IPECAC SYRUP
| IPECAC SYRUP (ip'e-kak) Ipecac Syrup Classifications: emetic; Therapeutic: emetic Pregnancy Category: C |
Availability
15 mL, 30 mL doses
Action
Derived from dried roots of Cephaelis ipecacuanha. Contains cephaeline (produces emesis) and emetine, a toxic alkaloid that is excreted slowly from the body. Emetine can cause potentially fatal cumulative toxicity with repeated use. It appears to inhibit protein synthesis and energy production in muscle tissue with resultant skeletal and cardiac muscle toxicity.
Therapeutic Effect
Acts locally on gastric mucosa and centrally on chemoreceptor trigger zone (CTZ) in the medulla to induce vomiting.
Uses
Emergency emetic to remove unabsorbed ingested poisons.
Contraindications
Comatose, semicomatose, inebriated, deeply sedated patients; patients in shock; patients with depressed gag reflex; seizures, active or impending; treatment of ingested strong alkali, acids, or other corrosives, strychnine, petroleum distillates, volatile oils, or rapid-acting CNS depressants; pregnancy (category C), lactation, infants <6 mo
Cautious Use
Impaired cardiac function; elderly; arteriosclerosis; cerebovascular disease; head trauma.
Route & Dosage
| Emergency Emesis Adult: PO 30 mL followed by 1–2 240 mL (8 oz) glasses of water, may repeat once in 20 min if necessary Child: PO >1 y, 15 mL followed by 1–2 240 mL (8 oz) glasses of water, may repeat once in 20 min if necessary; <1 y, 5–10 mL followed by 120–240 mL (4–8 oz) of water, may repeat once in 20 min if necessary |
Administration
Oral- Do not confuse with ipecac fluid extract, which is 14 times stronger and has caused deaths when mistakenly given at the same dosage as ipecac syrup.
- Do not induce vomiting if victim is unconscious, semiconscious, or convulsing.
- Store in tight containers at temperature not exceeding 25° C (77° F).
Adverse Effects (≥1%)
Body as a Whole: Achy, stiff muscles, severe myopathy, convulsions, coma. CV: Cardiomyopathy, cardiotoxicity, cardiac arrhythmias, atrial fibrillation, tachycardia, chest pain, dyspnea, hypotension, fatal myocarditis. GI: Diarrhea, mild GI upset. If drug is not vomited but absorbed or if ipecac overdosage: persistent vomiting, gastroenteritis, bloody diarrhea, sensory disturbances, stomach cramps, tremor.Pharmacokinetics
Onset: 15–30 min. Duration: 25 min. Elimination: Metabolite can be detected in urine up to 60 d after excessive doses.Nursing Implications
Assessment & Drug Effects
- Note: Emetic effect occurs in 15–30 min and continues for 20–25 min. If vomiting does not occur in 20–30 min, repeat dose once.
- Contact physician immediately if vomiting does not occur within 15–20 min after a second dose. Dosage should be recovered by gastric lavage and activated charcoal if necessary.
- Note: Ipecac syrup can be cardiotoxic if not vomited and allowed to be absorbed.
- Report immediately to physician if vomiting persists longer than 2–3 h after ipecac syrup is given.
Patient & Family Education
- Call an emergency room, poison control center, or physician before using ipecac syrup.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug