Dosing and uses of Ipecac syrup
Adult dosage forms and strengths
oral syrup
- 7%
Overdose/Poisoning
15-30 mL PO once; may repeat once with 15 mL if vomiting does not occur within 20-30 min
If vomiting does not occur within 30-45 min after second dose, perform gastric lavage
Give with 3-4 glasses of water
Pediatric dosage forms and strengths
oral syrup
- 7%
Overdose/Poisoning
<6-12 months: 5-10 mL PO once with 4-8 ounces of water; give only under medical supervision
1-12 years: 15 mL PO once with 1-2 glasses of water; may repeat once with 15 mL once if vomiting does not occur within 20-30 min
>12 years: As adults; 5-30 mL PO once with 3-4 glasses of water; may repeat once with 15 mL once if vomiting does not occur within 20-30 min
If vomiting does not occur within 30-45 min after second dose, perform gastric lavage
Ipecac syrup adverse (side) effects
Frequency not defined
Prolonged vomiting
Aspiration
CNS depression
Mallory-Weiss tear
Delay of other therapy (charcoal/N-acetylcysteine)
Pneumomediastinum
May cause vomiting-induced vagal bradycardia
Warnings
Contraindications
Lethargy
Absent gag reflex
Coma
Short time between ingestion of poison and charcoal administration/lavage
History of ingestion of substence that causes CNS depression or seizures
Ingestion of caustics, volatile liquids, or sharp objects
Cautions
May not work on empty stomach
Do not confuse ipecac syrup with ipecac fluid extract (14 times stronger)
Not indicated if patient had spontaneous vomiting
Falling out of favor with many poison control centers; may delay gastric lavage if vomiting prolonged
Milk or carbonated beverages may decrease effect
Abuse may occur in patients with bulimia or anorexia nervosa; associated with cardiomyopathies and death in patients with eating disorder
May be cardiotoxic if not vomited and allowed to be absorbed; emetine absorption may result in heart conduction disturbances
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown if excreted in breast milk; caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Ipecac syrup
Mechanism of action
Gastric irritant and stimulates chemoreceptor trigger zone in CNS by alkaloids emetine and cephaeline to produce vomiting
Pharmacokinetics
Effective within 30 min post ingestion
Absorption: Significant when emesis not produced
