Halting Ipecac Abuse

Ipecac syrup has long been used to induce vomiting after poisons or other toxic materials have been swallowed. It usually produces vomiting within 15 to 60 minutes. According to Tomas J. Silber, MD, of Children’s National Medical Center, Washington, DC, ipecac abuse has repeatedly been reported as a cause of morbidity and mortality among teenagers and young adults.

Dr. Silber reported that ipecac abuse occurs predominately among young women who are either experimenting with purging, or those developing an eating disorder, or among those who already have anorexia nervosa (binge eating, purging type) or bulimia nervosa. About 5% of persons with eating disorders surreptitiously abuse ipecac, most in an attempt to lose weight.

Some of the more serious side effects of the widely used emetic include myocarditis with arrhythmias, myositis, gastroesophgeal disorders, including Mallory Weiss tears, diarrhea, and metabolic abnormalities such as alkalosis, hypokalemia, and dehydration. Once use of ipecac is halted, these conditions usually can be reversed. Deaths have been reported, usually in connection with cardiovascular problems.

Suspicious signs

Dr. Silber reports that detecting ipecac abuse requires a high index of suspicion. Some telltale signs include abnormal findings on standard electrocardiograms and echocardiograms and/or elevation of muscle enzymes (creatine phosphokinase, or CPK, and aldolase). In addition, emetine, the alkaloid in ipecac, can be identified in serum, urine, and tissue with high-performance liquid chromatography.

As Dr. Silber reported at the 2004 International Conference on Eating Disorders in May, toxicologists are currently questioning the value of using ipecac for childhood poisoning. According to Dr. Silber, changing ipecac’s over-the-counter status, making it available only by prescription, could eliminate or significantly reduce its potential for abuse.