Ipecac, Cautions

Adverse reactions
Large doses of Radix Ipecacuanhae have an irritant effect on the gastrointestinal tract, and may induce persistent bloody vomiting or diarrhea.

Mucosal erosions of the entire gastrointestinal tract have been reported. The absorption of emetine, which may occur if vomiting is not induced, may give rise to adverse effects on the heart, such as conduction abnormalities or myocardial infarction. These, in combination with dehydration, may cause vasomotor collapse followed by death. Chronic abuse of the roots to induce vomiting in eating disorders has been implicated in the diagnosis of cardiotoxicity and myopathy due to the accumulation of emetine . Adverse effects of repeated vomiting, such as metabolic
complications, aspiration pneumonitis, parotid enlargement, dental abnormalities, and oesophagitis or haematemesis due to mucosal lacerations may be observed . Cardiovascular toxicity, manifesting as muscle weakness, hypotension, palpitations and arrhythmias, may occur . Death was reported for one subject who had ingested 90–120 ml of a
syrup prepared from the roots per day for 3 months.

Prolonged vomiting has been reported in 17% of patients given the roots for the treatment of poisoning, which may lead to gastric rupture, Mallory-Weiss lesions of the esophagogastric junction, cerebrovascular events, pneumomediastinum and pneumoperitoneum .

Allergy to the roots was reported after inhalation of powdered roots, characterized by rhinitis, conjunctivitis and chest tightness .

There have been a number of deaths reported in small children due to an overdose owing to the substitution of 10.0–60.0 ml of a fluid extract of the roots for a syrup prepared from the roots . It is believed that the fluid extract was mistaken for the syrup. The fluid extract is 14 times more potent than the syrup.

Other adverse reactions to the roots include severe diarrhea, nausea and abdominal cramps

<h2>Contraindications</h2>

While emesis is usually indicated after poisoning resulting from oral ingestion of most chemicals, emesis induced by Radix Ipecacuanhae is contraindicated in the following specific situations:

<ul>

<li>following ingestion of a corrosive poison, such as strong acid or alkali;</li>

<li>when airway-protective refl xes are compromised, for example in patients who are comatose or in a state of stupor or delirium;</li>

<li>following ingestion of a central nervous system stimulant, when vomiting may induce convulsions;</li>

<li>in cases of strychnine poisoning; or following ingestion of a petroleum distillate</li>

<li>Radix Ipecacuanhae has been used as an abortifacient in traditional medicine and its use is therefore contraindicated during pregnancy. </li>

<li>The roots should not be given to patients in shock, at risk of seizure, or with cardiovascular disorders</li>

<li>Do not exceed recommended doses. Do not give the fluid extract to children. For children up to 6 months of age, the syrup should only be administered under the supervision of a physician.</li>

</ul>

<h2>Drug interactions</h2>

The emetic action of the roots may be delayed or diminished if given with or after charcoal. Concomitant administration of milk was believed to reduce the efficiency of emesis induced by the roots. However, no significant differences in the time to onset of vomiting, the duration of vomiting, or the number of episodes were observed in 250 children who were given a syrup prepared from the roots with milk compared with 250 children given the syrup with clear fluids.

Decreases in the absorption of paracetamol, tetracycline and aminophylline were observed after concomitant administration of 20.0 ml of an aqueous extract of the roots.