IPECAC

Ipecac has been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating	Health Concerns
	Poisoning
	Intestinal parasites
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies): In traditional herbal medicine, ipecac appears to have been primarily used as an emetic, or an agent that induces vomiting.¹ The herb was reportedly first exported to Europe in 1672.² The alkaloids in the plant were identified originally in 1817.

Active constituents: Ipecac’s major constituents are the alkaloids emetine and cephaline. The roots also contain tannins and small amounts of anthraquinone glycosides.³ The alkaloids have several important actions, including activation of brain centers that can induce vomiting, inhibition of the sympathetic nervous system, and inhibition of protein synthesis.⁴

Ipecac syrup is commonly used as a remedy for poisoning, taken following ingestion of toxic but noncaustic substances. In most people, ingestion of adequate amounts leads to vomiting within 30 minutes.⁵

The protein-inhibiting effects of emetine and other alkaloids of ipecac may account for the ability of the plant to inhibit growth of or kill several types of parasites, including ameba, pinworms, and tapeworms.^{6 7} However, the amount of ipecac needed to produce these effects in people are high and can lead to severe side effects. Emetine or its somewhat safer form, dihydroemetine, are reserved for rare cases of people infected with amebas that are not cured by using anti-ameba drugs.⁸ Due to the danger involved, ipecac or emetine should never be used without first consulting a physician.

How much is usually taken? To induce vomiting after ingesting something poisonous (after consulting with poison control centers or emergency services), adults are generally advised to take 15–30 ml of ipecac syrup followed by 3–4 glasses of water.⁹ Children age 1–12 years should take 15 ml of ipecac syrup followed by 1–2 glasses of water. Children under age 1 year should be given 5–10 ml syrup followed by one half to 1 glass of water. The poisoned subject should be kept moving and the head kept upright after taking ipecac. It may take up to 30 minutes before vomiting occurs. A second application of 15 ml followed by more water can be used if vomiting does not occur after 30 minutes. If vomiting still does not occur after the second use, it is best to go immediately to the nearest hospital to have the ipecac pumped out of the stomach and obtain further help for the original poisoning. Milk or carbonated drinks should not be substituted for water after taking ipecac, as they might interfere with ipecac’s absorption and efficacy. Activated charcoal will also interfere with the absorption and efficacy of ipecac. Charcoal should only be given after ipecac has caused vomiting. Ipecac should never be used to induce vomiting of caustic poisons such as gasoline, acids, or bleach. Ipecac tincture and fluid extract are much stronger than ipecac syrup. Ipecac tincture or fluid extract should never be taken in the amounts listed above for ipecac syrup.

Are there any side effects or interactions? When used as directed for poisoning, ipecac will cause severe nausea, vomiting, and intestinal cramps. If too much ipecac is ingested, it may cause dizziness, rapid heartbeat, and palpitations. Cases have been reported of people with bulimia who abused ipecac by taking it frequently to induce vomiting and developed severe muscle damage or heart damage, and, in some cases, died.^{10 11} Since emetine is removed from the body slowly, the amounts can build up with repeated use and cause damage later. Ipecac should not be used during pregnancy or breast-feeding.

At the time of writing, there were no well-known drug interactions with ipecac.

1. Schmeller T, Wink M. Utilization of alkaloids in modern medicine. In: Roberts M, Wink M (eds). Alkaloids—Biochemistry, Ecology and Medicinal Applications. New York: Plenum Press, 1998, 435–59 [review].

2. Evans WC. Trease and Evans’ Pharmacognosy, 13th ed. London: Baillière Tindall, 1989, 595–9.

3. Izaddoost M, Robinson T. Synergism and antagonism in the pharmacology of alkaloidal plants. Herbs Spices Med Plants 1986;2:137–58 [review].

4. Schmeller T, Wink M. Utilization of alkaloids in modern medicine. In: Roberts M, Wink M (eds). Alkaloids—Biochemistry, Ecology and Medicinal Applications. New York: Plenum Press, 1998, 435–59 [review].

5. Covington TR, Hussar DA, Lasagna L, et al (eds). Drug Facts and Comparisons. St. Louis: Facts and Comparisons, 1998, 3599.

6. Oelkers HA. Studies on anthelmintics. Arzneim Forsch 1962;121:810–2.

7. Wright CW, Phillipson JD. Natural products and the development of selective antiprotozoal drugs. Phytother Res 1990;4:127–39 [review].

8. Schmeller T, Wink M. Utilization of alkaloids in modern medicine. In: Roberts M, Wink M (eds). Alkaloids—Biochemistry, Ecology and Medicinal Applications. New York: Plenum Press, 1998, 435–59 [review].

9. Covington TR, Hussar DA, Lasagna L, et al (eds). Drug Facts and Comparisons. St. Louis: Facts and Comparisons, 1998, 3599.

10. Palmer EP, Guay AT. Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. New Engl J Med 1985;313:1457–9.

11. Adler AG, Walinsky P, Krall RA, Cho SY. Death resulting from ipecac syrup poisoning. JAMA 1980;243:1927–8.

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