Wikipedia:WikiProject Chemicals/Chembox validation/VerifiedDataSandbox and Syrup of ipecac: Difference between pages

{{Short description|Plant-derived drug used for airway decongestion and to induce vomiting}}

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| verifiedrevid = 470475743

| image = Bruine stopfles met label “TINCT. IPECAC.”, objectnr 40295-A-B.JPG

|caption=Flask for [[tincture]] of ipecac (ipecac roots and [[rhizome]]s dissolved in alcohol, which is watered down and sweetened to make syrup of ipecac)

| CAS_number_Ref = {{cascite|changed|??}}

| CAS_number = 8012-96-2

| UNII_Ref = {{fdacite|correct|FDA}}

| UNII = 62I3C8233L

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| legal_status = [[Over-the-counter drug|OTC]]{{where|date=October 2016}}

'''Syrup of ipecac''' ({{IPAc-en|ˈ|ɪ|p|ᵻ|k|æ|k}}), or simply '''ipecac''', is a drug that was once widely used as an [[expectorant]] (in low doses) and a rapid-acting [[emetic]] (in higher doses). It is obtained from the dried [[rhizome]] and [[root]]s of the ipecacuanha plant (''[[Carapichea ipecacuanha]]''), from which it derives its name. It is no longer regularly used in medicine.

In particular, the rapidly induced [[projectile vomiting|forceful vomiting]] produced by ipecac was considered for many years to be an important [[first aid|front-line]] treatment for orally ingested [[poisons]]. However, subsequent studies (including a comprehensive 2005 [[meta-study]]) revealed the stomach purging produced by ipecac to be far less effective at lowering total body poison concentrations than the [[adsorption]] effect of oral [[Activated charcoal (medication)|activated charcoal]] (which is effective through the entire gastrointestinal tract and is often coupled with [[whole bowel irrigation]]). Ipecac also presents a small risk of [[overdose]] (being a mild poison itself) and a major risk of [[esophagitis]] and [[aspiration pneumonia]] if used to purge [[corrosive]] poisons. Having long been replaced (even in the emetic role) by more effective medications, the [[American Society of Health-System Pharmacists]] (ASHP) now advises that "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals."<ref>{{cite web | url = http://www.ashp.org/menu/DrugShortages/DrugsNoLongerAvailable/Bulletin.aspx?id=468 | work = Discontinued Drug Bulletin | title = Ipecac Syrup | access-date = 2014-12-16 | archive-date = 2014-12-16 | archive-url = https://web.archive.org/web/20141216172421/http://www.ashp.org/menu/DrugShortages/DrugsNoLongerAvailable/Bulletin.aspx?id=468 | url-status = dead }}</ref>

Ipecac is commonly made from alcohol extraction of the plants Cephaelis acuminata and Cephaelis ipecacuanha. The extract is commonly mixed with glycerin, sugar (syrup), and methylparaben. The active ingredients are plant alkaloids, cephaeline, and methyl-cephaeline (emetine).<ref>{{cite book |vauthors = Benzoni T, Gibson J | chapter = Ipecac | date = 31 January 2023 | title = StatPearls [Internet]. | location = Treasure Island (FL) | publisher = StatPearls Publishing | chapter-url= https://www.ncbi.nlm.nih.gov/books/NBK448075/#:~:text=Ipecac%20is%20commonly%20made%20from,methyl%2Dcephaeline%20(emetine) | pmid=28846272 }}</ref>

== Use ==

{{Globalize|section|USA|2name=the United States|date=October 2016}}

[[File:Ipecac.jpg|thumb|Ipecac plant]]

Ipecac was used in cough mixtures as an [[expectorant]] or an [[emetic]] from the 18th until the early 20th century.{{citation needed|date=February 2017}} For instance, ipecac and [[opium]] were used to produce [[Dover's powder]], which was used in syrup form.{{citation needed|date=February 2017}}

In 1965, the [[Food and Drug Administration]] (FDA) approved the sale of up to one ounce of syrup of ipecac without a prescription. At the time it was approved, its use was recommended by the [[American Academy of Pediatrics]], [[American Association of Poison Control Centers]], [[American Medical Association]], and the FDA's medical advisory board as a method to induce vomiting "for quick first-aid use in the home, under medical supervision", for use in cases of accidental [[poison]]ing.<ref>{{Cite news|url = https://news.google.com/newspapers?id=3wUrAAAAIBAJ&pg=4879%2C4587550|title = New Lifesaver For Your Medicine Chest|last = Galton|first = Lawrence |date = 1966-01-09|work = Parade|access-date = 2015-06-04}}</ref>

Current guidelines from the [[American Academy of Pediatrics]], however, strongly advise against this and in fact recommend the disposal of any syrup of ipecac present in the home.<ref>{{cite journal | title = Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention | journal = Pediatrics | volume = 112 | issue = 5 | pages = 1182–5 | date = November 2003 | pmid = 14595067 | doi = 10.1542/peds.112.5.1182 | author = American Academy Of Pediatrics Committee On Injury Violence | doi-access = free }}</ref> Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons,<ref>{{cite journal | title = Position paper: Ipecac syrup | journal = Journal of Toxicology. Clinical Toxicology | volume = 42 | issue = 2 | pages = 133–43 | year = 2004 | pmid = 15214617 | doi = 10.1081/CLT-120037421 | last1 = American Academy Of Clinical Toxico | s2cid = 218865551 }}</ref> because of a lack of evidence that syrup of ipecac actually helps improve the outcome in cases of poisoning. Moreover, accidental overdose of ipecac can result when administered in the home.<ref>{{cite journal | vauthors = Bateman DN | title = Gastric decontamination--a view for the millennium | journal = Journal of Accident & Emergency Medicine | volume = 16 | issue = 2 | pages = 84–6 | date = March 1999 | pmid = 10191436 | pmc = 1343284 | doi = 10.1136/emj.16.2.84 }}</ref> When dealing with poisoning cases in the hospital, it became difficult to obtain a [[differential diagnosis]] when syrup of ipecac had been administered, as this can add further symptoms.

A 2005 review by a [[Health Resources and Services Administration]]-funded scientific panel concluded that vomiting alone does not reliably remove poisons from the [[stomach]]. The study suggested that indications for use of ipecac syrup were rare, and patients should be treated by more effective and safer means. Additionally, its potential [[Adverse effect (medicine)|side effects]], such as [[lethargy]], can be confused with the poison's effects, complicating [[medical diagnosis|diagnosis]]. The use of ipecac may also delay the use of other treatments (e.g., [[activated charcoal (medication)|activated charcoal]], [[whole bowel irrigation]], or oral [[antidote]]s) or make them less effective.<ref>{{cite journal | vauthors = Manoguerra AS, Cobaugh DJ | title = Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons | journal = Clinical Toxicology | volume = 43 | issue = 1 | pages = 1–10 | year = 2005 | pmid = 15732439 | doi = 10.1081/CLT-200046735 }}</ref>

=== Misuse ===

Ipecac has been used by people with [[bulimia nervosa]] as a means to achieve [[weight loss]] through induced [[vomiting]]. Repeated use in this manner is believed to cause damage to the heart and muscles, which can ultimately result in the user's death.<ref>{{cite journal | vauthors = Silber TJ | title = Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status? | journal = The Journal of Adolescent Health | volume = 37 | issue = 3 | pages = 256–60 | date = September 2005 | pmid = 16109351 | doi = 10.1016/j.jadohealth.2004.08.022 }}</ref>

Misuse of ipecac has been blamed for the death of singer [[Karen Carpenter]] in 1983 who suffered from anorexia nervosa. <ref>{{cite journal | vauthors = Schmidt R |title=Karen Carpenter's tragic story |journal=The Guardian |date=24 October 2010 |url=https://www.theguardian.com/books/2010/oct/24/karen-carpenter-anorexia-book-extract}}</ref> It has also been used as an agent for [[Münchausen syndrome by proxy]].<ref>{{cite journal | vauthors = Shannon M | title = The demise of ipecac | journal = Pediatrics | volume = 112 | issue = 5 | pages = 1180–1 | date = November 2003 | pmid = 14595066 | doi = 10.1542/peds.112.5.1180 }}</ref>

== Mechanism of action ==

The actions of ipecac are mainly those of major [[alkaloid]]s, [[emetine]] (methylcephaeline) and [[cephaeline]].{{citation needed|date=February 2017}} They both act locally by irritating the gastric [[mucosa]] and centrally by stimulating the medullary [[chemoreceptor trigger zone]] to induce vomiting.{{citation needed|date=February 2017}}

== Discontinuation ==

Ipecac has been found to have minimal health benefits, and is ultimately ineffective at purging the body of poisonous substances. It was initially discontinued due to production costs and lack of raw materials. As the ASHP advises: "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals." Humco and Paddock Laboratories, the last two companies to continue manufacturing ipecac syrup, both stopped production in 2010.<ref>{{cite web | url = https://www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?Type=Rss&Id=468 | work = Discontinued Drug Bulletin | title = Ipecac Syrup }}</ref>

A heavily cited position statement outlines critical details of its effectiveness: <blockquote>

In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. 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. There is insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential.<ref>{{cite journal | vauthors = Krenzelok EP, McGuigan M, Lheur P | title = Position statement: ipecac syrup. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists | journal = Journal of Toxicology. Clinical Toxicology | volume = 35 | issue = 7 | pages = 699–709 | year = 1997 | pmid = 9482425 | doi = 10.3109/15563659709162567 }}</ref>

</blockquote>

== See also ==

* [[Antiemetic]]

== References ==

{{Reflist|2}}

== External links ==

*[https://web.archive.org/web/20051023041114/http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3B112/5/1182 AAP policy on Poison Treatment in the Home]

*[http://www.gwdocs.com/health/1131123674555.html Chemical Poisoning and Syrup of Ipecac]{{dead link|date=February 2017}}

{{Cough and cold preparations}}

{{Antidotes}}

{{Authority control}}

{{DEFAULTSORT:Syrup Of Ipecac}}

[[Category:Emetics]]

[[Category:Herbalism]]