Cough ipecac

Miscellaneous Natural Products. The longhst of natural products used in early cough preparations has diminished to the point where only a few are still mentioned. Four natural products stiU used occasionally outside the United States ate squill, hotehound, cociEana, and ipecac. 

Ipecac is prepared from the dried roots and rhizomes of Cephaelis ipecacuanha (Brot.) A. Rich, and contains the alkaloids emetine [483-18-1] (17) and cephaeJine [483-17-0] (18) in a ratio between 2 1 and 4 1. It has been used extensively in cough preparations and is beheved to act by gastric reflex stimulation. Toxic effects include vomiting, irritation of the gastrointestinal tract, and cardiac arrhythmias (19). Ipecac symp is available over-the-counter in the United States only in 30-mL containers for use as an emetic in treating poisonings. 

CociEana, the dried bark of Guana rusbji (Britt.) Rushy, was probably first used by the natives of the BoUvian Andes as an emetic—cathartic. It is often prescribed as an alternative to ipecac in the treatment of cough, and the emetic side effects at high doses suggest a mechanism of action similar to that of ipecac. 

The root of the ipecac is commonly used as an expectorant in the treatment of bronchitis, croup, asthma amoebacide and whooping cough, as an emetic in cases of poisoning, and an amoebacide in amoebic dysentery. It has appeared in the Japanese Pharmacopoeia (2001) as ipecac, powdered ipecac and ipecac S)nxip [6]. The ipecac is rich in isoquinoline alkaloids such as emetine, cephaeline, psychotrine. 

Emetine (Fig. 7-9) in the form of the crude drug obtained from the roots and rhizomes of Ipecac (Cephaelis ipecacuanha) has been in use since the seventeenth century. The alkaloid, as the hydrochloride, has been used parenterally to treat amebic dysentery. It is also effective in hepatic infestation, but not against amebic cysts. Because of its cardiac toxicity and emetogenic properties, it has been superseded by metronidazole and chloroquine, but it is still used as an alternative. The amebicidal mechanism of emetine is protein synthesis inhibition by interference of peptidyl-RNA translocation. Since this action is general to eukaryotic cells, its relative selectivity in the presence of mammalian cells is not well understood. Unrelated uses of Ipecac (presumably due to its alkaloid content) are as an expectorant in cough preparations and an emergency emetic (Syrup of Ipecac). 

Z ) Nauseant Expectorants These act as expectorants in small doses and nauseant and emetic in large doses, e.g., tartar emetic, ipecac, etc. These are usually mixed with sweet-tasting cough syrups that help to cure croupous bronchitis in children. 

Used in cough syrups and similar preparations as an alternative to ipecac, being particularly popular in the British Commonwealih countries. 

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