Details About Overdose or Poisoning Generic Salt ::  Ipecac Syrup

Ipecac Syrup

    

Drug Pharmacology ::

I. Pharmacology. Ipecacsyrup is a mixture of plant-derived alkaloids, principally emetine andcephaeline, that produce emesis by direct irritation of the stomach andstimulation of the central chemoreceptor trigger zone. Vomiting occursin 90% of these patients, usually within 20–30 minutes. Depending onthe time after ingestion of the toxin, ipecac-induced emesis removes15–50% of the stomach contents. There is no evidence that the use ofipecac improves the clinical outcome in poisoned patients, and itshould not be administered routinely in their management.

Drug Indications ::

Indications. For a more complete discussion of gastric decontamination, see Gastrointestinal decontamination.

   

Theuse of ipecac syrup may be beneficial in rare situations in which thereis substantial risk of serious toxicity, no existing or likely risk ofa contraindication to its use, no alternative therapy available forgastric decontamination, and an expected delay of more than 1 hour formedical care in a heath-care facility. It should not be administered ifit will adversely affect a more definitive treatment that might beprovided in a hospital setting.

Inhealth-care facilities, the use of ipecac may delay the administrationor reduce the effectiveness of activated charcoal, oral antidotes, andwhole-bowel irrigation. Thus, its routine administration in theemergency department has been abandoned.

Drug Contra-Indications ::

III. Contraindications./b>

   

Comatose or obtunded mental state.

Ingestion of a caustic or corrosive substance or sharp object.

Ingestion of petroleum distillates or hydrocarbons (see Hydrocarbons).

Ingestionof a drug or toxin likely to result in abrupt onset of seizures or coma(eg, tricyclic antidepressants, strychnine, camphor, nicotine, cocaine,amphetamines, isoniazid).

E. Severe hypertension.

F. Patients at high risk for hemorrhagic diathesis (eg, coagulopathy or esophageal varices).

Drug Adverse Effects ::

IV. Adverse effects

   

Persistent GI upset after emesis may significantly delay administration of activated charcoal or other oral antidotes.

Severeand repeated vomiting may cause esophageal (Mallory-Weiss) tears,pneumomediastinum, hemorrhagic gastritis, or intracranial hemorrhage.

Vomiting may stimulate the vagal reflex, resulting in bradycardia or atrioventricular block.

Drowsiness occurs in about 20% and diarrhea in 25% of children.

E. Singleingestions of therapeutic doses of ipecac syrup are not toxic (theformerly used fluid extract was more potent), and failure to inducevomiting does not require removal of the ipecac. However, chronic repeated ingestionof ipecac (eg, in patients with bulimia) may result in accumulation ofcardiotoxic alkaloids and lead to fatal cardiomyopathy and arrhythmias.

F. Use in pregnancy. FDAcategory C (indeterminate) (see Table III–1). There is minimal systemicabsorption, but it may induce uterine contractions in late pregnancy.

Drug Lab Interactions ::

Drug or laboratory interactions

   

Ipecac syrup potentiates nausea and vomiting associated with the ingestion of other gastric irritants.

Ipecacsyrup is adsorbed in vitro by activated charcoal; however, ipecac stillproduces vomiting when given concurrently with charcoal.

Ipecacsyrup contains 1.5–2% ethanol, which may cause an adverse reaction inpatients taking disulfiram (see Disulfiram) or other agents that havedisulfiram-like effects (eg, metronidazole and Coprinus mushrooms).

Drug Dose Management ::

Dosage and method of administration

   

Children 6–12 months old. Give 5–10 mL. Note: Not recommended for non–health-care facility use in this age group.

Children 1–12 years old. Give 15 mL.

Adults and children over 12 years old. Give 30 mL.

Followipecac administration with 4–8 oz of water or clear liquid. If emesisdoes not occur within 30 minutes, repeat the dose of ipecac and fluid.

Drug Chemical Formulations ::

Formulations

   

Ipecac syrup, 30 mL.

Withthe availability of more effective means of gastric decontamination anda lack of evidence that ipecac improves clinical outcome, there is noneed to stock ipecac in the hospital setting.

Disclaimer ::

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