IPECAC SYRUP
(ip'e-kak)
Ipecac Syrup
Classifications: gastrointestinal agent; emetic
Pregnancy Category: C

Availability

15 mL, 30 mL doses

Actions

Derived from dried rhizomes and roots of Cephaelis ipecacuanha. Contains cephaeline (produces emesis) and emetine, a toxic alkaloid that is excreted slowly from the body. Emetine can cause potentially fatal cumulative toxicity with repeated use. It appears to inhibit protein synthesis and energy production in muscle tissue with resultant skeletal and cardiac muscle toxicity.

Therapeutic Effects

Acts locally on gastric mucosa and centrally on chemoreceptor trigger zone (CTZ) in the medulla to induce vomiting.

Uses

Emergency emetic to remove unabsorbed ingested poisons.

Contraindications

Comatose, semicomatose, inebriated, deeply sedated patients; patients in shock; patients with depressed gag reflex; seizures, active or impending; impaired cardiac function; arteriosclerosis; treatment of ingested strong alkali, acids, or other corrosives, strychnine, petroleum distillates, volatile oils, or rapid-acting CNS depressants.

Cautious Use

Safe use in pregnancy (category C), lactation, or infants <6 mo is not established.

Route & Dosage

Emergency Emesis
Adult: PO 30 mL followed by 1–2 240 mL (8 oz) glasses of water, may repeat once in 20 min if necessary
Child: PO >1 y, 15 mL followed by 1–2 240 mL (8 oz) glasses of water, may repeat once in 20 min if necessary; <1 y, 5–10 mL followed by 120–240 mL (4–8 oz) of water, may repeat once in 20 min if necessary

Administration

Oral

Adverse Effects (1%)

Body as a Whole: Achy, stiff muscles, severe myopathy, convulsions, coma. CV: Cardiomyopathy, cardiotoxicity, cardiac arrhythmias, atrial fibrillation, tachycardia, chest pain, dyspnea, hypotension, fatal myocarditis. GI: Diarrhea, mild GI upset. If drug is not vomited but absorbed or if ipecac overdosage: persistent vomiting, gastroenteritis, bloody diarrhea, sensory disturbances, stomach cramps, tremor.

Pharmacokinetics

Onset: 15–30 min. Duration: 25 min. Elimination: Metabolite can be detected in urine up to 60 d after excessive doses.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education


Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug