Ipecac (Cephaelis ipecacuanha)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
Cephaeline, Cephaelisipecacuanha, cephaline, emetamine, emetine, Euphorbiaipecacuanhae, Ipeca®, ipecacuana, ipecacuanha, ipecacuanha Syrup APF, ipecacuanhic acid, ipecacuanhin, isoquinoline alkaloids, o-methylpsychotrine, protoemetine, Pure-Pak®, Psychotriaipecacuanha, psychotrine, Rubiaceae, Tithymalopsisipecacuanhae.
Syrup of ipecac, used medicinally since the 1500s, is made from the dried root and rhizome (underground stem) of the ipecacuanha plant (Cephaelis ipecacuanha). This plant grows in Brazilian rainforests and other locations in Central and South America. Ipecac's primary medicinal use is to cause vomiting after a person takes in a toxic substance. The induced vomiting reportedly removes toxic substances from the stomach, hinders their absorption, and speeds recovery. Currently, many experts recommend abandoning ipecac use in both home and clinical settings and employing other therapies such as activated charcoal, which has been shown to be effective and lacking in potential for abuse.
Another ipecac use is to treat gastrointestinal infections caused by amoeba. While ipecac is active against the amoebic form of dystentery (diarrhea), it is ineffective against bacterial dysentery.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
In several studies, ipecac was shown to be effective in reducing acetaminophen (e.g., Tylenol®) concentration when administered within 30 minutes or less after acetaminophen overdose.
Ipecac has been used as an antidote to poisoning because it is inexpensive, easy to administer, and can be used in a home setting. Its effectiveness depends on how quickly it is given after poison ingestion and on the particular poison. Because of its disadvantages, including a lack of effectiveness for all poisons and potential for abuse, it is being replaced by other treatments, especially activated charcoal.
*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.
Abortifacient (uterine contraction stimulant), amoeba infections, croup, diaphoretic (induces sweating), dysentery, expectorant (induces coughing up of mucus), fever reduction.
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Adults (18 years and older)
To induce vomiting, 30-50 milliliters of syrup of ipecac (total alkaloids: 123-157 milligrams per 100 milliliters) followed by 200-600 milliliters of water has been taken by mouth and repeated after 30 minutes if no vomiting occurs. For treatment of amoeba infection, emetine (a component of ipecac) has been given by mouth at significantly lower doses than are used to produce vomiting; however, specific dosage and duration of therapy are not available. Sixty milligrams of ipecac has been given daily by injection under the skin (site not specified) for no more than 10 or 12 doses.
Children (under 18 years old)
The American Academy of Pediatrics has urged parents to abandon the use of ipecac for poison control. Ipecac use is not advised in children less than six months of age. For vomiting induction in children six months to one year of age, 10 milliliters followed by 120-240 milliliters of water has been given by mouth. If vomiting does not occur, the dose may be repeated once after 20-30 minutes. For vomiting induction in children 1-12 years of age, 30 milliliters of syrup of ipecac followed by 120-240 milliliters of water has been taken by mouth. If vomiting does not occur, the dose may be repeated once after 20-30 minutes.
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Avoid in individuals with known allergy or hypersensitivity to ipecac. Asthma and rhinitis ("stuffy nose") have been reported with ipecac exposure. Emetine (a component of ipecac) may cause irritation if applied to the skin.
Side Effects and Warnings
A fluid extract of ipecac is reportedly 14 times stronger than syrup of ipecac; as little as 10 milliliters of fluid extract may be fatal.
Ipecac may cause air behind the chest cavity, air in the membrane around the heart, arthritis, asthma, bleeding from the junction of the esophagus and stomach following a vomiting episode (Mallory-Weiss syndrome), cardiomyopathies (heart muscle weakness), diarrhea, lowered levels of serum potassium, myopathies (muscular weakness, symptoms of which include difficulty in swallowing, diffuse body ache, electrolyte loss, fecal incontinence, foot drop, and inability to walk), intracerebral hemorrhage in the elderly, nausea, rhinitis ("stuffy nose"), skin irritation, and vomiting.
Ipecac abuse may result in cardiac failure and death.
Cases of aspiration pneumonia occurred after administration of ipecac and activated charcoal.
Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery.
Use cautiously in children under 12 years of age and the elderly.
Avoid in patients who have a depressed mental status or gag reflex, a history of Münchausen syndrome, a history of eating disorders, a history of susceptibility to bleeding, or a history of Mallory-Weiss syndrome (bleeding from the junction of the esophagus and stomach following a vomiting episode).
Avoid in patients who have ingested a sharp foreign object, a toxin that may cause seizures, a strong acid, a strong alkali, a tricyclic antidepressant, camphor, cocaine, heroin, a hydrocarbon, or strychnine.
Avoid in patients who are under six months of age.
Avoid during pregnancy and breastfeeding.
Avoid with known allergy or hypersensitivity to ipecac.
Pregnancy and Breastfeeding
Avoid during pregnancy and breastfeeding. Ipecac has been reported to cause uterine contractions.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.
Interactions with Drugs
Ipecac may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, CNS depressants, and alcohol. Caution is advised while driving or operating machinery.
Vomiting produced by ipecac administration may reduce the effects of many drugs if given within one hour of taking the drug.
Antiemetics (drugs that inhibit vomiting) decrease the incidence of vomiting in patients who have taken ipecac. Activated charcoal reduces the emetic effect of ipecac. Therefore, activated charcoal is often not given until vomiting has stopped. Bismuth subsalicylate may reduce vomiting following ipecac.
Ipepac may also interact with marijuana and serotonin receptor antagonists.
Interactions with Herbs and Dietary Supplements
Ipecac may increase the amount of drowsiness caused by some herbs or supplements such as sedatives.
Vomiting produced by ipecac administration may reduce the effects of many herbs and supplements if given within one hour of taking the herb or supplement.
Antiemetic (vomit-inhibiting) herbs and supplements decrease the incidence of vomiting in patients who have ingested ipecac. Activated charcoal reduces the emetic effect of ipecac. Therefore, activated charcoal is often not given until vomiting has stopped.
Ipecac may also interact with carbonated beverages and milk.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Albertson TE, Derlet RW, Foulke GE, et al. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann Emerg Med 1989;18(1):56-59. View Abstract
Bader AA, Kerzner B. Ipecac toxicity in "Munchausen syndrome by proxy". Ther Drug Monit 1999;21(2):259-260. View Abstract
Bond GR. Home syrup of ipecac use does not reduce emergency department use or improve outcome. Pediatrics 2003;112(5):1061-1064. View Abstract
Brinker AD 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(6):759-761. View Abstract
Greene S, Harris C, Singer J. Gastrointestinal decontamination of the poisoned patient. Pediatr Emerg Care 2008;24(3):176-186. View Abstract
Kendrick D, Smith S, Sutton A, et al. Effect of education and safety equipment on poisoning-prevention practices and poisoning: systematic review, meta-analysis and meta-regression. Arch Dis Child 2008;93(7):599-608. View Abstract
Lee MR. Ipecacuanha: the South American vomiting root. J R Coll Physicians Edinb. 2008;38(4):355-360. View Abstract
Litovitz T, Clancy C, Korberly B, et al. Surveillance of loperamide ingestions: an analysis of 216 poison center reports. J Toxicol Clin Toxicol 1997;35(1):11-19. View Abstract
Meadows-Oliver M. Syrup of ipecac: new guidelines from the AAP. J Pediatr Health Care 2004;18(2):109-110. View Abstract
Pond SM, Lewis-Driver DJ, Williams GM, et al. Gastric emptying in acute overdose: a prospective randomised controlled trial. Med J Aust 1995;163(7):345-349. View Abstract
Position paper: Ipecac syrup. J Toxicol Clin Toxicol 2004;42(2):133-143. View Abstract
Rashid N. Medically unexplained myopathy due to ipecac abuse. Psychosomatics 2006;47(2):167-169. View Abstract
Silber TJ. Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status? J Adolesc Health 2005;37(3):256-260. View Abstract
Steffen KJ, Mitchell JE, Roerig JL, et al. The eating disorders medicine cabinet revisited: a clinician's guide to ipecac and laxatives. Int J Eat Disord 2007;40(4):360-368. View Abstract
Tandberg D, Diven BG, McLeod JW. Ipecac-induced emesis versus gastric lavage: a controlled study in normal adults. Am J Emerg Med 1986;4(3):205-209. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017