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.