ipecac syrup

Action and Spectrum

Actions and Spectrum: 

ipecac syrup is a medication used historically as an emetic, which induces vomiting. It is derived from the dried root of the ipecacuanha plant, which contains several alkaloids, including emetine and cephaeline. Here are some of the actions and the spectrum of ipecac syrup: 

• Actions: ipecac syrup acts on the chemoreceptor trigger zone in the brainstem, which stimulates the vomiting center and induces vomiting. It also irritates the gastric mucosa, possibly contributing to its emetic effect. 
• Spectrum: ipecac syrup is typically used for the emergency treatment of poisoning, particularly in cases where a toxin has been ingested within the previous hour or so. It is used to treat chronic constipation or bronchitis, although its use in these situations is controversial and generally not recommended. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Aspiration 

Prolonged vomiting 

Mallory-Weiss tear 

CNS depression 

Pneumomediastinum 

Therapy delay 

Black Box Warning

Contraindication / Caution

Contraindication/Caution: 

While ipecac syrup has been historically used as an emetic and for other purposes, there are several contraindications and precautions to consider before using it. Here are some of the most important: 

• Contraindications: ipecac syrup is contraindicated in patients with certain medical conditions, including intestinal obstruction, hemorrhagic disorders, recent gastrointestinal surgery, and some cardiac conditions. Patients who have ingested corrosive substances or hydrocarbons should not use them. As these can cause severe complications if vomited. 
• Caution in specific populations: ipecac syrup should be used cautiously in children under six months, as they may be more susceptible to complications such as aspiration pneumonia. It should also be used cautiously in elderly patients, as they may be more prone to adverse effects such as cardiac arrhythmias or electrolyte imbalances. 
• Side effects: ipecac syrup can cause several side effects, including nausea, vomiting, abdominal cramping, and dizziness. It may also cause electrolyte imbalances, particularly in patients who vomit excessively or have preexisting medical conditions. Prolonged use of ipecac syrup can also lead to addiction and psychological dependence. 

Pregnancy / Lactation

Pregnancy consideration:  

Category C 

Breastfeeding warnings:  

It is yet to be discovered if the drug is excreted in breast milk. Hence use cautiously. 

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• <b>Category B: There is no affirmation of risk to the fetus found in animal reproduction studies, and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a human product; Pregnant women must take care of the potential risks. 
• Category D: Adequate data with sufficient evidence of human fetal risk from various platforms is available. However, despite potential dangers may be used only in emergencies for potential benefits. 
• Category X: Drugs listed in this category outweigh risks over benefits. The drug is not for pregnant women. 
• Category N: No data for the drug under this category is available. 

Pharmacology

Pharmacology: 

The pharmacology of ipecac involves its effects on the gastrointestinal and central nervous systems. Here are some of the pharmacological actions of ipecac: 

• Emetic action: ipecac stimulates the chemoreceptor trigger zone in the brainstem, which leads to the activation of the vomiting center and the induction of vomiting. It is the primary pharmacological action of ipecac. 
• Irritation of the gastric mucosa: ipecac also irritates the mucosa, contributing to its emetic effect. This irritation can also lead to other gastrointestinal symptoms, such as abdominal pain and diarrhea. 
• Antitussive action: ipecac has been shown to have antitussive (cough-suppressing) properties, although its use for this purpose is not recommended due to its potential side effects. 
• Cardiac effects: ipecac can cause cardiac effects, including bradycardia and hypotension, particularly in high doses or patients with pre-existing cardiac conditions. 
• Toxicity: Prolonged use of ipecac or excessive doses can lead to toxicity, including electrolyte imbalances and cardiac arrhythmias. In addition, chronic use of ipecac can lead to psychological dependence and addiction. 

Pharmacodynamics: 

The pharmacodynamics of ipecac refer to how it exerts its effects on the body at the cellular and molecular levels. The main pharmacodynamic effect of ipecac is the induction of vomiting, primarily mediated through its effects on the central nervous system. Here are some of the pharmacodynamic actions of ipecac: 

• Stimulation of the chemoreceptor trigger zone (CTZ): ipecac is thought to stimulate the CTZ, a region in the brain that detects toxins and other irritants in the bloodstream. This stimulation leads to the activation of the vomiting center in the brainstem, resulting in the induction of vomiting. 
• Activation of the vomiting center: ipecac also directly activates the vomiting center in the brainstem, which coordinates the muscle contractions that lead to vomiting. 
• Irritation of the gastric mucosa: ipecac can also irritate the gastric mucosa, stimulating the vomiting reflex and contributing to its emetic effect. 
• Antitussive action: ipecac has also been shown to have antitussive (cough-suppressing) properties, although the exact mechanism of this effect is not well understood. 
• Cardiac effects: ipecac can cause cardiac effects, including hypotension and bradycardia, which may be mediated through its effects on the autonomic nervous system. 

Pharmacokinetics: 

Absorption 

Produces effect 30 minutes after the ingestion 

Significantly absorbed when emesis is not produced 

Adminstartion

Administration: 

ipecac syrup is induces vomiting in cases of accidental ingestion of poisons or other toxic substances. It is typically administered orally, either directly or mixed with a liquid. Here are some general guidelines for the administration of ipecac syrup: 

• Use only as directed: ipecac syrup should only be administered by healthcare professionals or poison control center. Following the instructions is essential, and never using more than the recommended dose. 
• Timing is critical: ipecac syrup is most effective when given within 30 minutes of ingesting the toxic substance. After this time, it may not be effective and could even be harmful. 
• Dosage: The recommended dose of ipecac syrup is 15 ml for adults and 10 ml for children over one. The dose can be repeated once after 20 minutes if vomiting does not occur. 
• Administration: ipecac syrup can be taken directly by mouth. It can also be mixed with small amounts of water or juice. It should be administered slowly to minimize the risk of aspiration. 
• Monitoring: After taking ipecac syrup, the person should be monitored closely for signs of vomiting and other adverse effects, such as abdominal pain, diarrhea, or dehydration. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ipecac syrup  

Pronounced: ai-puh-kak si-ruhp 

Why do we use ipecac syrup? 

ipecac syrup is used in emergencies to induce vomiting in cases of accidental ingestion of poisons or other toxic substances. The goal of using ipecac syrup is to remove the toxic substance from the body. The use of ipecac syrup is typically reserved for cases in which the ingestion of the poison or toxin occurred within the last 30 minutes and when the poison control center or healthcare professional recommends its use. 

ipecac syrup is considered a first-line treatment for certain types of poisoning, including: 

• Ingestion of certain medications, such as acetaminophen or salicylates (aspirin) 
• Ingestion of certain household products, such as cleaning solutions or pesticides 
• Ingestion of certain plants or mushrooms 
• Overdose of certain drugs, such as opioids