IPECAC SYRUP

Chemistry - Ipecac syrup is prepared from powdered ipecac which is derived from the roots andrhizomes of certain plants. Ipecac has two active alkaloids, emetine and cephaeline. Each ml of
Ipecac syrup contains 70 mg of powdered ipecac (1.23 - 1.57 mg of the ether soluble alkaloids).
Ipecac syrup has a characteristic odor and occurs as a clear, to amber colored hydroalcoholic syrup.
Ipecac syrup may also be known as syrup of ipecac or ipecacuanha syrup.

Storage, Stability, Compatibility

Store ipecac syrup in tight containers at temperatures less than25°C. Although ipecac syrup may be effective for several years after the labeled expiration date, delayed emetic action or lack of efficacy have also been reported with the use of expired productand expired product cannot be recommended for use if alternatives exist.

Pharmacology - IPECAC SYRUP

The major alkaloids of ipecac, emetine and cephaeline are believed to cause themajor pharmacologic actions of the drug. Ipecac acts both locally by irritating the gastric mucosaand centrally by stimulating the chemoreceptor trigger zone. The medullary centers must be responsive for emesis to occur, however. Contents of both the stomach and upper intestinal tract maybe evacuated by ipecac.

Uses, Indications

Ipecac is used to induce vomiting in dogs and cats after ingestions of certaintoxic compounds or drugs in overdose quantities.

Pharmacokinetics - IPECAC SYRUP

Little is known regarding the pharmacokinetics of ipecac or its alkaloids. Theamount of absorbed tends to be highly interpatient variable. When administered to dogs or cats, vomiting usually occurs within 10-30 minutes.

Contraindications, Precautions, Reproductive Safety

Emetics can be an important aspect inthe treatment of orally ingested toxins, but must not be used injudiciously. Emetics should not beused in rodents or rabbits, because they are either unable to vomit or do not have stomach wallsstrong enough to tolerate the act of emesis. Emetics are also contraindicated in patients that are:hypoxic, dyspneic, in shock, lack normal pharyngeal reflexes, seizuring, comatose, severely CNSdepressed or where CNS function is deteriorating, or extremely physically weak. Emetics shouldalso be withheld in patients who have previously vomited repeatedly. Emetics are contraindicated inpatients who have ingested strong acids, alkalies, other caustic agents because of the risks ofadditional esophogeal or gastric injury with emesis. Because of the risks of aspiration, emetics areusually contraindicated after petroleum distillate ingestion, but may be employed when the risks oftoxicity of the compound are greater than the risks of aspiration. Use of emetics after ingestion ofstrychnine or other CNS stimulants may precipitate seizures.
Emetics generally do not remove more than 80% of the material in the stomach (usually 40-60%)and successful induction of emesis does not signal the end of appropriate monitoring or therapy.
Because of the drug's potential cardiotoxic effects, use with caution in animals with preexistingsevere cardiac dysfunction.

Adverse Effects, Warnings

At recommended doses, ipecac rarely exhibits toxic effects, but caninduce lacrimation, salivation, and an increase in bronchial secretions. In humans, ipecac has rarelycaused protracted vomiting, diarrhea and lethargy.
If after a second ipecac dose emesis does not occur, many clinicians recommend performinggastric lavage because of the potential for ipecac-induced cardiotoxicity and also to remove theingested toxicant.
Warning: Do not confuse ipecac syrup with ipecac fluidextract which is about 14 times morepotent than ipecac syrup and could cause cardiotoxicity and death if used at ipecac syrup dosages.
Ipecac fluidextract is no longer commercially available in the United States.

Overdosage, Acute Toxicity

Overdoses of ipecac may result in serious cardiotoxicity with resulting arrhythmias, hypotension or fatal myocarditis. No specific antidotal therapy is available, but activated charcoal may be given to help adsorb any unabsorbed ipecac; supportive therapy may also be employed.

Drug Interactions

While activated charcoal will adsorb ipecac syrup and several veterinary references state that ipecac should not be used when charcoal therapy is contemplated, ipecac may be given initially followed by activated charcoal after vomiting has occurred.
Do not administer with milk, dairy products, or carbonated beverages as ipecac efficacy may be diminished.