Syrup of ipecac

Syrup of ipecac

Flask for tincture of ipecac (ipecac roots and rhizomes dissolved in alcohol, which is watered down and sweetened to make syrup of ipecac)
Clinical data
Routes of administration	Oral
ATC code	R05CA04 (WHO) V03AB01 (WHO)
Legal status
Legal status	OTC[where?]
Identifiers
CAS Number	8012-96-2 N
ChemSpider	none
UNII	62I3C8233L
ECHA InfoCard	100.029.439
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Syrup of ipecac (/ˈɪpɪkæk/), 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 roots 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 forceful vomiting produced by ipecac was considered for many years to be an important 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 (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."^[1]

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).^[2]