Pharmacology: Ipecac induces vomiting by both gastric irritation and central stimulation of the chemoreceptor trigger zone.
Approximately 95% of patients vomit within 15 to 30 minutes of administration of a therapeutic dose and vomiting usually persists for 30 minutes to 2 hours. Approximately 28 to 60% of an ingested toxin will be removed by emesis if ipecac is given within 5 minutes following ingestion of the toxin. If given 1 hour after, a maximum of 30% of the toxin will be removed.
Indications: To induce vomiting in the early management of certain oral poisonings. Ideally, ipecac should be given on the advice of a Poison Control Centre or physician, especially in the case of infants and children.
tag_ContraindicationsContraindications: Situations where emesis is contraindicated, include: poisoning involving strong acids or alkalies, unconscious, semicomatose or severely inebriated patients, patients experiencing convulsions and patients who have lost the gag reflex.
Warnings: The use of ipecac syrup in patients who have ingested petroleum distillates is controversial. Use may be considered in: poisonings involving petroleum distillates when product contains a more toxic ingredient such as heavy metals or pesticides; mixed poisonings where the quantity ingested is certain to be toxic.
Administration of ipecac syrup and the resulting vomiting may induce convulsions in patients who have ingested CNS stimulants. Care must be taken when administering ipecac syrup in these situations.
Ipecac syrup should be used with caution in cases of poisonings involving CNS depressants since loss of consciousness may occur before emesis has resulted.
Precautions: Do not use ipecac fluid extract in place of ipecac syrup since it is 14 times more concentrated. Activated charcoal should not be administered until after ipecac syrup has induced emesis and vomiting is complete.
If vomiting does not occur after 2 doses of ipecac syrup, gastric lavage should be performed.
Care should be taken to avoid aspiration of vomitus in young children and infants because of their poorly developed gag reflex.
Administration of ipecac syrup should not preclude the use of other emergency measures. Its use may be advised after consultation with a Poison Control Centre or physician as a preliminary measure prior to transporting the patient to hospital.
Pregnancy: Safety has not been established. Ipecac syrup should be used during pregnancy only when potential benefit outweighs risk.
Lactation: Data are not available.
Adverse Effects: When used in the treatment of drug overdose or poisoning, ipecac syrup does not usually cause systemic toxicity. Protracted or prolonged vomiting, diarrhea and lethargy may occasionally occur.
Toxicity may occur in patients with eating disorders who chronically consume large amounts of ipecac syrup. Myopathy, with manifestations of muscle weakness and pain, hyporeflexia, tenderness and stiffness, has been the major presenting adverse effect. Cardiotoxicity including hypotension, cardiac failure and more severely arrhythmias, may be serious and potentially fatal.
Protracted vomiting produced by the chronic ingestion of ipecac syrup may cause some metabolic abnormalities, dental abnormalities, eosophagitis, gastric reflux, Mallory-Weiss syndrome, parotid gland enlargement and aspiration pneumonitis.
Dosage: Do not use ipecac fluid extract in place of ipecac syrup. Ipecac should be given as soon as possible after ingestion of a toxin, ideally within 1 hour. Dose should be followed by 1 to 2 glasses of water since ipecac is ineffective when the stomach is empty. Administration with milk can prolong the time to vomiting because it decreases the irritant action of ipecac on the stomach.
Adults: 15 to 30 mL.
If vomiting has not occurred within 15 to 20 minutes, the dose may be repeated once in adults and children over 12 years.
IPECAC SYRUP General Monograph,Emetic