ipecac

Summary

Summary: A syrup made from the dried rhizomes of two different species, CEPHAELIS ipecacuanha and C. acuminata. They contain EMETINE, cephaeline, psychotrine and other ISOQUINOLINES. Ipecac syrup is used widely as an emetic acting both locally on the gastric mucosa and centrally on the chemoreceptor trigger zone.

Top Publications

  1. Manoguerra A, Cobaugh D. Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons. Clin Toxicol (Phila). 2005;43:1-10 pubmed
    The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways...
  2. Silber T. Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status?. J Adolesc Health. 2005;37:256-60 pubmed
    To review and address the abuse of ipecac, describing its epidemiology, toxicity, clinical characteristics, and laboratory assessment. A Medline search (1980-2003) for Ipecac abuse and Ipecac toxicity, n = 34...
  3. Steffen K, Mitchell J, Roerig J, Lancaster K. The eating disorders medicine cabinet revisited: a clinician's guide to ipecac and laxatives. Int J Eat Disord. 2007;40:360-8 pubmed
    ..frequency of alternative medication use in bulimia nervosa (BN), and to review available nonprescription emetic (ipecac) and laxative products and their potential toxicities...
  4. Bond G. Home syrup of ipecac use does not reduce emergency department use or improve outcome. Pediatrics. 2003;112:1061-4 pubmed
    The usefulness of syrup of ipecac as a home treatment for poisoning and the need to keep it in the home has been increasingly challenged. Many poison centers do not recommend any use of syrup of ipecac...
  5. Carter K, Izsak E, Marlow J. Munchausen syndrome by proxy caused by ipecac poisoning. Pediatr Emerg Care. 2006;22:655-6 pubmed
    To present a case of Munchausen syndrome by proxy caused by ipecac poisoning to increase the awareness of their warning signs and symptoms so that they may be recognized and diagnosed earlier...
  6. Criddle L. An overview of pediatric poisonings. AACN Adv Crit Care. 2007;18:109-18 pubmed
  7. Amitai Y, Mitchell A, McGuigan M, Lovejoy F. Comment on "Acetaminophen: the 150 mg/kg myth". Clin Toxicol (Phila). 2005;43:217 pubmed
  8. Krenzelok E. Ipecac syrup-induced emesis...no evidence of benefit. Clin Toxicol (Phila). 2005;43:11-2 pubmed
  9. Kamei T. [Treatment guidelines of acute poisoning in primary care setting]. Chudoku Kenkyu. 2004;17:233-40 pubmed

More Information

Publications62

  1. Barry J. Diagnosis and management of the poisoned child. Pediatr Ann. 2005;34:937-46 pubmed
    ..Prevention efforts have the potential to decrease the incidence of pediatric poisonings. The universal poison control center number provided should be distributed and posted in homes, clinics, and emergency departments. ..
  2. Sheffield P. Emetics, cathartics, and gastric lavage. Pediatr Rev. 2008;29:214-5; discussion 215 pubmed publisher
  3. Fountain J, Beasley D. Activated charcoal supercedes ipecac as gastric decontaminant. N Z Med J. 1998;111:402-4 pubmed
    ..This article outlines the relative merits of syrup of ipecacuanha and activated charcoal, and concludes that the latter is preferable in many respects. Details of its appropriate administration are discussed. ..
  4. Hojer J, Troutman W, Hoppu K, Erdman A, Benson B, Megarbane B, et al. Position paper update: ipecac syrup for gastrointestinal decontamination. Clin Toxicol (Phila). 2013;51:134-9 pubmed publisher
    An update of the first position paper on ipecac syrup from 1997 was published by the American Academy of Clinical Toxicology and the European Association of Poison Centres and Clinical Toxicologists in 2004...
  5. Söderpalm A, Schuster A, de Wit H. Antiemetic efficacy of smoked marijuana: subjective and behavioral effects on nausea induced by syrup of ipecac. Pharmacol Biochem Behav. 2001;69:343-50 pubmed
    ..Nausea and emesis were induced by syrup of ipecac. Marijuana significantly reduced ratings of "queasiness" and slightly reduced the incidence of vomiting ..
  6. Zhang W, Bah J, Wohlfarth A, Franzén J. A stereodivergent strategy for the preparation of corynantheine and ipecac alkaloids, their epimers, and analogues: efficient total synthesis of (-)-dihydrocorynantheol, (-)-corynantheol, (-)-protoemetinol, (-)-corynantheal, (-)-protoemetine, and rel. Chemistry. 2011;17:13814-24 pubmed publisher
    ..the total and formal synthesis of a broad number of optically active natural products from the corynantheine and ipecac alkaloid families, for example, indolo[2,3-a]- and benzo[a]quinolizidines...
  7. Sedlacek H, Ramsey D, Boucher J, Eagleson J, Conder G, Clemence R. Comparative efficacy of maropitant and selected drugs in preventing emesis induced by centrally or peripherally acting emetogens in dogs. J Vet Pharmacol Ther. 2008;31:533-7 pubmed publisher
    ..in preventing emesis induced by emetogens acting centrally (apomorphine; Study 1) or peripherally (syrup of ipecac; Study 2) in dogs...
  8. Beuhler M, Sasser H, Watson W. The outcome of North American pediatric unintentional mushroom ingestions with various decontamination treatments: an analysis of 14 years of TESS data. Toxicon. 2009;53:437-43 pubmed publisher
    ..The treatment subgroups analyzed were ipecac, single-dose activated charcoal, and no gastric decontamination...
  9. Ressel G. AAP releases policy statement on poison treatment in the home. Am Fam Physician. 2004;69:741-2 pubmed
  10. Mintegi S, Dalziel S, Azkunaga B, Prego J, Arana Arri E, Acedo Y, et al. International Variability in Gastrointestinal Decontamination With Acute Poisonings. Pediatrics. 2017;140: pubmed publisher
    ..1%), activated charcoal and gastric lavage (122, 36.1%), gastric lavage (47, 13.9%), and ipecac (3, 0.9%). In 155 (45.8%, 40.5%-51...
  11. Sun L, Hu X, Liu L, Jin H, Lin R. [Rapid detection of alkaloids in Ipecac by direct analysis in real time tandem mass spectrometry (DART-MS/MS)]. Zhongguo Zhong Yao Za Zhi. 2012;37:1426-30 pubmed
    To detect alkaloids in Ipecac by direct analysis in real time tandem mass spectrometry (DART-MS) without pre-treatment and chromatographic separation...
  12. Lapus R, Slattery A, King W. Effects on a Poison Center's (PC) triage and follow-up after implementing the no Ipecac use policy. J Med Toxicol. 2010;6:122-5 pubmed publisher
    For years, The American Academy of Pediatrics (AAP) had supported home use of syrup of Ipecac. However, due to mounting evidence that Ipecac use did not improve outcome nor reduce Emergency Department (ED) referrals, the AAP in November ..
  13. Amigó M, Nogué S, Sanjurjo E, Faro J, Ferró I, Miro O. [Efficacy and safety of gut decontamination in patients with acute therapeutic drug overdose]. Med Clin (Barc). 2004;122:487-92 pubmed
    ..However, this does not prevent clinical deterioration or continued drug absorption in all cases and may be accompanied by adverse events. ..
  14. Shannon M. The demise of ipecac. Pediatrics. 2003;112:1180-1 pubmed
  15. Muller A. Mushrooms: toxins right in your own backyard. J Emerg Nurs. 2003;29:483-5 pubmed
  16. Good A, Kelly C, Bateman D. Differences in treatment advice for common poisons by poisons centres--an international comparison. Clin Toxicol (Phila). 2007;45:234-9 pubmed
    ..were: activated charcoal (AC) alone (5 centres); gastric lavage (GL) alone (1); AC and/or GL (3); AC, GL and/or ipecac (2). Only 40% (4/10) recommended AC and 50% (3/6) GL within 1 hour...
  17. Garrison J, Shepherd G, Huddleston W, Watson W. Evaluation of the time frame for home ipecac syrup use when not kept in the home. J Toxicol Clin Toxicol. 2003;41:217-21 pubmed
    The home administration of ipecac syrup remains a recommendation in some guidelines for the management of specific pediatric poisonings...
  18. Kubo K, Chishiro T. [Six-year review of cigarette ingestion in children--gastric lavage versus medical observation]. Chudoku Kenkyu. 2008;21:115-22 pubmed
    ..We conluded that ingestion of cigarette in children is generally benign. No gastric lavage, but medical observation for two hours following ingestion in emergency department is our recommendation of management. ..
  19. Wagner C, Bowers W. Cardiomyopathy in a child induced by intentional ipecac poisoning. Air Med J. 2006;25:236-7 pubmed
  20. Lee M. Ipecacuanha: the South American vomiting root. J R Coll Physicians Edinb. 2008;38:355-60 pubmed
    ..was then delayed until the early 1800s when the School of Chemistry at Paris established that the dried root of ipecac contained two powerful alkaloids, emetine and cephaeline, that consistently caused vomiting and diarrhoea...
  21. Seger D. Parallax view. Clin Toxicol (Phila). 2005;43:13-5 pubmed
  22. Marc B. Managing high-risk body-stuffers who swallow the evidence. J Forensic Leg Med. 2008;15:200-1 pubmed publisher
  23. Luiz J, Heseltine J. Five common toxins ingested by dogs and cats. Compend Contin Educ Vet. 2008;30:578-87; quiz 587-8 pubmed
    ..When a dog or cat ingests a common household toxin, rapid decontamination is critical. This article provides treatment recommendations for some of the most common toxicoses in dogs and cats, along with a summary table for quick reference. ..
  24. Murali P, Rajasekaran S, Paramesh P, Krishnarajasekar O, Vasudevan S, Nalini K, et al. Plant-based formulation in the management of chronic obstructive pulmonary disease: a randomized double-blind study. Respir Med. 2006;100:39-45 pubmed
  25. Tan G, Kinghorn A, Hughes S, Pezzuto J. Psychotrine and its O-methyl ether are selective inhibitors of human immunodeficiency virus-1 reverse transcriptase. J Biol Chem. 1991;266:23529-36 pubmed
    ..dihydrogen oxalate and O-methylpsychotrine sulfate heptahydrate (MP), the salts of isoquinoline alkaloids from ipecac, were found to be potent inhibitors of the DNA polymerase activity of human immunodeficiency virus-1 reverse ..
  26. Rudd J, Ngan M, Wai M. 5-HT3 receptors are not involved in conditioned taste aversions induced by 5-hydroxytryptamine, ipecacuanha or cisplatin. Eur J Pharmacol. 1998;352:143-9 pubmed
    ..Results are discussed in terms of the usefulness of the rat conditioned taste aversion paradigm to anti-emetic research. ..
  27. Juurlink D, McGuigan M. Gastrointestinal decontamination for enteric-coated aspirin overdose: what to do depends on who you ask. J Toxicol Clin Toxicol. 2000;38:465-70 pubmed
    ..Four centers (5 %) recommended syrup of ipecac and 38 (51%) recommended gastric lavage, compared with 0% and 0% of toxicologists, respectively...
  28. Krenzelok E. New developments in the therapy of intoxications. Toxicol Lett. 2002;127:299-305 pubmed
  29. Hasegawa M, Sasaki T, Sadakane K, Tabuchi M, Takeda Y, Kimura M, et al. Studies for the emetic mechanisms of ipecac syrup (TJN-119) and its active components in ferrets: involvement of 5-hydroxytryptamine receptors. Jpn J Pharmacol. 2002;89:113-9 pubmed
    b>Ipecac syrup, prepared from a galentical ipecac, contains the nauseant alkaloids cephaeline and emetine...
  30. Okada Y, Terada T, Inasawa H, Machida M. [Treatment of acute poisoning in conformity with position statement]. Chudoku Kenkyu. 2002;15:257-62 pubmed
  31. von Mach M, Weilemann L. [Current therapy of intoxications]. Dtsch Med Wochenschr. 2003;128:1779-81 pubmed
  32. Cantrell F. Sildenafil citrate ingestion in a pediatric patient. Pediatr Emerg Care. 2004;20:314-5 pubmed
    ..A 2-year-old male ingested 75 mg of sildenafil citrate (Viagra) 2 hours prior to arrival at an emergency room. Ipecac syrup had been given at home with one episode of vomiting...
  33. Meadows Oliver M. Syrup of ipecac: new guidelines from the AAP. J Pediatr Health Care. 2004;18:109-10 pubmed
  34. Bartlett D. The ABCs of gastric decontamination. J Emerg Nurs. 2003;29:576-7 pubmed
  35. Eldawy M, Mabrouk M, El Barbary F. Determination of chlorpheniramine maleate and tincture ipecac in dosage form by liquid chromatography with ultraviolet detection. J AOAC Int. 2003;86:675-80 pubmed
    A procedure was developed and validated for measuring chlorpheniramine maleate and tincture ipecac (as emetine hydrochloride) by reversed-phase liquid chromatography with methanol-10 mM sodium heptanesulfonate (20 + 30) as the mobile ..
  36. Kelly N, Sanchez S. Is syrup of ipecac still for sale? Comparison of pharmacies in a large urban area--2003 versus 2005. Clin Pediatr (Phila). 2007;46:320-4 pubmed
    There has been considerable publicity about the lack of benefit and potential dangers of syrup of ipecac. In November 2003, the American Academy of Pediatrics recommended against its use...
  37. Gupta S, Taneja V. Poisoned child: emergency room management. Indian J Pediatr. 2003;70 Suppl 1:S2-8 pubmed
    ..Whole bowel Irrigation is a new addition to the armamentarium of GI decontamination. At present antidotes are available for few toxins only so the management remains supportive for most poisons. ..
  38. Greene S, Harris C, Singer J. Gastrointestinal decontamination of the poisoned patient. Pediatr Emerg Care. 2008;24:176-86; quiz 187-9 pubmed publisher
    ..It challenges the accepted precepts of gut decontamination and assesses the utility of syrup of ipecac-induced emesis, orogastric lavage, single-dose-activated charcoal, cathartics, and whole-bowel irrigation.
  39. Tenenbein M. Recent advancements in pediatric toxicology. Pediatr Clin North Am. 1999;46:1179-88, vii pubmed
    ..The controversy over the type of gastrointestinal decontamination is resolving and recent recommendations are reviewed. Also two new antidotes, fomepizole for toxic alcohols and octreotide for sulfonylureas, are reviewed...
  40. Tietze L, Rackelmann N, Muller I. Enantioselective total syntheses of the Ipecacuanha alkaloid emetine, the Alangium alkaloid tubulosine and a novel benzoquinolizidine alkaloid by using a domino process. Chemistry. 2004;10:2722-31 pubmed
  41. Yen M, Ewald M. Toxicity of weight loss agents. J Med Toxicol. 2012;8:145-52 pubmed publisher
    ..These included: syrup of ipecac, cathartics, human chorionic gonadotropin hormone, 2,4 Dinitrophenol, guar gum, phenylpropanolamine, ma huang/ ..
  42. Bond G. The role of activated charcoal and gastric emptying in gastrointestinal decontamination: a state-of-the-art review. Ann Emerg Med. 2002;39:273-86 pubmed
    ..these patients, individual physicians must act on a personal valuation: Is it better to use a treatment that might have some benefit but definitely has some risk or not to use a treatment that has any risk unless there is proven benefit? ..
  43. Brinker A, Nourjah P. Trends in the use of ipecac in the ED setting: data from the 1992-2002 NHAMCS-ED (letter). Am J Emerg Med. 2006;24:759-61 pubmed
  44. Buckley N, Eddleston M. The revised position papers on gastric decontamination. Clin Toxicol (Phila). 2005;43:129-30 pubmed
  45. Axelsson P, Thörn S, Wattwil M. Betamethasone does not prevent nausea and vomiting induced by ipecacuanha. Acta Anaesthesiol Scand. 2004;48:1283-6 pubmed
    ..As ipecacuanha releases 5-hydroxytryptamin, it can be concluded that betamethasone does not have 5-HT3 antagonistic effects. ..
  46. Asano T, Ishihara K, Wakui Y, Yanagisawa T, Kimura M, Kamei H, et al. Absorption, distribution and excretion of 3H-labeled cephaeline- and emetine-spiked ipecac syrup in rats. Eur J Drug Metab Pharmacokinet. 2002;27:17-27 pubmed
    ..3, 28.7 and 40.6 ng eq./mL) were reached at 2.00-3.33 hours following oral dosing of ipecac syrup. The maximum plasma radioactivity levels of 3H-emetine (2.71, 6.47 and 9.62 ng eq./mL) were reached at 1...
  47. Heard K. Gastrointestinal decontamination. Med Clin North Am. 2005;89:1067-78 pubmed
    ..After careful consideration of the risks, GI decontamination should be targeted at patients who, in the opinion of the treating physician, have a potentially life-threatening exposure...
  48. Madden M. Pediatric poisonings: recognition, assessment, and management. Crit Care Nurs Clin North Am. 2005;17:395-404, xi pubmed
  49. Chen L, Gielen A, McDonald E. Validity of self reported home safety practices. Inj Prev. 2003;9:73-5 pubmed
    ..of self reported data on parents' home safety practices of using smoke alarms and stair gates, and having syrup of ipecac. Families from a pediatric continuity clinic in a large, urban teaching hospital with infants from birth to 6 ..
  50. Kölzer M, Weitzel K, Göringer H, Thines E, Opatz T. Synthesis of bioactive 2-aza-analogues of ipecac and alangium alkaloids. ChemMedChem. 2010;5:1456-64 pubmed publisher
  51. Asano T, Watanabe J, Sadakane C, Ishihara K, Hirakura K, Wakui Y, et al. Biotransformation of the ipecac alkaloids cephaeline and emetine from ipecac syrup in rats. Eur J Drug Metab Pharmacokinet. 2002;27:29-35 pubmed
    The metabolism of cephaeline and emetine, which are the primary active components of ipecac syrup, were investigated in rats. Cephaeline-6'-O-glucuronide was found to be a biliary metabolite of cephaeline...
  52. Cooper M, Sologuren A, Valiente R, Smith J. Effects of lerisetron, a new 5-HT3 receptor antagonist, on ipecacuanha-induced emesis in healthy volunteers. Arzneimittelforschung. 2002;52:689-94 pubmed
    ..In conclusion, lerisetron has been shown to be effective in the treatment of ipecacuanha-induced nausea and vomiting at intravenous doses of 18 mg and at oral doses of 20 mg for up to 12 hours. ..
  53. Rashid N. Medically unexplained myopathy due to ipecac abuse. Psychosomatics. 2006;47:167-9 pubmed
    The use of ipecac, once recommended as an emetic for use in toxic ingestions, has more recently been discouraged for use in home and emergency room settings...