The ipecac syrup ( ), commonly referred to as ipecac , is a widely used drug as an expectorant (in low doses) (in higher doses). This is derived from dry rhizomes and roots of Carapichea ipecacuanha from which he obtained his name.
In particular, the powerful vomiting triggered by ipecac is considered for many years to be an important frontline treatment for oral-digested toxins. However, subsequent studies (including a comprehensive 2005 meta-study) revealed gastric cleansing produced by ipecac is much less effective in reducing total body toxicity than the effect of oral activated charcoal (which is effective through the entire gastrointestinal tract and is often combined with total intestinal irrigation). Ipecac also presents a small risk of overdose (being mild toxic itself) and a major risk of aspiration esophagitis and pneumonia if used to clean corrosive toxins. After long replacements (even in the emetic role) by more effective drugs, the American Society of Health-System Pharmacists now suggest that "Ipecac syrup is no longer recommended for routine management of outpatient consumption of drugs or other chemicals."
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The ipecac commercial preparations consist of 1/14 extract of alcohol from the roots and rhizomes of Carapichea ipecacuanha. The rest consists of glycerin, sugar syrup, and methylparaben. The Ipecac root itself is toxic, but in this dilute form, its ability to induce vomiting immediately means that the syrup is rarely fatal.
Maps Syrup of ipecac
Use
Ipecac is used in cough mix as expectorant or emetic from 18 to early 20th century. For example, Ipecac and opium are used to produce Dover powder, which is used in the form of syrup.
In 1965, the FDA approved the sale of up to an ounce of ipecac syrup without a prescription. At the time approved, its use was recommended by the AAP, the AAPCC, the AMA, and the FDA's medical advisory board as a method to induce vomiting "for rapid first aid use at home, under medical supervision", for use in cases of accidental poisoning.
The current guidelines of the American Academy of Pediatrics, however, strongly suggest against this and in fact recommend removal of the ipecac syrup present at home. Many toxicological associations have also issued positioning papers which recommend against their use as first-line treatment for the most digestible toxins, due to a lack of evidence that ipecac syrup actually helps improve outcomes in cases of poisoning. In addition, an accidental ipecac overdose can occur when administered at home. When faced with poisoning cases in the hospital, it becomes difficult to get a differential diagnosis when ipecac syrup has been given, as this can add further symptoms.
A 2005 review by a scientific panel funded by HRSA concluded that vomiting alone could not remove toxins from the stomach. This study suggests that indications for the use of ipecac syrup are scarce, and patients should be treated in a more effective and safer manner. In addition, the potential side effects, such as lethargy, can be confusing with the effects of toxins, complicated diagnosis. The use of ipecac may also delay the use of other treatments (eg, activated charcoal, intestinal irrigation, or oral antidotes) or make it less effective.
Abuse
Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss through induced vomiting. Repeated use in this way is believed to cause damage to the heart and muscles, which can ultimately lead to the death of the user. Abuse of ipecac has been blamed for the death of singer Karen Carpenter in 1983. It has also been used as an agent for MÃÆ'¼nchausen syndrome by proxy.
Action mechanism
The ipecac action is mainly from the main alkaloids, emetin (methylcephaeline) and cephaeline. Both act locally by irritating the gastric mucosa and centrally by stimulating the trigger zone of the medullary chemoreceptor to induce vomiting.
Termination
Ipecac has been found to have minimal health benefits, and ultimately ineffective to rid the body of toxic substances. Initially discontinued due to production costs and lack of raw materials. As ASHP suggests: "Ipecac syrup is no longer recommended for routine management of outpatient treatment or other chemicals." Humco and Paddock Laboratories, the only two producers left, both stopped production of ipecac syrup in 2010.
A widely quoted position statement outlines important details of its effectiveness:
In an experimental study the number of markers removed by ipecac varies considerably and decreases over time. There is no evidence from clinical studies that ipecac increases the outcome of patients being poisoned and their routine administration in the emergency department should be abandoned. There is not enough data to support or exclude ipecac administration immediately after the consumption of toxins. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and overall intestinal irrigation. Ipecac should not be given to patients who have a reduced rate or loss of consciousness to come or who have ingested corrosive substances or hydrocarbons with high aspiration potential.
See also
References
External links
- AAP Policy on Home Poison Treatment
- Chemical Poisoning and Ipecac Syrup
Source of the article : Wikipedia
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