Ipecac Syrup
Ipecac syrup is an alkaloid derivative of the ipecacuanha plant (Cephaline ipecacuanha). The principal alkaloids, emetine and cephaline, both have emetogenic properties. The emetine extract has been used for the treatment of amebiasis. Syrup of ipecac is no longer widely available over the counter, nor is it recommended for home use by pediatricians.
Mechanism of toxicity
Mechanism of action. Ipecac causes vomiting in two phases: by direct irritation of the gastric mucosa and by systemic absorption and stimulation of the central chemoreceptor trigger zone.
Acute ingestion can cause profuse vomiting and diarrhea, especially ingestion of the more concentrated fluid extract (no longer available in the United States).
Chronic repeated dosing. The emetine component causes inhibition of protein synthesis, which is particularly demonstrated in human myocytes and skeletal muscle cells after overdose or prolonged use. Another proposed mechanism for cellular toxicity is blockade of sodium and calcium channels.
Toxic dose. Toxicity depends on the formulation and whether the exposure is acute or chronic.
Acute ingestion of 60–120 mL of syrup of ipecac is not likely to cause serious poisoning. However, the fluid extract, which is approximately 14 times more potent than syrup of ipecac, has caused death after ingestion of as little as 10 mL.
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