Ipecacuanha (Cephaelis Ipecacuanha).

Botanical name: 

Related entries: Euphorbia ipecacuanha

The root of (1) Cephaelis Ipecacuanha (Brotero), A. Richard, or of (2) Cephaelis acuminata, Karsten (Nat. Ord. Rubiaceae). Brazil and other parts of South America. Dose, 1 to 20 grains.
Common Names: Ipecac, (1) Rio Ipecac, (2) Cartagena Ipecac.

Principal Constituents.—The alkaloids emetine (C30H44N2O4), cephaeline (C28H33N2O4), cephaelic (ipecacuanhic) acid, volatile oil, tannin, etc.
Preparations.—1. Pulvis Ipecacuanha, Powdered Ipecac. Dose, 1 to 20 grains. (Usual emetic dose, 10 to 15 grains.)
2. Specific Medicine Ipecac. Dose, 1/30 to 20 drops (for specific purposes the fractional dose is employed).
3. Syrupus Ipecacuanha, Syrup of Ipecac. Dose, 1 to 20 minims (expectorant); 2 to 4 fluidrachms (emetic).
4. Alcresta Ipecac. Dose, 1 tablet daily.

Specific Indications.—Irritation with long and pointed tongue, with reddened tip and edges, and accompanied by nausea and vomiting, with or without fever; irritation with increased secretions; irritation of stomach, bowels, bronchial tubes, bronchioles, and pulmonic air cells, and nervous system; irritative diarrhoea; dysentery, with the ipecac tongue; acute bowel disorders with increased secretion; hypersecretion of bronchial fluid with mucous rales (minute dose); diminished expectoration (medium doses); irritative cough, with or without dyspnea; hoarseness from coughs and colds; hemorrhage; menorrhagia (medium doses); as an emetic when the stomach is overloaded or in foul condition, with broad, flabby and slimy tongue (full doses).

Action.—Ipecac, in material amounts, is irritant to the skin and mucosa. Applied by inunction it excites irritation, and produces vesicular and pustular eruptions and sometimes ulcers. When inhaled it causes heat and violent sneezing. In susceptible individuals the powdered drug excites pronounced attacks simulating asthma, the chief symptoms being great dyspnea, with wheezing respiration and cough, and marked anxiety and prostration. This is often accompanied by violent and prolonged sneezing and spitting of blood, and followed usually by a free expectoration of mucus. In doses of less than 1 grain, ipecac is a gastric tonic and hepatic stimulant. Large doses (15 grains or more) are emetic. If emesis fails catharsis may result; or both emesis and purgation may be produced by it. Ipecac feces are peculiar-bilious and mush-like. From 3 to 10 grains of the powdered drug will cause nausea, with more or less depression of the pulse, languor, diaphoresis, and increase of mucous secretion. As an emetic it is fairly slow (15 to 20 minutes), active and thorough, causes much nausea and muscular straining, and the ejection of a large quantity of mucus. A state of tolerance may be established by the prolonged use of ipecac. Though said to have no appreciable effect upon the circulation, the therapeutic action of small doses seems to controvert this statement, a stimulating effect accepted in Eclectic therapy as special sedation resulting.

Emetine has produced death by gastro-intestinal inflammation and cardiac paralysis.

Therapy.—The field of therapeutic activity of ipecac is restricted chiefly to the digestive and respiratory tracts, and to some extent to the blood vessels, acting as a hemostatic. It is decidedly irritant to mucous surfaces, particularly that of the nasal passages, and in some individuals will precipitate an attack simulating spasmodic asthma. It increases biliary activity, is expectorant in small doses, and emetic in full doses, and there is evidence that it possesses antiseptic qualities.

Ipecac is used chiefly for five great purposes: (1) In full doses as an emetic; (2) in small doses as a nauseant expectorant; (3) to check active hemorrhage; (4) to check vomiting; (5) and as employed mostly in Eclectic therapy, to control irritation and inflammation of the mucous passages of alimentation and respiration.

The chief specific indications are: (1) The full, broad tongue, heavily coated, with constant nausea or vomiting. Here it should be used in full doses as an emetic; (2) irritation of digestive tract, with long, pointed, reddened tongue and tendency to nausea, vomiting, diarrhea or dysentery; (3) scanty expectoration, with irritative cough and hoarseness; (4) active hemorrhage.

The conditions demanding the specific use of ipecac are those showing irritation, capillary engorgement, and hypersecretion.

As an emetic ipecac is not suited for emergency cases, such as poisoning, if other more suitable and more rapid emetics can be procured. Zinc sulphate or apomorphine is more prompt and more certain in poison cases, especially narcotic poisoning. But for the purpose of relieving the stomach of its contents when overloaded, or when food is fermenting and undergoing faulty digestion, and the tongue is heavily coated, the breath foul, and nausea, or vomiting imminent, a full emetic dose of ipecac is justifiable and efficient. In this way it often relieves gastric distress and pain, being of very great value in acute indigestion, and checks bilious attacks with sick headache due to the causes mentioned.

One of the therapeutic facts long ago recognized by those whose eyes are not otherwise open to the utility of specific medication is that ipecac (though a common emetic), in very small doses, is one of the best of antiemetics. This is most easily accomplished when the tongue is red and pointed and shows evidence of irritation. There are other cases, however, in which the nausea depends upon foul accumulations in the stomach. The tongue is then broad, flabby, and slimy, and nausea is pronounced. In such instances a full emetic dose may be given, and if nausea and vomiting then persist it may be followed by minute doses. This usually is effective. Ipecac in small doses is one of the recognized agents of value in the nausea and vomiting of pregnancy.

Ipecac is often lost sight of as a remedy for active hemorrhage. Of course, it operates best where the quantity of blood lost is small. We have seen most excellent results follow its use in hemoptysis and in the hemorrhage from gastric ulcer. It should not be given in doses large enough to cause emesis. In typhoid fever it is less valuable than carbo-vegetabilis or gallic acid, but may be used for the bloody discharges of dysentery. It may also be exhibited in nosebleed, haematuria and in menorrhagia, in the latter case often doing excellent service when given in a single full dose.

The greatest value of ipecac lies in its beneficient effect upon irritation of the gastric and intestinal mucosa. The long, pointed tongue, with reddened tip and edges, the uneasiness and pain, the tendency to diarrhea and particularly to dysentery, and the disposition to nausea are so completely met by it as to give it prominence among the specific medicines for acute diseases of stomach and bowels. If there is fever, it should be given with the indicated sedative, usually aconite. It is especially a remedy for summer disorders of children. It, together with aconite and magnesium sulphate, forms the best treatment for acute dysentery with muco-sanguineous passages. For this purpose we have used it invariably and always with complete success.

Ipecac in large doses (20 to 60 grains), administered after a preceding dose of opium to produce sedation, is considered one of the most certain methods of meeting amebic or tropical dysentery and preventing the subsequent formation of hepatic abscess. This is followed every four hours with twenty-grain doses, tolerance having become established until the peculiar mush-like ipecac stools are produced.

Ipecac finds a prominent place in acute gastric irritation, in gastric inflammation, in acute hepatitis, in enteritis, and particularly in cholera infantum of the irritative type. It is especially useful in acute mucous diarrhea and in the diarrhea of dentition. In all abdominal conditions requiring ipecac there is the characteristic tongue—long, with reddened tip and edges, and prominent papillae. There is tenderness upon pressure, and the patient is noticeably irritable, and easily disturbed by noises. There is vascular irritability and marked hyperaesthesia. All the faculties are preternaturally acute and the patient extremely sensitive. In such cases no remedy will render better service than ipecac, given in small doses. Often there is the white line around the mouth, contraction of tissue, with pinched countenance; and even if there is no fever, there is a suggestion of approaching nervous explosion, so great is the hyperaesthesic condition of the little patient. In such instances it is decidedly calmative, relaxant and soothing; but the dose must be guarded to keep it below the nauseant point.

A new field for ipecac and its alkaloid particularly is the endamebic infection, pyorrhoea alveolaris. The specific medicine may be used around the teeth or emetine injected; and it has been suggested that ipecac preparations form a part of the daily mouth wash. The use of alcresta ipecac has produced some remarkable results in pyorrhea. However, it has become established that there are different types of pyorrhea, and that the emetine treatment often fails, and its early reputation as a specific has not been sustained. Still it is the most useful treatment so far advised, and will be used until a better one can be devised.

Ipecac is used less, perhaps, as an expectorant in Eclectic practice than by members of the dominant school. Still, where there is a short, irritative cough, with lack of secretion (nauseant doses), and in cases with excessive secretion (stimulant doses), small doses of ipecac are decidedly useful. It is also valuable in harsh, croupal cough and in explosive cough and in irritable conditions brought on by too frequent or violent use of the voice. Thus it finds a place in the treatment of common colds, bronchitis, broncho-pneumonia and pneumonia, la grippe, and in the cough of measles. Taken internally and sprayed locally, it is one of the greatest remedies for hoarseness due to atony of the vocal cords, and for aphonia due to either irritation or atony of the vocal apparatus. It must not be expected to cure such conditions when due to a tubercular larynx, but many such cases may be temporarily ameliorated by such treatment. It is less valuable in croupous conditions than lobelia, but if used in the various forms of croup, emesis should be gradually (not suddenly) provoked by repeated moderate doses.

The dose of ipecac as an emetic is 15 to 20 grains, in plenty of warm water. For other purposes the following usual prescription may be used: Rx Specific Medicine Ipecac, 5-15 drops; Water, 4 fluidounces. Mix. Sig.: One teaspoonful every 2 or 3 hours, as indicated.

The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.