| Revision as of 15:52, 11 January 2012 editCheMoBot (talk | contribs)Bots141,565 edits Updating {{drugbox}} (changes to verified fields - added verified revid - updated 'UNII_Ref', 'ChEMBL_Ref', 'ChEBI_Ref', 'KEGG_Ref', 'StdInChI_Ref', 'StdInChIKey_Ref') per Chem/Drugbox validation (report [[Misplaced Pages talk:WikiProje...← Previous edit | Revision as of 03:42, 7 March 2012 edit undo71.104.195.86 (talk)No edit summaryNext edit → | ||
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| '''Syrup of ipecac''' ({{IPAc-en|icon|ˈ|ɪ|p|ɨ|k|æ|k}}), commonly referred to as '''ipecac''', is derived from the dried ] and ]s of the ] plant, and is a well known ] (substance used to induce ]). | |||
| ==Preparation== | ==Preparation== | ||
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| Ipecac was used in cough mixtures as an ] or an emetic from the 18th until the early 20th century. Ipecac and ] were used to produce ], which was used in syrup form. Ipecac syrup is still used to induce vomiting, though it is no longer widely recommended. | Ipecac was used in cough mixtures as an ] or an emetic from the 18th until the early 20th century. Ipecac and ] were used to produce ], which was used in syrup form. Ipecac syrup is still used to induce vomiting, though it is no longer widely recommended. | ||
| ⚫ | I FARTED A COW :DDDDaccidental overdose of ipecac can result when administered in the home.<ref>{{citation|title = Gastric decontamination—a view for the millennium|last = Bateman|first = D N|journal = ]|volume = 16|pages = 84|year = 1999|publisher = BAEM|url = http://emj.bmj.com/cgi/content/abstract/16/2/84|pmid = 10191436|doi = 10.1136/emj.16.2.84|issue = 2|pmc = 1343284}}</ref> | ||
| ] once recommended ipecac be kept in the home as a ready emetic for use in cases of accidental ]ing.<ref name="Committee1994" /> Current guidelines from the ], however, strongly advise against this and in fact recommend the disposal of any syrup of ipecac present in the home.<ref>{{citation|author = Committee on Injury, Violence, and Poison Prevention|title = Poison Treatment in the Home|journal = Pediatrics|volume = 112|pages = 1182–1185|doi = 10.1542/peds.112.5.1182|year = 2003|url = http://pediatrics.aappublications.org/cgi/content/full/112/5/1182|pmid = 14595067|issue = 5}}</ref> Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons,<ref>{{Citation|last1 = Manoguerra|first1 = A S|last2 = Krenzelok|first2 = E P|last3 = McGuigan|first3 = M|last4 = Lheureux|first4 = P|year = 2004|title = AACT/EAPCCT position paper: ipecac syrup|journal = Clinical Toxicology|volume = 42|pages = 133–43|doi = 10.1081/CLT-120037421|author = Toxicology, American Academy of Clinical|pmid = 15214617|issue = 2|postscript = .}}</ref> because there has been no evidence that syrup of ipecac actually helps improve the outcome in cases of poisoning. Moreover, | |||
| ⚫ | |||
| A 2005 review by an ]-funded scientific panel concluded that vomiting alone does not reliably remove poisons from the ]. 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 ], such as ], can be confused with the poison’s effects, complicating ]. Ipecac may also delay the administration or reduce the effectiveness of other treatments, such as ], ], or oral ]s.<ref>{{citation|title = Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons|last1 = Manoguerra|first1 = A S|last2 = Cobaugh|first2 = D J|journal = Clinical Toxicology|volume = 43|pages = 1–10|year = 2005|url = http://www.informaworld.com/smpp/content~content=a713719870~db=all|doi = 10.1081/CLT-200046735|author = Manoguerra, Anthony|issue = 1|pmid = 15732439|author3 = Guidelines for the Management of Poisoning Consensus Panel}}</ref> | A 2005 review by an ]-funded scientific panel concluded that vomiting alone does not reliably remove poisons from the ]. 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 ], such as ], can be confused with the poison’s effects, complicating ]. Ipecac may also delay the administration or reduce the effectiveness of other treatments, such as ], ], or oral ]s.<ref>{{citation|title = Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons|last1 = Manoguerra|first1 = A S|last2 = Cobaugh|first2 = D J|journal = Clinical Toxicology|volume = 43|pages = 1–10|year = 2005|url = http://www.informaworld.com/smpp/content~content=a713719870~db=all|doi = 10.1081/CLT-200046735|author = Manoguerra, Anthony|issue = 1|pmid = 15732439|author3 = Guidelines for the Management of Poisoning Consensus Panel}}</ref> | ||
Revision as of 03:42, 7 March 2012
This article is about the medicine. For the company, see Ipecac Recordings.{{Drugbox| Verifiedfields = changed | verifiedrevid = 470475743 | | IUPAC_name = | image = | width = | image2 = | CASNo_Ref = | InChI = | smiles = | InChIKey = | CAS_number_Ref = | CAS_number = 8012-96-2 | ChemSpiderID_Ref = | ChemSpiderID = | ATC_prefix = R05 | ATC_suffix = CA04 | ATC_supplemental = V03AB01 (WHO) | PubChem = | DrugBank_Ref = | DrugBank = | ChemSpiderID = NA | | molecular_weight = | molar_refractivity = | bioavailability = | metabolism =
Preparation
The commercial preparation of ipecac consists of 1/14 of an alcoholic extract of the roots and rhizomes of ipecac root. The rest is composed of glycerin, sugar syrup, and methylparaben. Ipecac root itself is a poison, but due to the normal strengths used and the inability of the patient to keep the solution ingested, it is seldom fatal.
Use
Ipecac was used in cough mixtures as an expectorant or an emetic from the 18th until the early 20th century. Ipecac and opium were used to produce Dover's powder, which was used in syrup form. Ipecac syrup is still used to induce vomiting, though it is no longer widely recommended.
I FARTED A COW :DDDDaccidental overdose of ipecac can result when administered in the home.
A 2005 review by an HRSA-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 side effects, such as lethargy, can be confused with the poison’s effects, complicating diagnosis. Ipecac may also delay the administration or reduce the effectiveness of other treatments, such as activated charcoal, whole bowel irrigation, or oral antidotes.
Misuse
Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss through induced defensive 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. Misuse of ipecac has been blamed for the death of well-known singer Karen Carpenter in 1983. It has also been used as an agent for Münchausen syndrome by proxy.
Mechanism of action
The actions of ipecac are mainly those of its major alkaloids, emetine (methylcephaeline) and cephaeline. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.
Discontinuation
Ipecac has been found to have minimal health benefits, and ultimately ineffective at purging the body of poisonous substances, and as such global production of the syrup has been stopped. As the ASHP puts it, "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals".
A position statement cited several times outlines critical details of its effectiveness, including this direct quote: "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 are 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."
References
- Committee on Injury, Violence, and Poison Prevention (1994), "Office-Based Counseling for Injury Prevention" (PDF), Pediatrics, 94 (4): 566–567, PMID 7936874
{{citation}}: CS1 maint: multiple names: authors list (link) - Bateman, D N (1999), "Gastric decontamination—a view for the millennium", British Medical Journal, 16 (2), BAEM: 84, doi:10.1136/emj.16.2.84, PMC 1343284, PMID 10191436
- Manoguerra, A S; Cobaugh, D J; Guidelines for the Management of Poisoning Consensus Panel (2005), "Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons", Clinical Toxicology, 43 (1): 1–10, doi:10.1081/CLT-200046735, PMID 15732439
{{citation}}: More than one of|author=and|last1=specified (help) - Silber, T J (2005), "Ipecac syrup abuse, morbidity, and mortality: Isn't it time to repeal its over-the-counter status?", Journal of Adolescent Health, 37 (3): 256–260, doi:10.1016/j.jadohealth.2004.08.022, PMID 16109351, retrieved 2008-05-02
- Schmidt R |Karen Carpenter's tragic story |The Guardian 24 October 2010 |url=http://www.guardian.co.uk/books/2010/oct/24/karen-carpenter-anorexia-book-extract
- Shannon M (2003), "The demise of ipecac", Pediatrics, 112 (5): 1180–1, doi:10.1542/peds.112.5.1180, PMID 14595066.
{{citation}}: Unknown parameter|month=ignored (help) - http://www.ashp.org/Import/PRACTICEANDPOLICY/PracticeResourceCenters/DrugShortages/GettingStarted/DrugsNoLongerAvailable/Bulletin.aspx?id=468
- . doi:10.3109/15563659709162567. PMID 9482425.
{{cite journal}}: Cite journal requires|journal=(help); Missing or empty|title=(help)
External links
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