Syrup of Ipecac - EmeticNo longer used or recommended in the US as a treatment for poisoning.
Syrup of Ipecac
Syrup of ipecac, 1 oz. plastic bottle, 1 each
ITEM / SKU: G821-E
For emergency use to cause vomiting for poison victims. Before using, call physician, the hospital emergency room, or the Poison Control Center for advice. Contains: in 100 ml. 123-157 mg. ether-soluble alkaloids of ipecac. Alcohol 1.0-2.5%.
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From Wikipedia: (Information is provided for informational purposes only, and implies to endorsement, nor statement of veracity by Express Companies, Inc, or any of its affiliates)
Syrup of ipecac (derived from the dried rhizome and roots of the Ipecacuanha plant), is an emetic—a substance used to induce vomiting. It is used in cases of accidental poisoning, and is perhaps the best-known emetic. Ipecac was also used in cough mixtures as an expectorant and from the 18th until the early 20th century, Ipecac and opium were used to produce Dover's powder, which was used in syrup form.
Though it has a long history of use, not only in the US but in other countries too, syrup of Ipecac has come under recent scrutiny.
One recent scientific review (2005) by an expert panel concluded that vomiting alone does not reliably remove poisons from the stomach. The study suggested that indications for use of Ipecac syrup were rare and patients should be treated by more effective and safer means. Additionally, Ipecac’s potential side effects, such as lethargy, can be confused with the poison’s effects, complicating diagnosis. Ipecac may also delay the administration or reduce the effectiveness of other treatments such as activated charcoal, whole bowel irrigation, or oral antidotes. The current first-line treatment for most ingested poisons is now activated charcoal, which operates much more quickly and effectively than Ipecac treatment.
Although Ipecac was once recommended by pediatricians to be kept in the home, the current guidelines from the American Academy of Pediatrics recommends against keeping syrup of Ipecac in the home and in fact recommends disposal of any syrup of Ipecac present in the home.
The reason for this new policy was:
1. There was no evidence that syrup of Ipecac actually helps improve the outcome in cases of poisoning
2. Administering syrup of Ipecac can delay administering more effective treatments, such as activated charcoal and/or antidotes
3. Syrup of Ipecac can change neurologic status, and so the effects of the Ipecac can be mistaken for the effects of the poisoning
4. Accidental overdose of Ipecac can result when administered in the home
5. Universal availability of Ipecac in the home may have contributed to Ipecac abuse by bulimics and intentional misuse of Ipecac in cases of Munchausen syndrome by proxy.
Mechanism of action
The actions of Ipecac are mainly those of its major alkaloids, emetine (methylcephalin) and cephalin. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.
Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss. Repeated abuse is believed to cause damage to the heart, which can ultimately result in the user's death. The death of singer Karen Carpenter in 1983 has been popularly attributed to her abuse of Ipecac for weight control.
From the Poison Control Center:
What is Ipecac Syrup?
Ipecac syrup is a medicine that causes vomiting. In the past it was used to partially empty a person’s stomach after a poison. It is now rarely recommended.
It is NOT necessary to keep ipecac syrup in your home.
In case of poisoning, call the poison center right away at....... .
What Happened to Ipecac Syrup?
For years, parents were told to keep ipecac syrup at home. This medicine could be used to make a child vomit after swallowing poison. Now, your doctor doesn’t tell you to keep it. The poison center doesn’t tell you to use it. You can’t even buy ipecac in the drugstore.
What happened? And NOW what should you do?
The short story: Call the poison center right away at 1-800-222-1222 if you think someone has been poisoned. If the poison was swallowed, breathed in, or splashed on someone’s skin or eyes, the poison center experts will tell you what to do right away. Local experts will answer your phone call, 24 hours a day, 7 days a week. Most of the time, you can stay safely at home with the poison center’s advice. But, be prepared:
- Click here to order phone stickers and magnets with the poison center’s emergency number.
- Click here for first aid instructions for poisoning.
The longer story: It seemed to make sense. If someone swallowed poison and then threw up, they shouldn’t get sick. This treatment approach was used for decades.
At first, people who swallowed poison were given many ineffective remedies:
- raw egg white;
- the "universal antidote" of burnt toast, tannic acid and mild of magnesia;
- salt water;
- tickling the back of the throat.
Sometimes, these remedies did cause vomiting. But they often caused problems of their own. For example, too much salt caused sodium poisoning, seizures and even death. Gagging someone often caused throat bleeding and swelling. Also, these home remedies were never reliable enough to be used to treat poisoning. And complicated charts about what remedy went with what poisoning were confusing.
Small brown bottles of ipecac syrup seemed to solve these problems. When given to children or adults, ipecac made most of them throw up within 20-30 minutes. Since at least the 1960’s, standard parenting advice included keeping a bottle of ipecac syrup at home. In fact, many pediatricians and health clinics gave ipecac to parents, “just in case”.
What we know now: It turns out that a big piece of the picture was missing. Yes, ipecac made people throw up, whether or not they swallowed poison. But did throwing up keep them from actually getting sick from the poison?
Recently, researchers looked at all of the evidence about ipecac syrup. They agreed that ipecac syrup reliably caused vomiting. They also agreed that this didn’t make any difference! In other words, there was little research to show that people who swallowed ipecac after poisoning did any better than others.
In addition, this review highlighted some problems with ipecac:
- There are times when ipecac is unsafe. It shouldn't be given to someone who swallowed chemicals that cause burns on contact or medicines that can cause seizures very quickly. It can be dangerous to people with some types of medical problems. When such poisoning victims got ipecac anyway, they developed serious complications or even died.
- More and more people with eating disorders were using ipecac to make themselves throw up. Regular use of ipecac syrup is dangerous; for example, chronic users have died from heart problems.
- Sometimes people vomiting after ipecac could not keep down other drugs they needed to treat their poisonings.
Based on these facts, pediatricians, poison centers, and federal regulators have re-evaluated the use of ipecac. Follow the links at the end for the fine print.
Should you keep ipecac at home?
- The American Academy of Pediatrics recommends that ipecac syrup NOT be stocked at home.
- Likewise, 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-only drug. To date, FDA has not acted on the panel recommendation.
- In the Washington, DC metropolitan area, the National Capital Poison Center does not recommend that parents stock ipecac syrup at home. In fact, most pharmacies no longer stock ipecac syrup.
I hear about activated charcoal…Activated charcoal is a medicine that is used to treat some serious poisonings. It is often given in emergency departments and sometimes, but rarely, at home.
The National Capital Poison Center does NOT recommend that parents keep activated charcoal at home. It goes back to research. Most studies do not show a benefit to keeping and giving activated charcoal at home.
The bottom line: Parents, child care providers, and everyone who spends time with children should post the poison center phone number on or near every phone. Call 1-800-222-1222 right away for a possible poisoning. Trained experts will guide you: if treatment is needed, they’ll tell you what to do. They will call you back to be sure that everything is all right.
For more information:
- In 2003, the U.S. Food and Drug Administration FDA Nonprescription Drug Advisory Council held a hearing about the over-the-counter status of ipecac syrup. The advisory panel then recommended to FDA that ipecac syrup no longer be available as a non-prescription drug. FDA has not made a decision (as of 12/05), but documents from the hearing are available on the web site. Go to www.fda.gov and enter the search term "ipecac". You will find the regulatory history of ipecac and presentations and submissions for and against the over-the-counter availability of ipecac syrup.
- In 2003, the American Academy of Pediatrics issued a policy statement "Poison Treatment in the Home" which concluded that ipecac syrup should no longer be routinely used in the home. Instead, they recommended that the first action of a caregiver of a child who may have swallowed a poison is to call the local poison control center at 1-800-222-1222.
- In 2004, an expert panel of toxicologists issued its "Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons." Panel members from the American Association of Poison Control Centers, the American Academy of Clinical Toxicology and the American College of Medical Toxicology concluded that ipecac is rarely useful in treating childhood poisoning.