Ipecac dosing

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. 

Ipecac is available without a prescription for use in the home. The instructions for use and the recommended dose are printed on the label. 

Ipecac is the root of Cephaetis ipecacuanha, or of C. acuminata, a perennial shrub growing in Brazil and other South American states (Figure 44.1). It contains three alkaloids — emetin, cephaelin, and psychotrin. The dose of the powdered drug as an expectorant is from 1/2 to 2 grain (0.03 to 0.13 g) as an emetic, 15 to 30 grain (1.0 to 2.0 g) (Table 44.1). 

The most useful household emetic is syrup of ipecac (not ipecac fluid extract, which is 14 times more potent and may cause fatalities). Syrup of ipecac is available in 0.5- and 1-fluid ounce containers (approximately 15 and 30 ml), which may be purchased without prescription. The drug can be given orally, but it takes 15 to 30 min to produce emesis this compares favorably with the time usually required for adequate gastric lavage. The oral dose is 15 ml in children from 6 months to 12 years of age and 30 ml in older children and adults. Because emesis may not occur when the stomach is empty, the administration of ipecac should be followed by a drink of water. 

Emetics, when administered in small doses, act as expectorants and are used in inflammatory conditions of the respiratory tract to increase the bronchial secretion and render it less tenacious. The most commonly used expectorants are ipecac, ammonium chloride, and apomorphine. The last named is administered in doses of 1 mg in the form of an elixir or syrup. Apomorphine injected in subemetic doses of 1 to 2 mg is also used as a sedative in the delirium following anesthesia, in acute alcoholic psychosis, and in patients manifesting severe agitation prior to anesthesia. 

Emetine [EM e teen] and dehydroemetine [de hye dro EM e teen] are alternate agents for the treatment of amebiasis. They inhibit protein synthesis by blocking chain elongation1. Intramuscular injection is the preferred route. Emetine is concentrated in the liver where it persists for a month after a single dose. It is slowly metabolized and excreted and can accumulate. Its ty2 is 5 days. The use of these ipecac alkaloids is limited by their toxicities. Dehydroemetine is probably less toxic than emetine. Close clinical observation is necessary when these drugs are used. Among the untoward effects are pain at the site of injection, transient nausea, cardiotoxicity (e.g., arrhythmias, congestive heart failure), neuromuscular weakness, dizziness, and rashes. 

Ext. Ipecacuanhs (extract of ipecac) A powerful emetic. In smaller doses, it was used as a diaphoretic and expectorant. 

Gastrointestinal decontamination with multiple dose activated charcoal is recommended for recent acute ingestion [86] and may be most effective (along with cathartics) for enteric coated salicylate preparations. Induction of emesis with ipecac is no longer recommended [86]. Alkalinization of the urine is recommended for patients with preserved renal function who are unsuitable or do not meet criteria for dialysis [87] and may be of benefit during preparation for hemodialysis. 

There is no antidote for azathioprine toxicity. Treatment for an overdose entails ipecac within 30 min or lavage within 1 h, followed by activated charcoal. Side effects may be minimized with adequate monitoring of peripheral blood count and liver enzymes. Asymptomatic leucopenia, as well as most other side effects, may be treated with dose reduction or drug cessation (and changing to 6-MP) however, a life-threatening leucopenic episode may require administration of granulocyte colony-stimulating factor as well as other supportive care. 

Induction of emesis depends on product toxicity, quantity, time since exposure, patient s weight, and the presence of symptoms. Cationic surfactants, perborates, and substantial ingestion of essential oils may benefit by administration of syrup of ipecac. Syrup of ipecac can be used in hydrocarbon ingestion only if the total dose of hydrocarbons exceeds 1 or 2 ml kg... 

Plasma hexachlorophene levels have not been demonstrated to correlate well with clinical effects. Hexachlorophene may cause seizures. The risk of seizures during emesis may preclude the use of ipecac syrup. Charcoal slurry, aqueous or mixed with saline cathartic or sorbitol, should be administered. The usual charcoal dose is 30-100 g in adults and 15-30 g in children (1 or 2 g kg in infants). If seizures cannot be controlled with diazepam or they recur, phenytoin or... 

Acute exposures are likely to be associated with CNS depression and, at very high doses, pulmonary irritation. Removal from exposure and ventilatory support are the initial priorities. Alert individuals ingesting >2 or 3 mg kg should be given syrup of ipecac. Because hydrocarbon pneumonitis is a significant risk with styrene ingestion, intubation should precede lavage in those individuals at risk of aspiration due to a reduced level of alertness. 

For acute exposure, ipecac should be administered and lavage performed. The use of single- or multiple-dose activated charcoal is supported by in vitro binding experiments and some animal data, and charcoal hemoperfusion may be a useful adjunct. Forced potassium diuresis appears to be harmful. Flemodial-ysis is also recommended with potassium administration. Since calcium metabolism is disturbed, supplementary calcium is indicated. The use of traditional metal chelators such as dimercaprol (British antilewisite) and penicillamine is not supported by the available evidence. In fact, the use of penicillamine may lead to redistribution of thallium into the central nervous system. Multiple animal studies have found evidence of enhanced elimination and improved survival with Prussian blue however, despite the fact that many humans have been treated with Prussian blue, the data presented are insufficient to judge its true efficacy. Despite this, one publication notes that... 

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