Ipecacuanha prepared

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. 

The roots of Cephcelis Ipecacuanha (Brot) A. Rich constitute the Brazilian ipecacuanha of commerce and also that cultivated in the Federated Malay States, Bengal and Burma. Carthagena ipecacuanha is derived from Cephcelis acuminata Karsten collected in Colombia. Emetine, the principal alkaloid of this drug, was first obtained by Pelletier and Magendie in 1817, but was first prepared in a pure state by Paul and Cownley, who separated from commercial emetine the phenolic base, cephaeline, and later obtained a third alkaloid, psychotrine. To these Pyman added emetamine and 0-methylpsychotrine. 

At the turn of the nineteenth century, methods became available for the isolation of active principles from crude drugs. The development of chemistry made it possible to isolate and synthesize chemically pure compounds that would give reproducible biological results. In 1806, Serturner (1783-1841) isolated the first pure active principle when he purified morphine from the opium poppy. Many other chemically pure active compounds were soon obtained from crude drug preparations, including emetine by Pelletier (1788-1844) from ipecacuanha root quinine by Carentou (1795-1877) from cinchona bark strychnine by Magendie (1783-1855) from nux vomica and, in 1856, cocaine by Wohler (1800-1882) from coca. 

Ipecac syrup is prepared from the dried rhizome and roots of Cephaelis ipecacuanha or Cephaelis acuminata, plants from Brazil and Central America that have the alkaloid emetine as their active principal ingredient. It acts directly on the CTZ and also indirectly by irritating the gastric mucosa. Ipecac is cardiotoxic if absorbed and can cause cardiac conduction disturbances, atrial fibrillation, or fatal myocarditis. If emesis does not occur, gastric lavage using a nasogastric tube must be performed. 

Note The most commonly used emetics are ipecac and apomorphine. Induced emesis is the preferred means of emptying the stomach in awake patients who have ingested a toxic substance or have recently taken a drug overdose. Emesis should not be induced if there is central nervous system depression or ingestion of certain volatile hydrocarbons and caustic substances. Ipecac syrup is prepared from the dried rhizome and roots of Cephaelis ipecacuanha or of C. accuminata, plants from Brazil and Central America, in which the alkaloid emetine is its active principal ingredient. 

Emesis has been used for children and also for adults who refuse activated charcoal or gastric lavage, or if the poison is not absorbed by activated charcoal. Its routine use in emergency departments has been abandoned, as there is no clinical trial evidence that the procedure improves outcome for poisoned patients. Emesis is induced, in fully conscious patients only, by Ipecacuanha Emetic Mixture, Pediatric (BNF), 10 ml for a child 6-18 months, 15 ml for an older child and 30 ml for an adult, i.e. all ages may receive the same preparation but in a different dose, which is followed by a tumblerful of water (250 ml). The active constituent of ipecacuanha is emetine it can cause prolonged vomiting, diarrhoea and drowsiness that may be confused with effects of the ingested poison. Even... 

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). 

It is affirmed that syrup made from extract prepared according to the above fonnuia is apt to become cloudy. It is proposed to avoid this result by dividing ipecacuanha in No. 50 powder into 3 parts, and obtaining tho extract by repcrcoiation in tho same man ner as tho seneka in No. 4598. 

Syrup of Ipecacuanha. Mix 2 fluid <)uuce.s officinal fluid extract of ipecacuanha with 30 fluid ounces syrup. (U. S. Ph). This syrup ia said to become cloudy occasionally, and the follorring preparation claims to be free from this objection. 

A few examples belonging to the class of sedative expectorants will now be discussed here. Examples Acetylcysteine Bromhexine hydrochloride Ammonium chloride Prepared Ipecacuanha Liquorice Cocillana Potassium iodide. 

Prepared ipecacuanha is employed in smaller doses as an expectorant. 

There are other objedts adapted to ftimulate the nerves, which terminate in variety of membranes, and thofe efpecially v/hich form the terminations of canals thus the preparations of mercury particularly affedf the falivary glands, ipecacuanha tfie ftomach, aloe the fphin6ier of the anus, cantharides that of... 

Use.—In the preparation of Pulvis Ipecacuanha com-positus, to facilitate the intimate mixture, and to prevent the agglutination, of the ingredients. 

Among them, Rio-Ipecacuanhae Radix is prepared from C. ipecacuanha, which grows wild in the Amazon area and is exported from Rio de Janeiro, Brazil. On the other hand, Carthagena-Ipecacuanhae Radix is prepared from the roots of C. acuminata, which grows wild in Colombia, South America, and is exported from Carthagena, Colombia. Furthermore,... 

Johore-Ipecacuanhae Radix is prepared from the roots of C. ipecacuanha, which was transplanted from Brazil to Ceylon (now Sri Lanka) and Johore in the Malay peninsula in the late nineteenth century. Nowadays, the cultivation of this plant in these areas has declined. 

Various groups of South American Indians used ipecac root long before their contact with Europeans. Ipecacuanha was brought to Europe late in the 17th century. This preparation is derived from the root of Cephaelis ipecacuanha (Rubiaceae). Ipecac (from Brazil) consists of about 2% alkaloids, 60-70% of which is emetine (111) and about 25% cephae-line (112) (Fig. 32.35). 

P. ipecacuanha occurs in the rainforests of Meso and South America. It was traditionally used in the Brazilian folk medicine. In the seventeenth century, the plant was brought by traders to France, and soon it found application in Europe as treatment against dysentery. The British physician Thomas Dover invented a special preparation P. ipecacuanha that was named Dover s powder after him. It consisted of Ipecacuanha root, opium, and potassium sulphate and was used as diaphoretic and medicine against cold and fever. 

Therapeutic Uses of Ipecacuanha Alkaloids. Emetine is used in medicine as an emetic, and in small doses as an expectorant but for the latter purpose ipecacuanha itself, or one of its galenical preparations, is generally used. Emetine is chiefly of interest as a remedy for amoebic dysentery owing to its direct toxic action on Entamceba histolytica, for which purpose it is employed as the hydrochloride for injection, or in one of the insoluble forms, such as emetine bismuth iodide, for oral administration. Methods devised by Dobell et al. have been much used for testing amoebicidal agents in vitro, and show that emetine is much more toxic to Entamceba histolytica than its stereoisomeride woemetine, or than A -methylemetine or 0-methylpsychotrine, aU of which have been tried clinically and found inactive. Pyman and his collaborators have synthesised for trial as amoebicides four series of substanees, of which typical examples are represented by formulae A, B (and B ), C and D. Representatives of type A... 

Prepared Ipecacuanha, B,P, This is ipecacuanha reduced to a fine powder and adjusted, if necessary, by the admixture in suitable proportion of powdered exhausted ipecacuanha, or of powdered lactose, to contain 2 0 per cent of the total alkaloids, calculated as emetine. If lactose is used the residue of alkaloids is generally more discoloured. 

Although numerous attempts have been made to obtain a satisfactory assay of this preparation, none has yet been successful. A determination by first extracting the fat with light petroleum and then using the method given under Powder of Ipecacuanha and Opium will give an approximation but it cannot be used for standardisation. 

Powder of Ipecacuanha and Opium, jB.P. (Dover s Powder). Contains prepared ipecacuanha and pow dered opium, of each 10 per cent, with lactose. 

The ipecacuanha in this preparation does not interefere with the morphine determination "... 

In this complex mixture the general method of preparation for the colorimetric nitrosomorphine assay given under Powder of Ipecacuanha and Opium requires considerable modification. For this preparation ... 

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