Ipecacuanhae Radix, B.P. Ipecacuanha Root.
Ipecacuanha root (Ipecacuanha, U.S.P.; Ipecac) is obtained from Psychotria Ipecacuanha, Stokes (N.O. Rubiaceae), a small plant indigenous to Brazil, and cultivated both there and in Selangor (Straits Settlements). The plant grows in small clumps and produces numerous fibrous roots, many of which thicken and become filled with starch. The plants are raised from the ground, the roots removed, cleaned, and dried. Several commercial varieties of ipecacuanha are distinguished:—
- Rio ipecacuanha, which is the variety chiefly used.
- Minas ipecacuanha, which is derived from the same plant, cultivated in the province of Minas Geraes in Brazil; this variety closely resembles the Rio, and contains about the same proportion of total alkaloid.
- Indian (Johore) ipecacuanha, also obtained from the same plant, cultivated in the Straits Settlements; it is rather larger than the Brazilian drug, which it otherwise closely resembles. All these three varieties are official in the B.P.
- Cartagena ipecacuanha, which with the Rio variety is official in the U.S.P., is derived from an unidentified species of Psychotria in Colombia; it is distinguished from all of the foregoing by its rather larger size (up to 10 millimetres in diameter) and by the annulations, which take the form of somewhat distant, narrow, raised ridges seldom extending quite round the root.
Rio ipecacuanha occurs in slender tortuous pieces of a reddish-brown or dark brown colour, the largest seldom exceeding 15 centimetres in length and 6 millimetres in thickness. It is characterised by its very distinct annulations, which resemble wedge-shaped discs. It is hard, breaking with a very short fracture, the transverse surface exhibiting a narrow, dense wood, in which no vessels can be detected, surrounded by a thick cortex, which is usually horny but occasionally starchy in appearance. It has a slight odour and bitterish taste. Examined under the microscope the wood is seen to consist of tracheids, the oblique ends of which are often perforated, elongated fibrous cells, and wood parenchyma, but no true vessels. The parenchymatous cells of the cortex are filled with starch grains, and here and there, with acicular crystals of calcium oxalate; there are no bast fibres. The cork consists of a few rows of narrow elongated cells. In the powdered drug the starch grains are the most conspicuous constituent; they are either simple or compound; the former are oval, or rounded grains, attaining 12μ in diameter, but never exceeding 15μ; the compound grains contain 2 to 5 constituent grains. The elements of the wood are characterised by the absence of vessels and the presence of perforated tracheids. Acicular crystals of calcium oxalate may also be found. The following admixtures with, or substitutes for, ipecacuanha root have to be guarded against:—
- Stems of P. Ipecacuanha; these are slender, cylindrical, and longitudinally striated, instead of annulated. They contain less alkaloid than the root (1.0 to 1.8 per cent.) and should not be present in appreciable quantity.
- Lesser striated ipecacuanha is dark grey in colour and constricted at irregular intervals; the cortex is violet (often dark) in colour and starchy, and the wood contains true vessels; it is probably derived from a species of Richardsonia.
- Greater striated ipecacuanha, which resembles the above, but the cortex contains sugar instead of starch, and the wood is devoid of vessels; it is the root of Psychotria emetica, Linn.
- Undulated ipecacuanha occurs in tortuous pieces bearing transverse lateral fissures; it possesses a porous wood and starchy, often violet, cortex. It is ascribed to Richardsonia pilosa, H. B. and K.
- White ipecacuanha, derived from Ionidium Ipecacuanha, Vent., and easily distinguished by its yellowish colour and want of annulations as well as by its large, porous wood.
- East Indian ipecacuanha (to be carefully distinguished from the cultivated, genuine ipecacuanha from the Straits Settlements) is the rhizome of a small monocotyledonous plant, and has the structure characteristic of such; it occurs in short cylindrical pieces, many of which are terminated with a bud, and has no central wood, being therefore easily distinguished.
All the above varieties and substitutes occur more or less frequently in commerce. Cartagena ipecacuanha is, however, the only one (other than the genuine) which is regularly imported in considerable quantity. None of them but the Brazilian (or Indian) and Cartagena contains the alkaloids characteristic of ipecacuanha. Powdered Cartagena ipecacuanha closely resembles genuine powdered ipecacuanha, but the largest starch grains often exceed 12μ and sometimes 15μ (17μ to 22μ), and the proportion of emetine to cephaeline is smaller. Ipecacuanha yields about 3 per cent. of ash on incineration.
Constituents.—The chief constituents of ipecacuanha root are the three alkaloids, emetine, cephaeline, and psychotrine, and the organic acid, ipecacuanhic acid. The root contains in addition much starch. The total alkaloid present varies in good samples of the root from 2 to 3 per cent. Of this total alkaloid, about 72 per cent. is emetine, and about 26 per cent. cephaeline, while psychotrine forms only 2 per cent. Ipecacuanha, U.S.P., should contain not less than 1.75 per cent. of alkaloids. Emetine is amorphous, but yields crystalline salts; cephaeline is crystalline. All three alkaloids are injuriously affected by light and alkalies, emetine more readily than cephaeline. Ipecacuanhic acid is a glucoside resembling quillajic acid, though it is doubtful whether it is a true saponin. Cartagena ipecacuanha contains approximately the same quantity of total alkaloid, of which, however, only 40 per cent. is emetine and 57 per cent. is cephaeline. In consequence of this difference the physiological activity differs from that of the root of P. Ipecacuanha, and the drug is therefore excluded from official use. The Brussels Conference agreed that powdered ipecacuanha should have an alkaloidal strength of 2 per cent., and that only the root bark should be powdered, the woody portion being rejected.
Action and Uses.—The properties of ipecacuanha are virtually those of its principal alkaloids, emetine and cephaeline. In small doses it is a powerful expectorant, its action lasting several hours. Large doses are powerfully irritant to the whole gastro-intestinal tract, and produce vomiting and diarrhoea. The powdered drug is extremely irritating to the nasal and laryngeal mucous membrane, producing violent sneezing and coughing. Ipecacuanha is used in small doses as an expectorant in acute and chronic bronchitis and in cough when secretion is scanty. It is well borne by children, and is largely used in croup and whooping cough. Large doses are used for their emetic action, which is exerted in twenty to thirty minutes. Doses of 1 to 4 grammes (15 to 60 grains) are given in tropical dysentery, accompanied by opium if retention is difficult. The mode of action of ipecacuanha in this respect is not clearly known, but it would appear to exert a specific effect upon the parasitic amoebae. The alkaloids of ipecacuanha are not absorbed. For children and for general use as an expectorant, the wine and vinegar of ipecacuanha are commonly used. To produce diaphoresis in incipient colds, the compound powder of ipecacuanha is most suitable in the form of powder, pill, or cachet. In chronic diarrhoea following dysentery, the powdered drug is given in pills, 3 decigrams (5 grains) in each. These are best massed with simple syrup or syrup of glucose. For this purpose and for use in acute dysentery, powdered ipecacuanha freed from emetine has been recommended, but the entire drug is preferable. Lozenges of ipecacuanha, and of ipecacuanha with morphine and pills of ipecacuanha with squill, are prepared for use in cough. Preparations of ipecacuanha are not suitable for hypodermic use.
Dose.—As an expectorant, 15 to 120 milligrams (¼ to 2 grains); as an emetic, 1 to 2 grammes (15 to 30 grains).
- Acetum Ipecacuanhae, B.P.—VINEGAR OF IPECACUANHA.
- Liquid extract of ipecacuanha, 5; alcohol, 10; diluted acetic acid, 85. Mix the liquids, filter the mixture, and add diluted acetic acid, if necessary, to make the product measure 100. Vinegar of ipecacuanha has the same action as Vinum Ipecacuanhae, but is said to give better results. On account of its acidity it should not be prescribed with alkalies. Dose.—½ to 2 mils (10 to 30 minims).
- Elixir Ipecacuanhae, B.P.C.—ELIXIR OF IPECACUANHA. 1 (miscible liquid extract) in 20.
- This preparation is of the same strength as Vinum Ipecacuanhae. Dose.—½ to 2 mils (10 to 30 minims), as an expectorant.
- Extractum Ipecacuanhae Liquidum, B.P.—LIQUID EXTRACT OF IPECACUANHA.
- Ipecacuanha root, in No. 20 powder, 100; calcium hydroxide, 10; alcohol, a sufficient quantity. Add 37.5 of the alcohol to the powdered drug, pack firmly in a percolator, add more of the alcohol, and allow to macerate for twenty-four hours, then percolate till exhausted, reserving the first 84 of percolate. Add the lime to the marc, mix, set aside for twenty-four hours; and again exhaust by percolation. Mix the last two percolates, recover the alcohol from the mixture by distillation, and dissolve the residue in the reserved percolate, finally standardise, and adjust so that the finished product shall contain from 2 to 2.25 per cent. of alkaloids. Liquid extract of ipecacuanha is used principally in the preparation of Acetum Ipecacuanhae and Vinum Ipecacuanhae; it is not very suitable for use in dispensing on account of its concentration, and because it deposits when mixed with aqueous or weak spirituous liquids. The latter objection may be obviated by the use of Extractum Ipecacuanhae, Liquidum Miscibile. Dose.—As an expectorant, 3 to 12 centimils (½ to 2 minims); as an emetic, 10 to 12 decimils (15 to 20 minims).
- Extractum Ipecacuanhae Liquidum Miscibile, B.P.C.—MISCIBLE LIQUID EXTRACT OF IPECACUANHA. Syn.—Miscible Extract of Ipecacuanha.
- This preparation yields from 2 to 2.25 per cent. of alkaloids when assayed by the B.P. process for Extractum Ipecacuanhae Liquidum. It forms a bright mixture with detannated sherry, and does not deposit readily when mixed with aqueous liquids. Dose.—As an expectorant, 3 to 12 centimils (½ to 2 minims); as an emetic, 10 to 12 decimils (15 to 20 minims).
- Fluidextractum Ipecacuanhae, U.S.P.—FLUIDEXTRACT OF IPECAC.
- Ipecac, in No. 80 powder, 100; alcohol (71 per cent.), sufficient to produce about 100. This preparation is standardised to contain 1.75 per cent. w/v of alkaloids. Average dose.—As an expectorant, 5 centimils (1 minim); as an emetic, 1 mil (15 minims).
- Glycerinum Ipecacuanhae, B.P.C.—GLYCERIN OF IPECACUANHA. Syn.—Glycerol Ipecacuanhae.
- Vinegar of ipecacuanha, 1; glycerin, 1. Used for children as an expectorant in croup and whooping cough. Dose.—2 to 4 mils (½ to 1 fluid drachm).
- Linctus Ipecacuanhae, B.P.C.—LINCTUS OF IPECACUANHA. 1 (vinegar) in 4.
- Used as a cough linctus for children, especially in whooping cough and croup. Dose.—2 to 4 mils (½ to 1 fluid drachm).
- Mistura Expectorans, B.P.C.—EXPECTORANT MIXTURE.
- Each fluid ounce contains 24 minims of vinegar of ipecacuanha, 16 minims of vinegar of squill, 2 fluid drachms of solution of ammonium acetate, 40 minims of glycerin, with a sufficient quantity of chloroform water. This mixture is used for its expectorant and diaphoretic properties. Dose.—15 to 30 mils (½ to 1 fluid ounce).
- Mistura Ipecacuanhae cum Soda, B.P.C.—IPECACUANHA MIXTURE WITH SODA.
- Each fluid ounce contains 10 minims of ipecacuanha wine, 15 grains of win sodium bicarbonate, 15 minims of aromatic spirit of ammonia, with a sufficient quantity of peppermint water. This mixture is employed as an expectorant and diaphoretic. Dose.—15 to 30 mils (½ to 1 fluid ounce).
- Oxymel Ipecacuanhae, B.P.C.—OXYMEL OF IPECACUANHA. 1 (liquid extract) in 40.
- Employed as an expectorant in croup and in the bronchial ailments of children. Dose.—2 to 4 mils (½ to 1 fluid drachm).
- Pilula Ipecacuanhae cum Scilla, B.P.—PILL OF IPECACUANHA WITH SQUILL.
- Compound powder of ipecacuanha, 60; squill in powder, 20; ammoniacum, in powder, 20; syrup of glucose, a sufficient quantity. Mix to form a mass. This pill contains about 5 per cent. of opium. Dose.—2 ½ to 5 decigrams (4 to 8 grains).
- Pilula Ipecacuanhae cum Urginea, I.C.A.—PILL OF IPECACUANHA WITH URGINEA.
- Compound powder of ipecacuanha, 60; urginea, dried and in powder, 20 ammoniacum, in powder, 20; syrup of glucose, a sufficient quantity. Mix to form a mass. This pill contains about 5 per cent. of opium, and is official in India and the Eastern Colonies. Dose.—2 ½ to 5 decigrams (4 to 8 grains).
- Pulvis Ipecacuanhae Compositus, B.P.—COMPOUND POWDER OF IPECACUANHA. Syn.—Compound Ipecacuanha Powder; Pulvis Doveri; Dover's Powder.
- Ipecacuanha root, in powder, 10 opium, in powder, 10 potassium sulphate, in powder, 80; mix the powders intimately. It is employed as a diaphoretic in incipient colds, as an anodyne in gastric pain, and to control dysentery and diarrhoea. Dose.—3 to 10 decigrams (5 to 15 grains).
- Pulvis Ipecacuanhae De-emetinisatus, B.P.C.—DE-EMETINISED IPECACUANHA POWDER.
- This preparation is free from all alkaloidal constituents of ipecacuanha root, but contains about 10 per cent. of resinous and other active constituents of the drug. It is said to be efficacious in the treatment of dysentery, without causing vomiting. Dose.— ½ to 2 grammes (8 to 30 grains).
- Pulvis Ipecacuanhae et Opii, U.S.P.—POWDER OF IPECAC AND OPIUM.
- Ipecac, in No. 60 powder, 10 powdered opium, 10; sugar of milk, in No. 30 powder, 80. Average dose.—5 decigrams (7 ½ grains).
- Syrupus Ipecacuanhae, B.P.C.—SYRUP OF IPECACUANHA. 1 (vinegar) in 2.
- Used as an expectorant for children in croup, whooping cough, etc. Dose.—2 to 8 mils (½ to 2 fluid drachms).
- Syrupus Ipecacuanhae, P.I.—SYRUP OF IPECACUANHA, P.I.
- Contains 1 part, by weight, of tincture of ipecacuanha with 9 parts, by weight, of simple syrup.
- Syrupus Ipecacuanhae, U.S.P.—SYRUP OF IPECAC.
- Fluidextract of ipecac, 7; acetic acid (36 per cent.), 1; glycerin, 10; sugar, 70; water, sufficient to produce 100. Average dose.—1 mil (15 minims), as an expectorant; 15 mils (4 fluid drachms), as an emetic.
- Tablettae Ipecacuanhae cum Scilla, B.P.C.—IPECACUANHA TABLETS WITH SQUILL.
- Each tablet contains compound powder of ipecacuanha, 2 grains; squill, grain; and ammoniacum, 2 grain. Each tablet is approximately equal to 2 ½ decigrams (4 grains) of the corresponding official pill mass. Dose.—1 or 2 tablets.
- Tinctura Ipecacuanhae. P.I.—TINCTURE OF IPECACUANHA, P.I.
- Strength, 10 per cent. Prepared by percolation with alcohol (70 per cent.).
- Tinctura Ipecacuanhae et Opii, U.S.P.—TINCTURE OF IPECACUANHA AND OPIUM. Syn.—Tincture of Dover's Powder.
- Tincture of deodorised opium, 100; fluidextract of ipecac, 10; alcohol (49 per cent.), sufficient to produce 100. The tincture is evaporated to 80 by weight, the fluidextract added, and the product made up to the required volume. Average dose.—5 decimils (8 minims).
- Trochiscus Ipecacuanhae, B.P.—IPECACUANHA LOZENGE.
- Each lozenge contains ipecacuanha root, in powder, ¼ grain; with fruit basis. Ipecacuanha lozenges are used as an expectorant in cough. They act as an irritant to the stomach, causing a reflex effect on the bronchiolar secretion. Dose.—1 to 3 lozenges.
- Vinum Ipecacuanhae, B.P.—IPECACUANHA WINE.
- Liquid extract of ipecacuanha, 5; sherry, 95. Mix the liquid extract with the sherry, set aside for forty-eight hours, and filter. Ipecacuanha wine is a valuable expectorant, acting reflexly on the bronchial secretion through the stomach. There is no evidence to show that it is absorbed. It is used especially for children in croup, whooping cough, etc. It is used as a spray in bronchitis .and asthma, diluted with an equal quantity of water if necessary. Dose.—½ to 2 ½ mils (10 to 30 minims), as an expectorant; as an emetic, 15 to 23 mils (4 to 6 fluid drachms).
- Vinum Ipecacuanhae, U.S.P.—WINE OF IPECAC.
- Fluidextract of ipecac, 10; alcohol, 10; white wine, to 100. Average dose.—1 mil (15 minims).