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Ipecac is a medicine commonly used to induce vomiting in cases of accidental poisoning. It is also a homeopathic remedy.
Treatment of poisoning
At one time, standard medical practice recommended syrup of ipecac to cause vomiting in cases of poisoning in order to remove the toxic substance from the stomach before absorption occurs. More recently, however, doctors are discouraging the use of ipecac in emergency treatment of poisoning. The reason for this change in practice is that ipecac has not been shown to be more effective than activated charcoal or gastric lavage; in addition, its use may delay the administration of these other methods of treatment. In 2004 the American College of Toxicology updated a 1997 position paper on the use of syrup of ipecac to treat poisoning with the following statement: "There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned."
Ipecac should never be used to induce vomiting if the poison is one of the following:
- alkalis (lye)
- strong acids
- fuel oil
- coal oil
- paint thinner
- cleaning fluid
In cases of poisoning, it is always best to contact a local poison control center, local hospital emergency room, or the family doctor for instructions before using syrup of ipecac.
Ipecac's reputation for inducing vomiting has encouraged some bulimics to take it on a regular basis in order to purge the contents of the stomach after an eating binge. This misuse of ipecac is extremely dangerous; it can cause heart problems, tears in the esophagus or stomach lining, vomiting blood, seizures, or even death.
The homeopathic remedy made from ipecac is called Ipecacuanha. Homeopathic preparations are given for a reason completely opposite from that of standard allopathic treatment. In homeopathy, ipecac is given to stop vomiting rather than to induce it. According to Hahnemann's law of similars, a substance that would cause vomiting in large doses when given to a healthy person will stimulate a sick person's natural defenses when given in extremely dilute and carefully prepared doses. Ipecacuanha is a favorite homeopathic remedy for morning sickness associated with pregnancy. It is also given to stop nausea that is not relieved by vomiting; when the vomitus is slimy and white; when there is gagging and heavy salivation; when the tongue is clean despite the patient's feelings of nausea; and when the patient is not thirsty. The nausea may be accompanied by a headache, cough, or heavy menstrual bleeding. The modalities (circumstances) that suggest Ipecacuanha as the appropriate homeopathic remedy is that the patient feels worse lying down; in dry weather; in winter; and when exercising or moving about.
A homeopathic practitioner would not necessarily prescribe ipecac for all cases of nausea. Arsenicum would be given when the nausea is caused by food poisoning and accompanied by strong thirst, Nux vomica when the nausea is the result of overindulgence in food or alcohol and accompanied by gas or heartburn. A sick child might be given Pulsatilla, particularly if rich foods have been eaten.
On the other hand, a homeopathic practitioner may prescribe ipecac for any of the following conditions that are not related to nausea and vomiting.
- Nosebleeds producing bright red blood.
- Dental bleeding.
- Diarrhea with cramping abdominal pain. The stools are green with froth or foam.
- Asthma of sudden onset. The patient has to sit up in order to breathe, but cannot bring up any mucus in spite of violent coughing.
- Hoarseness or loss of voice following a cold.
- Physical or mental exhaustion.
The medicinal effects of ipecac were recognized centuries ago by the Portuguese who settled in South America. They found a plant that can make people vomit and appropriately named it Caephalis ipecacuanha, meaning sick-making plant. Syrup of ipecac is now considered the safest drug to treat poisoning and is often the most effective. There are different types of ipecac preparations that vary greatly in strength. Syrup of ipecac is best for use at home to treat accidental poisoning. Ipecac fluid extract and ipecac tincture should be avoided as they are much stronger compounds and can be toxic.
Ipecacuanha is a homeopathic remedy made from ipecac by a process of dilution and succussion (shaking). In contrast to syrup of ipecac, it is given to relieve vomiting.
Syrup of ipecac
Syrup of ipecac is made from the dried roots and rhizomes (underground stems) of Cephaelis ipecacuanha. It is available over the counter in 0.5-1 oz bottles. Larger bottles require a doctor's prescription. The dosage for infants under 6 months old should be prescribed by the family doctor or poison control center. For children six months to one year, the usual dose is 5-10 ml or 1-2 tsp. One-half or one full glass (4-8 oz) of water should be taken immediately before or after the dose. The dose may be repeated once after 20-30 minutes if vomiting does not occur. For children one to 12 years of age, the usual dose is 15 ml (1 tbsp) to be taken with one full glass (8 oz) of water. Adults and teenagers should take 15-30 ml of ipecac with at least 1 full glass of water. Syrup of ipecac should not be taken with milk or soda drinks as these foods may prevent it from working properly. If vomiting does not occur within 20-30 minutes after the first dose, a second dose may be needed. If the second dose fails to induce vomiting, the patient should be taken to a hospital emergency room.
If both activated charcoal and syrup of ipecac are recommended to treat poison, ipecac must be used first. Activated charcoal should not be taken until 30 minutes after taking syrup of ipecac, or until the vomiting caused by ipecac stops.
Ipecacuanha is available as an over-the-counter remedy in 30x potency. This is a decimal potency, which means that one part of ipecac has been mixed with nine parts of alcohol or water; 30x means that this decimal dilution has been repeated 30 times. The dilute solution of ipecac is then added to sugar tablets so that the remedy can be taken in tablet form.
Syrup of ipecac
For inducing vomiting in cases of accidental poisoning, only the syrup form of ipecac should be used. Syrup of ipecac should not be mixed with milk or carbonated drinks as they may prevent vomiting.
Syrup of ipecac should not be used in the following situations (contact poison control center or family doctor for alternative treatments).
- Poisoning caused by strychnine; sustained-release theophylline; such corrosive substances as strong alkalis (lye); strong acids (such as toilet bowl cleaner); and such petroleum products as kerosene, gasoline, coal oil, fuel oil, paint thinner, or cleaning fluids.
- Overdoses of medications given for depression.
- Excessive vomiting.
- A serious heart condition.
- Timing. Do not give ipecac more than 4-6 hours after the poison was ingested.
- Very young children (less than six months old). Infants and very young children may choke on their own vomit or get vomit into their lungs.
- Drowsy or unconscious patients.
Ipecacuanha should not be given after Arsenicum or Tabac because these remedies will counteract it.
The following side effects have been associated with the use of syrup of ipecac:
- Loose bowel movements.
- Fast irregular heartbeat.
- Inhaling or choking on vomit.
- Stomach cramps or pains.
- Muscle stiffness.
- Severe heart problems often occur in cases of ipecac abuse. Because ipecac stays in the body for a long time, damage to the heart frequently occurs in persons who repeatedly take ipecac to induce vomiting.
- Seizures. These are most likely to occur in patients who accidentally swallow ipecac or in ipecac abusers.
- Death. Deaths have been reported due to ipecac abuse in bulimic persons.
Homeopathic Ipecacuanha has been highly diluted and is relatively nontoxic.
Bulimia nervosa — An eating disorder characterized by episodic binge eating followed by self-induced vomiting or laxative abuse.
Cephaeline — A chemical compound found in ipecac that irritates the stomach lining and triggers the vomiting reflex.
Fluid extract — A concentrated preparation of a drug.
Law of similars — A principle of homeopathic treatment according to which substances that cause specific symptoms in healthy people are given to sick people with similar symptoms.
Modality — A factor or circumstance that makes a patient's symptoms better or worse. Modalities include such factors as time of day, room temperature, the patient's level of activity, sleep patterns, etc.
Tincture — An alcoholic solution of a chemical or drug.
If used to induce vomiting, ipecac should not be given together with other drugs because it can decrease their effectiveness and increase their toxicity. If both syrup of ipecac and activated charcoal are needed to treat suspected poisons, ipecac should be given first. Activated charcoal should not be given until vomiting induced by ipecac has stopped. Carbonated beverages should also be avoided because they can cause the stomach to swell. The person should lie on the stomach or side in case vomiting occurs.
Homeopathic Ipecacuanha is considered complementary to Arnica and Cuprum. It is counteracted by Arsenicum and Tabac.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Bulimia Nervosa." Section 15, Chapter 196. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Poisoning." Section 23, Chapter 307. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
PDR Nurse's Drug Handbook. Montvale, NJ: Delmar Publishers, 2000.
"Position Paper: Ipecac Syrup." Journal of Toxicology: Clinical Toxicology 42 (February 2004): 133-143.
American College of Toxicology (ACT). 9650 Rockville Pike, Bethesda, MD 20814. (301) 634-7840. Fax: (301) 634-7852. http://www.actox.org.
American Foundation for Homeopathy. 1508 S. Garfield, Alhambra, CA 91801.
Homeopathic Educational Services. 2124B Kittredge St. Berkeley, CA 94704. (510) 649-0294. Fax: (510) 649-1955.
the dried rhizome and roots of Cephaelis ipecacuanha or Cephaelis acuminata; used as an emetic or expectorant.
The dried root of Uragoga (Cephaelis) ipecacuanha (family Rubiaceae), a shrub of Brazil and other parts of South America; contains emetine, cephaeline, emetamine, ipecacuanhic acid, psychotrine, and methylpsychotrine; has expectorant, emetic, and antidysenteric properties.
[native Brazilian word]
ipecac/ip·e·cac/ (ip´ĕ-kak) the dried rhizome and roots of Cephaelis ipecacuanha or C. acuminata; used as an emetic or expectorant.
a. A low-growing tropical American shrub (Psychotria ipecacuanha syn. Cephaelis ipecacuanha) having roots and rhizomes that yield emetine.
b. The dried roots and rhizomes of this shrub.
2. A medicinal preparation made from the dried roots and rhizomes of this shrub that is used to induce vomiting, particularly in cases of poisoning and drug overdose.
indications It is prescribed to cause emesis in certain types of recent poisonings and drug overdoses.
contraindications Known hypersensitivity to this drug prohibits its use. It is not used in unconscious patients or for poisoning by petroleum distillates, strong alkalis, acids, or strychnine.
adverse effect The most serious adverse effect is cardiotoxicity if vomiting does not occur and the substance is retained.
note If vomiting does not occur, the ipecac can be recovered by gastric lavage.
An amazonian shrub that contains an alkaloid (emetine) and cephaeline; it anthelmintic, emetic and expectorant, and used for cough, dysentery and parasitic infestation of the GI tract.
A homeopathic remedy used for asthma, mucocutaneous bleeding, nausea, cold or hot sweats and paroxysmal coughing.
ipecacMainstream medicine A medicinal–Cephalis ipecacuanha that stimulates the CNS and stomach, evoking emesis; its sole purpose is to facilitate vomiting in a person who has ingested poison or overdosed on a drug or medication. Cf Ipecac abuse.
the dried rhizome and roots of Cephaelis ipecacuanha or Cephaelis acuminata; used as an emetic or expectorant. Called also ipecacuanha; the common preparation is syrup of ipecac.