Syrup of Ipecac Study Supports AAP Recommendation Against Home Use
Almost 40 years ago, the U.S. Food and Drug Administration (FDA) made syrup of ipecac available as an over-the-counter medication. For years parents have been instructed to keep a bottle in the home for use in childhood poisonings. But in November of last year, the American Academy of Pediatrics (AAP) changed its policy and now advises against home use.
Findings from a recent study by G. Randall Bond, MD, support the AAP's policy change. Dr. Bond, medical director of the Cincinnati Drug and Poison Information Center, wanted to see if higher incidence of home syrup of ipecac use in children was associated with fewer hospital visits. He analyzed data from each of the 64 poison centers in the United States.
"Places that use syrup of ipecac the most should have fewer children going to the hospital," Dr. Bond says. "And they should have the same or better outcome as far as severity is concerned." Instead, the results of his analysis showed no correlation between ipecac use and hospital visits. Dr. Bond concluded that using syrup of ipecac at home did not improve patient outcomes, nor did it decrease trips to the hospital.
Less Need for Ipecac
"The AAP recommendation makes sense," Dr. Bond says. "It turns out that claims made about how ipecac works are not true." Syrup of ipecac has long been known to make kids vomit portion of their stomach contents, but the individual variability was unreliable. No one could tell how much each child vomited. Additionally, poison centers have learned more about which substances are toxic and how best to treat them, often eliminating the need for ipecac or any intervention.
Other developments, such as childproof medicine bottles, have also had an impact on child poisonings and have lessened the need to intervene. "Our need to act has been decreased by interventions such as child-proofing the home and particularly changes in packaging," Dr. Bond says.
"We as a poison center have advocated against using syrup of ipecac at home for years.There are so few opportunities to use it, there is more potential for misuse at this point." Misuse can include improper administration by parents, as well as abuse by bulimics. "The benefit is so restrictive that it has more potential downside than upside," Dr. Bond says. It is also important to note that poisoning deaths have dropped dramatically over the last 50 years and that most emergency rooms have stopped using the drug in favor of the more effective activated charcoal.
Stress Other Prevention Instead
Dr. Bond feels time and money spent educating parents on ipecac use could better be used on emphasizing other injury prevention strategies. "Ipecac doesn't save many injuries," Dr. Bond says. With this AAP policy now in place and the research there to support it,"pediatricians can spend more time during a well-child visit on injury prevention topics that are more relevant."
Currently the poison centers across the United States are not all following the same standard regarding home syrup of ipecac use. Should they be? That question is a controversial one. According to Dr. Bond, there is a movement toward developing guidelines for poison management at the national level.
Dr. Bond predicts that one day ipecac will no longer be in any homes. In fact, the FDA has accepted a recommendation to eventually make syrup of ipecac available by prescription only. In the meantime, pediatricians can best serve their patient families by advising them of the AAP's policy change and urging them to post the universal phone number for poison control near the phone: 800-222-1222.
Dr. Bond is professor of clinical pediatrics and emergency medicine in the Division of Emergency Medicine, and he is medical director of the Cincinnati Drug and Poison Information Center. His paper was published in Pediatrics (112[5]:1061-1064, 2003 November 1).
