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Ipecacuanha; Uses/ Indications, Dosage, Side Effects

Ipecacuanha/Ipecac is obtained from the plant Cephaelis ipecacuanha and contains a number of emetic alkaloids including emetine and cephaeline.^[rx] Ipecac was approved by Health Canada as an OTC but all those products are now discontinued.^[rx] The FDA does not have currently any approved product containing ipecac, however, ipecac as an ingredient is accepted to be sold over the counter in packages of 1 fluid ounce (30 ml) for the emergency use to cause vomiting in poisoning.

Materia Medica of Ipecacuanha

Mind – Irritable; holds everything in contempt. Full of desires, for what they know not.
Head – Bones of the skull feel crushed or bruised. Pain extends to teeth and root of the tongue.
Eyes – Inflamed, red. Pain through eyeballs. Profuse lachrymation. Cornea dim. Eyes tire from near vision. State of vision constantly changing. Spasm of accommodation from the irritable weakness of the ciliary muscle. Nausea from looking on moving objects.
Face – Blue rings around eyes. Periodical orbital neuralgia, with lachrymation, photophobia, and smarting eyelids.
Nose – Coryza, with stoppage of nose and nausea. Epistaxis.
Stomach – Tongue usually clean. Mouth, moist; much saliva. Constant nausea and vomiting, with pale, twitching of face. Vomits food, bile, blood, mucus. Stomach feels relaxed as if hanging down. Hiccough.
Abdomen – Amebic dysentery with tenesmus; while straining pain so great that it nauseates; little thirst. Cutting, clutching; worse, around the navel. Body rigid; stretched out stiff.
Stools – Pitch-like green as grass, like frothy molasses, with griping at the navel. Dysenteric, slimy.
Female – Uterine hæmorrhage, profuse, bright, gushing, with nausea. Vomiting during pregnancy. Pain from navel to the uterus. Menses too early and too profuse.
Respiratory – Dyspnœa; constant constriction in chest. Asthma. Yearly attacks of difficult shortness of breathing. Continued sneezing; coryza; a wheezing cough. Cough incessant and violent, with every breath. Chest seems full of phlegm, but does not yield to coughing. Bubbling rales. Suffocative cough; the child becomes stiff, and blue in the face. Whooping-cough, with a nosebleed, and from the mouth. Bleeding from lungs, with nausea; feeling of constriction; rattling cough. Croup. Hæmoptysis from slightest exertion (Millef). Hoarseness, especially at end of a cold. Complete aphonia.
Fever – Intermittent fever, irregular cases, after Quinine. Slightest chill with much heat, nausea, vomiting, and dyspnœa. Relapses from improper diet.
Sleep – With eyes half open. Shocks in all limbs on going to sleep (Ign).
Extremities – Body stretched stiff, followed by spasmodic jerking of arms towards each other.
Skin – Pale, lax. Blue around eyes. Military rash.

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Indications of Ipecacuanha

Ipecac is indicated as an emetic agent for the induction of vomiting in poisoning victims who ingested systemic poison in order to prevent absorption of the chemicals through the gastrointestinal tract. In low doses, ipecac was also used as an expectorant.^[rx]

Reports have suggested that ipecac was vastly used in patients with eating disorders to produce vomiting.^[rx]

Thinning mucous to make coughing easier
Bronchitis associated with croup
Hepatitis
Amoebic dysentery
Loss of appetite
Cancer

Dosage of Ipecacuanha

Emesis Induction

15 to 30 mL of syrup of ipecac, once. Approximately 240 mL of water should be administered after the ipecac.
If emesis does not occur within 30 minutes, and emesis is still deemed to be of value, a second 15 to 30 mL dose may be administered with another 240 mL of water. No more than 2 doses (60 mL) of ipecac should be given. Gastric lavage should be performed if emesis does not occur after the second dose.

Pediatric Dose for Emesis Induction

<6 months: Use is not recommended.
6 to 12 months: 5 to 10 mL orally once. 120 to 240 mL of water should be given before or after the ipecac. Infants should be positioned carefully to avoid aspiration of vomitus.
1 to 12 years: 15 mL orally once. 240 mL of water should be given before or after the ipecac.
>12 years: 15 to 30 mL orally once. 240 mL of water should be given before or after the ipecac.
If emesis does not occur within 30 minutes, and emesis is still deemed to be of value, a second dose may be administered with more water. No more than 2 doses ipecac should be given. Gastric lavage should be performed if emesis does not occur after the second dose.

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Side Effects of Ipecacuanha

Diarrhea
Fast or irregular heartbeat
Nausea or vomiting (continuing more than 30 minutes)
Stomach cramps or pain
Troubled breathing
Unusual tiredness or weakness
Weakness, aching, and stiffness of muscles, especially those of the neck, arms, and legs