Ipecac Syrup

A to Z Drug Facts

(IPP-uh-kak syrup)

Available as generic only,  PMS-Ipecac

Class: Antidote

 Action Produces vomiting by local irritant effect and stimulation of chemoreceptor trigger zone.

 Indications Treatment of drug overdose and certain poisonings.

 Contraindications Do not use in semiconscious, unconscious, pregnant, or lactating persons; do not use if strychnine, corrosives (eg, alkalis, strong acids), or petroleum distillates have been ingested.

 Route/Dosage

ADULTS: PO 15 to 30 ml followed by 3 to 4 glasses of water. May repeat dose within 20 min if vomiting does not occur. CHILDREN < 1 YR: PO 5 to 10 ml followed by ½ glass of water. CHILDREN 1–12 YR: PO 15 ml followed by 1 to 2 glasses of water.

 Interactions

Activated charcoal: Will absorb ipecac syrup. Give activated charcoal only after ipecac syrup has produced vomiting. Milk or carbonated beverages: Do not administer with ipecac syrup.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Heart conduction disturbances; atrial fibrillation; fatal myocarditis. CNS: Depression. GI: Diarrhea.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Abuse: Severe cardiomyopathies and death may occur in bulimic and anorexic persons abusing ipecac syrup. Syrup/Fluid extract: Do not confuse ipecac syrup with ipecac fluid extract, which is 14 times stronger and has caused some deaths.

 Administration/Storage

• Consult poison control center before administering, especially in children < 1 yr.
• Have patient sit upright with head forward before administering dose and for at least 30 min after administration.
• Follow administration with 3 to 4 glasses of water for adults and ½ to 2 glasses for children.
• If vomiting does not occur within 20 min, dose may be repeated.
• Do not administer with milk or carbonated beverages.
• Do not give to patient who is unconscious or convulsing.
• Do not give if patient has ingested caustic substances or oils.
• Administer activated charcoal only after vomiting has been induced and completed.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Determine what was ingested, paying particular attention to products for which ipecac is contraindicated (eg, caustic substances, oils).
• Assess patient's level of consciousness.
• Assess for adverse reactions such as CNS stimulation or depression, respiratory depression, prolonged vomiting, lethargy, or diarrhea.
• Assess effectiveness of drug shortly after administration.
• Assess respiratory rate and pattern, BP, and heart rate.
• Monitor for cardiac arrhythmias in patient receiving high doses of ipecac syrup, particularly if patient is very young (< 1 yr) or elderly.
• Notify physician if adverse reactions occur.
• Take safety precautions if sedation occurs: Place bed in low position with head of bed elevated, put side rails up, and assist patient with ambulation.
• Repeat initial dose of ipecac syrup in 20 min if first dose was not effective.
• Inform physician frequently about effectiveness of drug (frequency and amount of vomiting).
• Save all emesis for laboratory identification of ingested poison.
• If patient experiences extreme vomiting, take measures to maintain hydration, such as IV fluid support including electrolytes.
• If vomiting does not occur within 30 min after second dose, perform gastric lavage.

 Patient/Family Education

• Caution parents not to induce vomiting if child has swallowed caustic substance or petroleum product or if child is unconscious, semiconscious, or having convulsions.
• Instruct parents of children < 1 yr to keep small amount (one 30 ml bottle) on hand for emergencies.
• Instruct parents to always consult physician or poison control center before administration.
• Teach parents not to exceed recommended amounts.
• Teach families to give drug with adequate amounts of water — not milk or carbonated beverages.
• Advise parents that drug has shelf life of 1 yr and should be replaced yearly. Instruct parents to check expiration date before purchasing product.
• Do not give ipecac syrup to an unconscious or very drowsy child because vomited material may enter lungs and cause pneumonia.
• Teach parents to repeat dose if child does not vomit within 20 min and then to take child to emergency room, because gastric lavage may be necessary.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts