Syrup of Ipecacuanha

Munchausen s syndrome by proxy involving syrup of ipecacuanha has been reported in an 18-month-old child who was brought by his mother with persistent vomiting for 4 weeks with generalized myopathy and pneumonia (6). Its over-the-counter avaUabihty, low cost, and effective emetic properties give this drug a high appeal for such abuse. 

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. 

Cadet s Compound Syrup of Ipecacuanba. Mix 2 ounces each syrup of ipecacuanha and syrup of poppies, 1 ounce syrup of orange flowers, and li oxymel of FouiU. 2 tea-spoonfuls constitute a dose in whooping-cough. 

Atlee s Cot h SEixture. 2 mind acetate of morphia 1 drachm each tincture of belladonna and tincture of nux-Tomica 3 drachma each antimonial wine and syrup of ipecacuanha root 1 ounce fluid extract of wild cherry bark, and 2 ounces syrap of balsam of tola. A teo-spounful 4 times a day relieves chronic or backing cough. 

Syrup of ipecacuanha induces emesis in over 90% of patients. It can only be u.scd in coascious paiienLx. There i.s no evidence that ipecacuanha reduces ilie severity of poisoning and its use has hecn abandoned. 

Syrup of ipecac is available as a nonprescription product in many countries. It is derived from the dried rhizome and roots of the Cephaelis ipecacuanha or Cephaelis acuminata plant. These plants contain the potent emetic alkaloids emetine and cephaeline, which induce vomiting by both direct local gastrointestinal effects and central nervous system actions. Emesis following syrup of ipecac ingestion typically occurs within 20 min of ingestion and persists for 30-120 min. 

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 Because of its cardiac toxicity and emetogenic properties, it has been superseded by metronidazole and chloroquine, but it is still used as an alternative.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). 

Ayer s Wild Cherry Expectorant. Mix together 3 grains acetate of morphia, 2 fluid drachms tincture of blood-root, 3 fluid drachms each antimonial wino ancl ipecacuanha wine, and 3 fluid ounces syrup of wild cherry bark. Dose, 1 tea-spoonful in catarrh, bronchitis, and influenza. 

Ayer s Cherry Pectoral. Tho following receipt is said to bo somewhat near to, ifnotcxactly identical with tho receipt after which this well known article is compounded Take of syrup of wild cherry, 6 drachms syrup of squills, 3 drachms tincture of blood-root. 2 drachms sweet spirits of nitre, 2 drachms antimonial wine, 3 drachms wino of ipecacuanha, 3 drachms simple syrup, 14 ounces acetate of morphine, 2 grains. Mix, and add oil of bitter almonds,... 

Ipecac is a mixture of the alcohol-soluble alkaloid that is obtained from the South American plant Cephaelis ipecacuanha and is used solely in the form of syrup of ipecac. Apomorphine hydrochloride and copper sulfate are also emetics. Syrup of ipecac and copper sulfate cause emesis by locally irritating the stomach, whereas apomorphine stimulates the chemoreceptor trigger zone for emesis located in the caudal portion of the fourth ventricle (area postrema), which in turn stimulates the vomiting center in the lateral reticular formation of the medulla (see also Figure 73). 

Ipecac is a mixture of the alcohol-soluble alkaloid which is obtained from the South American plant Cephaelis ipecacuanha, and is used solely in the form of syrup of ipecac. Apomorphine hydrochloride and copper sulfate are also emetics. 

Ipecac symp is an alkaloid derivative of the ipecacuanha plant (Cephaline ipecacuanha). The principal alkaloids, emetine and cephaeline, both have emeto-genic properties. The emetine extract has been used for the treatment of amebiasis. Syrup of ipecac is widely available over the counter as an effective, rapidly acting emetic agent. Presently, the major source of poisoning is chronic intoxication resulting from intentional misuse by patients with eating disorders. Cases of Munchausen s syndrome by proxy, in which a parent repeatedly administers ipecac to a child, have also been reported. 

Ipecac is obtained from the dried rhizome and roots of Cephaelis ipecacuanha (Rubiaceae), a low bush indigenous to Brazil. Ipecac contains five isoquinoline alkaloids, including emetine, cephaline and psychotrine. Emetine hydrochloride is used as an antiprotozoal agent. Syrup of ipecac is an emetic and poison antidote. 

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. 

Ipecac, which is a mixture of the alcohol-soluble alkaloids from the underground parts of the South American plant, C. ipecacuanha, is used almost solely as the U.S.P. ipecac syrup. 

Compoimd Syrun of Black Cokosh. Macerate 2 ounces olock cohosh (black snake-root), 1 ounce seneka root, 1 ounce liquorice root, and ounce ipecacuanha root in dilate alcohol for 24 hours then transfer to a percolator and run through two pints evaporate the excess of alcohol by a water-bath, and convert into a syrup with sufficient quantity of sugar lastly, treat 2 ounces wild cher bark with half a pint of cold water, which add to the syrup previously cooled. 

Emetic Mixture. Ipecacuanha wine, i ounce water, 1 ounce siinpto syrup, I ounce. Mix. For a child, 20 drops or m( re, every quarter of an hour until vomiting ensues. An adult may take from i to 1 ounce. 

The emetic effects are presumably mediated by 5-hydroxytryptamine 3 (5HTj) receptors (Hasegawa et al, 2002). Ipecacuanha syrup is used to induce emesis after accidental ingestion of poisons. In lower doses, the extract of P. ipecacuanha roots is used as expectorant. 

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