Ipecac

Scientific Name(S): Cephaelis ipecacuanha A. Rich. Also known as Psychotria ipecacuanha. Other Cephaelis species include C. acuminata (Cartagena ipecac). Family: Rubiaceae

Common Name(S): Ipecac, ipecacuanha, golden root, Rio or Brazilian ipecac, Matto Grosso ipecac, Costa Rica ipecac

Botany: The ipecac is a small perennial tropical plant that grows to about 2 feet in height. Horizontal roots extend from its slender underground stem. At maturity, the roots have a dark brown or red covering, a bitter taste and 2 musty odor. The plant is native to the humid forests of
Bolivia and Brazil where large plantations have been established to commercialize the collection of ipecac root. Much of the root crop continues to be harvested from the dd, particularly in South America. India is also an important producer of ipecac.

History: Brazilian Indians valued ipecac as a remedy for dysentery and this information was brought to Europe by Portuguese missionaries. The dried root and rhizome are the source of the medicinally useful products. Ipecac has been widely used in its syrup form as a potent and effective emetic. Ipecac powder had been used to induce sweating at the onset of influenza and small amounts of the extract have been incorporated into cough syrups as expectorants. Emetine, derived from the root, has been used for more than a century to treat dysentery.

Uses of Ipecac

Ipecac has been used as an emetic and treatment for dysentery. It has amebicidal components.

Side Effects of Ipecac

Ipecac extracts can be highly toxic and should not be confused with syrup of ipecac.

Toxicology: Ipecac extracts can be highly toxic when given either acutely or chronically. Powdered ipecac is a respiratory irritant and pharmacists may develop rhinitis or asthma following repeated exposure to the powder during compounding procedures.

Cephaeline is more toxic than emetine, causing more nausea and vomiting. Emetine, which constitutes more than half of the total ipecac content, is a cardiotoxin. If given over a period of time or in total doses exceeding 1g, the cumulative effect of emetine may lead to myositis at the injection site, gastrointestinal and nervous system symptoms, hematuria and circulatory collapse. Emetine is therefore given in low doses for a short period of time, with a break of several weeks between treatment regimens. Emetine can irritate skin if applied topically. The synthetic compound 2,3-dihydroemetine is often used to treat amebiasis; it may lead to less cardiotoxicity but may be less effective than emetine.

Fluid extract of ipecac had largely been abandoned because of the large number of fatal overdoses that were occurring when the product was mistaken for syrup of ipecac. The fluid extract is 14 times more concentrated than the syrup and as little as 10 ml has been fatal. By comparison, syrup of ipecac, which is kept in most households as a first-aid emetic has demonstrated a remarkable safety profile. As much as 105 ml of the syrup has been retained in a child with only minor changes in the ECG. However, at least one fatality has been reported with the syrup, this in a 26-year-old woman who had drank 3 to 4 bottles of the syrup each night over a 3-month period in order to lose weight. Another case described a woman who ingested 200 ml ipecac syrup per week for 3 months to lose weight who developed myopathy, whichresolved to normal 4 months after stopping ipecac use. This myopathy may be accompanied by cardiomyopathy.

Summary: Ipecac is a widely used natural product that is an effective emetic whose components have been used to treat dysentery. Ipecac and its constituents should be used cautiously because their misuse can lead to serious acute and chronic toxicities.