Ipecac syrup

Dosage Forms & Strengths

oral syrup

• 7%

Overdose/Poisoning

No longer recommended for poisonings; activated charcoal is the treatment of choice

15-30 mL PO once; may repeat once with 15 mL if vomiting does not occur within 20-30 min

If vomiting does not occur within 30-45 min after second dose, perform gastric lavage

Give with 3-4 glasses of water

Dosage Forms & Strengths

oral syrup

• 7%

Overdose/Poisoning

Currently not recommended as an emetic for childhood poisonings; activated charcoal is the treatment of choice

<6-12 months: 5-10 mL PO once with 4-8 ounces of water; give only under medical supervision

1-12 years: 15 mL PO once with 1-2 glasses of water; may repeat once with 15 mL once if vomiting does not occur within 20-30 min

>12 years: As adults; 5-30 mL PO once with 3-4 glasses of water; may repeat once with 15 mL once if vomiting does not occur within 20-30 min

If vomiting does not occur within 30-45 min after second dose, perform gastric lavage

Brazilian Indians valued ipecac as a remedy for dysentery and this information was brought to Europe by Portuguese missionaries. 2 , 3 It was used by the physician Jean Helvetius in 1686 to cure the son of Louis XIV of amebic dysentery. 3 It remained a secret remedy until Helvetius sold it to the French government, which in 1688 subsequently disclosed that the composition of the dysentery remedy contained a large amount of ipecacuanha. 3 The French chemist Pierre Joseph Pelletier extracted the alkaloid substance from the ipecacuanha in 1817 and named it emetine, believing the mixed alkaloids to be 1 compound. Two English chemists, Paul and Cownley, later demonstrated in 1894 that there were actually 2 distinct alkaloids, emetine and cephaeline. 3 The dried root and rhizome are the sources of the medicinal products. Ipecac has been widely used in its syrup form as a potent and effective emetic. Ipecac powder has been used to induce sweating at the onset of influenza, and small amounts of the extract have been incorporated into cough syrups as expectorants. Emetine, derived from the root, has been used for more than a century to treat dysentery. 4 In October 1965, the Food and Drug Administration ruled that 30 mL (1 oz) bottles of ipecac syrup could be dispensed without a prescription. Ipecac syrup is part of public health strategies for childhood poisoning prevention, but it no longer is routinely recommended. 3

Ipecac is not currently recommended as an emetic for childhood poisonings. Activated charcoal now is the treatment of choice. Always refer to a health care professional or poison control center when an accidental poisoning occurs. Do not confuse the syrup with the fluid extract of ipecac, which is 14 times stronger. 14 Ipecac syrup, which contains total alkaloids 123 to 157 mg per 100 mL, has been used to induce vomiting. The usual dose range for the syrup is 10 to 30 mL, yielding a dose of alkaloids 12 to 48 mg. Follow ipecac administration in adults with 240 mL of water and 120 to 240 mL of water in children. The dose may be repeated if emesis does not occur in 20 to 30 minutes. For children 6 to 12 months of age, ipecac 5 to 10 mL with 120 to 240 mL of water usually is a sufficient dose. 12 In patients younger than 6 months of age, administer ipecac syrup only under physician supervision. Cumulative toxicity requires administration of emetine for amebic dysentery in low doses for short periods of time with intervals of several weeks between treatments.

Ipecac has been assigned to pregnancy category C by the FDA. Animal studies have not been reported. There are no controlled data in human pregnancy. Ipecac is only recommended for use during pregnancy when benefit outweighs risk.