Common Name:
Ipecac
Botanical Name:
Cephaelis ipecacuanha (Brot.) A. Rich or C. acuminata Karsten
Family:
Rubiaceae
Parts Used:
Dried roots and rhizomes.
Constituents:
Alkaloids (2.0 - 3.5%): emetine, cephaeline, psychotrine,
psychotrine methyl ether, and emetamine.1
The ratio of emetine to cephaeline in C. ipecacuanha is 2:1, while
in C. acuminata it is 1:1 to 1:2.6.2
Monoterpenoid isoquinoline glucosides: ipecoside, alangiside, and
others.3
Iridoid glucosides: sweroside and 7-dehydrologanin
Starch 30-40%
Calcium oxalate
Pharmacological Actions:
Expectorant
Emetic
Anti-amoebic
Historical Note:
Cephaelis ipecacuanha, known in commerce as Matto Grosso or
Brazilian ipecac, is a small evergreen shrub gathered primarily in
the Matto Grosso district of Brazil where plantations have been
established. It is also cultivated in Burma and Malaya but without
much success. C. acuminata, traded as Costa Rica ipecac, is
exported primarily from Costa Rica and to a lesser extent from
Columbia and Nicaragua.4 Europeans learned of ipecac in 1672
via the indigenous people of what is now Brazil where the root was
prized as a treatment of dysentery and as an expectorant. Today,
many households keep a bottle of ipecac syrup in the medicine
cabinet in case of accidental poisoning, especially in children.
Pharmacology:
Emetine and cephaeline are major constituents of ipecac root.
These alkaloids have a strong irritant effect upon the upper
gastrointestinal tract. Ipecac causes vomiting by this direct irritant
effect upon the stomach and via its effect on the chemoreceptor
trigger zone (vomiting center) in the area postrema of the medulla.5
Irritation of the upper gastrointestinal tract causes vomiting as
afferent impulses are relayed to the vomiting center in the medulla.
Increased salivation and nausea are the first signs of gastric
irritation. When taken in the recommended amount, emesis occurs
in 20-30 minutes.
Copyright Tieraona Low Dog, MD. 2008.
Most substances that cause vomiting have an expectorant and
strong secretolytic action when taken in small doses. Ipecac
causes a thin, watery secretion to be produced in the lungs. These
thin secretions “loosen up” thick, viscous phlegm so that it may be
more easily expectorated. Hence, the addition of ipecac to a
number of proprietary cough and cold medicines. At one time C.
ipecacuanha was preferred over C. acuminata because it was
believed that cephaeline had less expectorant activity and was
more toxic. This has not proven to be true. Emetine and
cephaeline have roughly the same toxicity and expectorant
activity.6
Emetine, and to a lesser extent cephaeline, both exhibit antiamoebic activity. Ipecac can be used to treat Entamoeba
histolytica, a major cause of amoebic dysentery.7
Applications:
Respiratory: Ipecac is included in a number of European
proprietary formulas for the treatment of cough with thick sputum.
It is of no value for respiratory illness accompanied by thin, watery
phlegm. The British Herbal Compendium recommends it for
chronic bronchitis, early stages of acute bronchitis, and whooping
cough.8
Gastrointestinal: Ipecac is commonly employed in the case of
accidental poisoning. Vomiting occurs usually 20 minutes after
administration.
The roots were originally used by Brazilian peoples for the
treatment of amoebic dysentery. The tincture is still employed by
a number of herbalists for this purpose.
Contraindications: Ipecac should never be used when corrosive poisons such as strong
acid or alkali have been consumed or after ingestion of petroleum
distillates (kerosene, gasoline). Vomiting should not be induced if
the patient is comatose because of the risk of aspiration.
Adverse Effects:
Ipecac is safe when used in the recommended doses for the
appropriate condition, however, overdoses can result in major fluid
imbalances, muscle weakness, shortness of breath, tachycardia,
and death.
Herb-Drug Interactions:
None known.
Dosage & Preparation:
Syrup of ipecac is available in 15 and 30 ml. bottles over-thecounter. The oral dose for accidental poisoning is 15 ml. in
Copyright Tieraona Low Dog, MD. 2008.
children from 6 months to 12 years and 30 ml. in older children
and adults followed by a full glass of water. Always contact your
local poison control center before administration.
Tincture (1:10): 0.5-1.0 ml. TID for expectoration. This equals
approximately 50-100 mg. of the dried rhizome and root. The
BHC states that the equivalent of 0.5-2.0 mg. alkaloids should be
taken up to five times daily as an expectorant.9 (The BPC includes
the addition of acetic acid.)
The dose depends upon the strength of the tincture, ADJUST
ACCORDINGLY.
Fluid Extract (1:1): not recommended. There is too much risk of
toxicity.
Author’s Notes:
As a reflex bronchomucolytic, ipecac is an excellent remedy for
use in cases of thick sputum that is difficult to expectorate. In low
doses, it is rare for patients to experience nausea and if it should
occur, a reduction in dose is all that is required.
Evans WC. Trease & Evans’ Pharmacognosy 14th Ed. WB Saunders Company, Ltd, London, 1996.
Pages 377-78.
2
PC Bradley, Ed. British Herbal Compendium: A Handbook of Scientific Information on Widely Used
Plant Drugs, Vol. 1. British Herbal Medicine Association, Dorset, England, 1996. Pages 133-34.
3
Ibid.
4
Ibid.
5
Hardman JG, Limbird LE. Eds. Goodman & Gilman’s The Pharmacological Basis of Therapeutics 9th
Ed. McGraw-Hill Publishers, New York, 1996. Pages 71-72.
6
Wichtl M. Herbal Drugs & Phytopharmaceuticals: A Handbook for Practice on a Scientific Basis. NG
Bisset, Ed. Medpharm Scientific Publishers, Stuttgart, Germany 1994. Pages 276-77.
7
Ibid.
8
PC Bradley, Ed. British Herbal Compendium: A Handbook of Scientific Information on Widely Used
Plant Drugs, Vol. 1. British Herbal Medicine Association, Dorset, England, 1996. Pages 133-34.
9
Ibid.
1
Copyright Tieraona Low Dog, MD. 2008.