Ipecac
Botanical Description & Habitat
Cephaelis ipecacuanha, Cephaelis acuminata
Family
Rubiaceae
Common Names:
Brazilian ipecac
Golden root
Ipecac
Rio ipecac
Habitat
The humid valleys and forests of Brazil; also cultivated around Singapore, and other places.
Description:
A small perennial plant. The roots have a dark brown or red covering, a bitter taste and a musty odor.
Medicinal Parts
Dried root or rhizome. It is still wild harvested.
Historical Properties & Uses
Ipecac was brought to Europe from Brazil in the 16th century and has been used ever since in Europe, and then America. It is used to treat various kinds of dysentery, as an expectorant, and, in large doses, as an emetic. Ipecac can be found in commercial respiratory drugs all over the world. The natives of Brazil used and use it to treat diarrhea.
Powdered ipecac and ipecac syrup are both official preparations in the United States; but the only official use for the substance in this country is an emetic. Occasionally an ipecac extract will appear on the market. The extract is several times more potent than the syrup, and the unsuspecting use of it can be very dangerous.
Method of Action
Ipecac is an Emetic
Ipecac contains the isoquinoline alkaloids emetine, cephaeline, psychotrine, methylsychotrine, and emetamine, together with ipecacuahnic acid, ipecacuanhin, saponins and starch. Ipecac has powerful alkaloids which have been shown to account for its action. It irritates the stomach walls, causing the cells to secrete enzymes which react with the alkaloids to produce disinfectants.
The alkaloids lead to hyperemia of the stomach mucous membranes, the stimulation of the sensitive nerve endings is relayed through the vagus nerve to central nervous system centers whereby a small dose stimulates the nausea center. The saponins work synergistically by decreasing the surface area and through a simultaneous stimulation of the mucous membranes. The spasmolytic action of emetine is through a direct effect on the musculature. Emetine is also responsible for the very good antiprotozoal action of ipecac (especially against Entamoeba histolytica).
Ipecac is an Expectorant
Though ipecac is best known for its emetic properties, it makes a better expectorant. Emetine, in reasonable doses, is actually more of an expectorant that an emetic, and opposite holds true for cephaeline, but there is usually twice as much emetine as cephaeline in the syrup.
For expectorant purpose, just enough syrup is administered to help the patient retch up mucus obstructions of the bronchi, thus obtaining rapid relief from asthmatic and other types of bronchial wheezing, but low enough not to produce vomiting. For expectorant purpose, the whole plant (root), in powdered form is preferable. An expectorant dose of powdered root is 1/4 to 2 grains; and emetic dose ranges from 15 to 30 grains.
Drug Interactions & Precautions
Known Interactions
In sub-laxative and sub-emetic doses ipecac should have no drug interactions. At higher doses, interactions similar to those involving diuretics and cathartics may occur.
Safety Factors & Toxicity
Obviously, large doses of ipecac should be avoided except in cases where rapid emptying of the stomach is desired (such as in poisoning). Ipecac abuse is rampant in the ranks of anorectic girls. Such abuse has motivated one group of American physicians to petition the FDA to ban the over-the-counter sale of ipecac in the United States. Continued abuse of ipecac can lead to cardiac arrest.
Ipecac is definitely contraindicated in general disability and exhaustion, shock or cardiac disease.
Preparation & Administration
Dried rhizome and roots
use 25-100mg
Liquid Extract
use 0.025-0.1ml; emetic dose = 0.5-2ml
Tincture
use 0.25-1ml; emetic dose = 5-20ml
Ipecac syrup (U.S.P. XIX)
usual dose = 15ml, repeated every 20 minutes if emesis does not occur. The dosage should be recovered by gastric lavage if emesis does not occur after the second dose. Usual dose range = 10-30ml. Usual pediatric dose, under 1 year of age = 5-10ml. Note: Copious fluids should be taken after the administration of an emetic dose.
Note: This Herbal Preparation information is a summary of data from books and articles by various authors. It is not intended to replace the advice or attention of health care professionals.
References
Corby, D.G., R.C. Lisciendro., et.al. The efficiency of methods used to evacuate the stomach after acute ingestions. Pediatrics, 40, 871, 1967.
Dresser, LP et al., Ipecac myopathy and cardiomyopathy. J. Neurol. Neurosurg. Psychiatry, 1993, 56:560.
Eggleston, C. & R.A. Hatcher. The seat of the emetic action of various drugs. J. Pharm. Exptl. Therap., 7, 225, 1915.
Facts and Comparisons. The Lawrence Review of Natural Products. Aug, 1994.
King, WD: Syrup of ipecac: a drug review. Clin. Toxicol. 1980, 17:353.
Mowrey, Daniel B., Ph.D. Exper. Psych., Brigham Young University. Director of Nebo Institute of Herbal Sciences. Director of Behavior Change Agent Training Institute. Director of Research, Nova Corp.
Rogers, L. Further experience of the specific curative action in amoebic disease of hypodermic injections of soluble salts of emetine. British Medical Journal, 2, 405, 1912
Rogers, L. The rapid cure of amoebic dysentery and hepatitis with hypodermic injections of soluble salts of emetine. British Medical Journal, 1, 1424, 1912.
Shirkey, H.C. Ipecac syrup. Its use as an emetic in poison control. Journal of Pediatrics, 69, 139, 1966.
Thumas, L.J. Ueber das brachcentrum und uber die wirkung einiger pharmakologischer mittel auf dasselbe. Arch. Path. Anat., etc. Berl, Cxxiii, 44, 1891.
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