., and Mann, K. V. Surveillance of loperamide ingestions: an analysis of 216 poison center reports. J.Toxicol.Clin.Toxicol. 1997;35(1):11-19. View abstract.
  • Luczynska, C. M., Marshall, P. E., Scarisbrick, D. A., and Topping, M. D. Occupational allergy due to inhalation of ipecacuanha dust. Clin.Allergy 1984;14(2):169-175. View abstract.
  • MacLean, W. C., Jr. A comparison of ipecac syrup and apomorphine in the immediate treatment of ingestion of poisons. J.Pediatr. 1973;82(1):121-124. View abstract.
  • Mateer, J. E., Farrell, B. J., Chou, S. S., and Gutmann, L. Reversible ipecac myopathy. Arch.Neurol. 1985;42(2):188-190. View abstract.
  • McNamara, R. M., Aaron, C. K., Gemborys, M., and Davidheiser, S. Efficacy of charcoal cathartic versus ipecac in reducing serum acetaminophen in a simulated overdose. Ann.Emerg.Med 1989;18(9):934-938. View abstract.
  • Meadows-Oliver, M. Syrup of ipecac: new guidelines from the AAP. J.Pediatr.Health Care 2004;18(2):109-110. View abstract.
  • Rossi AAB, de Oliveira LO, Venturini BA, dos Santos Silva R. Genetic diversity and geographic differentiation of disjunct Atlantic and Amazonian populations of Psychotria ipecacuanha (Rubiaceae). Genetica. 2009;136(1):57-67. View abstract.
  • Adler, A. G., Walinsky, P., Krall, R. A., and Cho, S. Y. Death resulting from ipecac syrup poisoning. JAMA 5-16-1980;243(19):1927-1928. View abstract.
  • Albertson, T. E., Derlet, R. W., Foulke, G. E., Minguillon, M. C., and Tharratt, S. R. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann.Emerg.Med 1989;18(1):56-59. View abstract.
  • Andersen, J. M., Keljo, D. J., and Argyle, J. C. Secretory diarrhea caused by ipecac poisoning. J.Pediatr.Gastroenterol.Nutr. 1997;24(5):612-615. View abstract.

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