Ipecac, most commonly known as Syrup of Ipecac, was historically an over-the-counter medicine used to induce vomiting. For decades, it was a household staple, recommended as an emergency first-aid measure for accidental poisoning or drug overdose. Its purpose was to rapidly empty the stomach contents, preventing the body from absorbing potentially toxic substances.
Plant Source and Active Components
The substance is derived from the dried roots and rhizomes of the plant Carapichea ipecacuanha, a slow-growing species native to the rainforests of Central and South America. These roots contain a mix of alkaloids, which are the pharmacologically active compounds responsible for the syrup’s effects. The two primary alkaloids are emetine and cephaeline.
Emetine is the most abundant of these compounds, acting as both an emetic and an anti-amoebic agent. Cephaeline is structurally similar to emetine but possesses a slightly stronger emetic effect. Syrup of Ipecac is typically an extract of these roots combined with glycerin, sugar, and water, yielding a bitter taste.
The Dual Mechanism of Emetic Action
Ipecac stimulates the vomiting reflex through two distinct physiological pathways. This dual mechanism ensures the induction of emesis, typically within 20 to 30 minutes of ingestion. It involves both a direct local irritation of the digestive tract and a centralized stimulation of the brain.
The local action occurs in the stomach, where the alkaloids directly irritate the gastric mucosa. This irritation triggers signals relayed via the vagus nerve to the vomiting center in the medulla oblongata. This peripheral stimulation is a quick-acting reflex response.
The central action begins after the alkaloids, particularly emetine, are absorbed into the bloodstream. These compounds travel to the Chemoreceptor Trigger Zone (CTZ) in the brain, an area located outside the blood-brain barrier. The CTZ monitors the blood for circulating toxins and relays this information to the vomiting center. By stimulating the CTZ directly, the alkaloids chemically signal the brain to initiate vomiting.
Why Ipecac is No Longer Recommended
Medical guidance shifted away from recommending Ipecac in the early 2000s, with major organizations advising against its use. Research determined there was no consistent evidence that Ipecac improved outcomes for poisoned patients. Its use often caused a delay in administering more effective treatments, such as activated charcoal or gastric lavage.
A primary concern is the risk of aspiration pneumonia, which occurs if the patient inhales stomach contents while vomiting. Furthermore, Ipecac’s active component, emetine, carries a risk of cardiotoxicity, or damage to the heart muscle. Emetine can interfere with protein biosynthesis in the myocardium and disrupt cardiac ion channels, potentially leading to serious heart problems. Because of these risks, the consensus is to call a poison control center immediately rather than attempt to induce vomiting at home.