Syrup of Ipecac

Syrup of ipecac (derived from the dried rhizome and roots of the Ipecacuanha plant), is an emetic—a substance used to induce vomiting. It is used in cases of accidental poisoning, and is perhaps the best-known emetic. Ipecac was also used in cough mixtures as an expectorant and from the 18th until the early 20th century, Ipecac and opium were used to produce Dover's powder, which was used in syrup form.

Use
Though it has a long history of use, not only in the US but in other countries too, syrup of Ipecac has come under recent scrutiny.

One recent scientific review (2005) by an expert 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, Ipecac’s 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. The current first-line treatment for most ingested poisons is now activated charcoal, which operates much more quickly and effectively than Ipecac treatment.

Although Ipecac was once recommended by pediatricians to be kept in the home, the current guidelines from the American Academy of Pediatrics recommends against keeping syrup of Ipecac in the home and in fact recommends disposal of any syrup of Ipecac present in the home.

The reason for this new policy was:
 * 1) There was no evidence that syrup of Ipecac actually helps improve the outcome in cases of poisoning
 * 2) Administering syrup of Ipecac can delay administering more effective treatments, such as activated charcoal and/or antidotes
 * 3) Syrup of Ipecac can change neurologic status, and so the effects of the Ipecac can be mistaken for the effects of the poisoning
 * 4) Accidental overdose of Ipecac can result when administered in the home
 * 5) Universal availability of Ipecac in the home may have contributed to Ipecac abuse by bulimics and intentional misuse of Ipecac in cases of  Munchausen syndrome by proxy.

Mechanism of action
The actions of Ipecac are mainly those of its major alkaloids, emetine (methylcephalin) and cephalin. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.

Abuse
Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss. Repeated abuse is believed to cause damage to the heart, which can ultimately result in the user's death. The death of singer Karen Carpenter in 1983 has been popularly attributed to her abuse of Ipecac for weight control.