Syrup of Ipecac No Longer Recommended
In October 1965, Syrup of Ipecac was approved by the Food and Drug Administration to be sold over-the-counter for emergency treatment of poisonings. The American Academy of Pediatrics, the American Association of Poison Control Centers, the American Medical Association, and the Medical Advisory Board of the Food and Drug Administration unanimously agreed on its use for this purpose. For more than forty years Syrup of Ipecac has been a staple in households with children, to be used in case of poisoning after consulting with the poison control center or a physician.
As of November 2003, the American Academy of Pediatrics (AAP) ushered in a new era when it announced its new guideline on syrup of ipecac. The AAP determined that Syrup of Ipecac no longer has a place in the home management of poisoning cases. Noting that use of syrup of ipecac had not been associated with improvement in patient outcome, the AAP recommended that parents no longer keep syrup of ipecac in the home and that they throw away any they may have on hand.
Additionally, in June 2003, the Nonprescription Drug Advisory Panel of the Food and Drug Administration (FDA) recommended that ipecac syrup be removed from over-the-counter (OTC) status. This is only a recommendation at this time, not an official FDA action.
The FDA is currently holding internal discussions about this recommendation. If the OTC status for ipecac syrup is revoked, it would available by prescription only. Should this occur, it is likely that manufacturers will cease producing ipecac altogether, in part due to the expense required to gain prescription approval as well as minimal expected sales.
Background
Syrup of Ipecac is derived from a Central American plant and has 2 active components, the alkaloids cephaline and emetine. Both of these components work locally in the stomach. Cephaline also acts in the area of the brain that triggers vomiting. The onset for vomiting is usually 15-30 minutes and can last 1-2 hours. Ipecac syrup can remove about one-third of the stomach contents if given within the first hour after a substance in swallowed. However after 90 minutes, there is no statistical reduction in amount of the substance removed.
Side effects of ipecac syrup can include drowsiness, lethargy, diarrhea and prolonged vomiting. Symptoms seen during chronic use, as in people with eating disorders, include irritability, lowered body temperature, loss of fluids, chemical imbalances, muscle weakness, diarrhea, heart problems (rapid heart rate and other abnormal rhythm problems). Deaths have been reported from the heart problems due to chronic abuse. Ipecac syrup can also delay the administration and/or reduce the effectiveness of other treatments such as charcoal, oral antidotes, or whole bowel irrigation used to decrease the toxicity of swallowed substances.
In addition, administration of ipecac syrup can lead to complications in certain patients. Ipecac syrup should not be given to a patient with decreased level of consciousness because it may cause the patient to choke. If administered in cases involving corrosive or hydrocarbon-containing substances, it may cause increased damage. These risks and the failure of a demonstrated patient benefit, as well as the potential for misuse, adverse effects, and abuse have led to the decline in the use of syrup of ipecac over the past few years.
Although complete agreement is lacking, the general consensus is to use ipecac syrup only in extremely rare circumstances and only upon consultation with a regional poison control center or medical toxicologist. It should not longer be kept on hand for use at home "in case of poisoning."
