Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons

Abstract

The use of gastric emptying techniques, including ipecac-induced emesis, in the management of poisoned patients has declined significantly in recent years. Historically, poison centers used ipecac syrup in two ways. Ipecac syrup was administered to patients prior to referral to the emergency department in attempts to start the gastric emptying process as early as possible. Additionally, poison centers used ipecac syrup in attempts to keep patients from requiring referral to medical facilities. In these situations, ipecac syrup was administered in the home and poison center staff performed follow-up telephone calls to gauge progress and outcome. Studies to determine the effectiveness of ipecac syrup demonstrate that it induces vomiting in a high percentage of people to whom it is administered and that it decreases the gastrointestinal absorption of ingested substances in a time-dependent fashion. However, the effectiveness of ipecac syrup in affecting patient outcome has not been studied in adequate clinical trials. Its effectiveness in preventing drug absorption has only been documented for a limited number of substances and is substantially reduced if it is given more than 30-90 minutes following ingestion of the toxic material. There are potentially significant contraindications, adverse effects and related problems associated with the use of ipecac syrup. It is the consensus of the panel that the circumstances in which ipecac-induced emesis is the appropriate or desired method of gastric decontamination are rare. The panel concluded that the use of ipecac syrup might have an acceptable benefit-to-risk ratio in rare situations in which: there is no contraindication to the use of ipecac syrup; and there is substantial risk of serious toxicity to the victim; and there is no alternative therapy available or effective to decrease gastrointestinal absorption (e.g., activated charcoal); and there will be a delay of greater than 1 hour before the patient will arrive at an emergency medical facility and ipecac syrup can be administered within 30-90 minutes of the ingestion; and ipecac syrup administration will not adversely affect more definitive treatment that might be provided at a hospital. In such circumstances, the administration of ipecac syrup should occur only in response to a specific recommendation from a poison center, emergency department physician, or other qualified medical personnel. The panel decided not to address the issue of whether ipecac should remain a nonprescription, over-the-counter product. The panel does not support the routine stocking of ipecac in all households with young children but was unable to reach consensus on which households with young children might benefit from stocking ipecac. Instead, the panel concluded that individual practitioners and poison control centers are best able to determine the particular patient population, geographic and other variables that might influence the decision to recommend having ipecac on hand.

Superwarfarins

“…Simultaneously, the AAPCC is still indicating that syrup of ipecac does have a place in therapy, and "concluded that individual practitioners and poison control centers are best able to determine the particular patient population, geographic and other variables that might influence the decision to recommend having ipecac on hand" (Manoguerra and Cobaugh, 2005). We recommend that the first action for a caregiver of a child who may have ingested one of these rodenticides is to consult with their local poison control center (AAP, 2003).…”

“…In case of a suspected terrorist act, misuse, intentional criminal, or any deliberate intentional suicidal ingestion, or when the amount ingested is either large or indeterminate, the patient should be referred to a healthcare facility for clinical and laboratory assessment, as well as treatment if necessary (Manoguerra and Cobaugh, 2005;POISINDEX, 2007).…”

“…In adults with deliberate ingestions and children with clinical evidence of bleeding, an initial PT and PTT should be obtained and then repeated at 24 and 48 h after ingestion (Manoguerra and Cobaugh, 2005).…”

Use and importance of quina (Cinchona spp.) and ipeca (Carapichea ipecacuanha (Brot.) L. Andersson): Plants for medicinal use from the 16th century to the present

“…The records of using ipecac to induce vomiting in patients who ingested poison peaked in the mid-1980s, and decreased thereafter (Manoguerra and Cobaugh, 2005). Currently the use of ipecac is not recommended for use after poisoning (Möller et al, 2007) due to ipecac abuse from easily accessible overthe-counter products (Silber, 2005) causing high levels of toxicity (Tietze and Rackelmann, 2004).…”

Demands on scientific studies in clinical toxicology

“…They are also an essential basis for poison information centers and poison treatment centers. Series of position papers have recently been published on appropriate treatment of poisonings [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”