Ipecac. Cephaelis ipecacuanha.

Synonym—Ipecacuanha.

CONSTITUENTS—

Emetine., the emetic principle existing in the stem, leaves and root, cholin and cephaeline in the root, ipecacuanhic acid, and a nauseating ethereal oil.

PREPARATIONS—

Extractum Ipecac Fluidum, Fluid Extract of Ipecac; dose, from one to forty minims.

Syrupus Ipecac, Syrup of Ipecac; dose, from ten to sixty minims.

Pulv. Ipecac et Opii, Powder of Ipecac and Opium, composed of Ipecac and opium of each ten parts, Sugar of Milk, eighty parts; dose, from three to ten grains.

Specific Medicine Ipecac; dose, for gastric, intestinal or bronchial irritation, five drops in four ounces of water; a tablespoonful every hour. As an emetic, from five to twenty minims in hot water.

Alcresta Ipecac is prepared by the action of Lloyd's reagent on the solution of the alkaloids of ipecac. It represents the medicinal properties of the ipecac, but will not produce nausea or emesis. It is superior to emetine in its general use because it is not hypodermic. One tablet represents ten grains of the powdered ipecac. It may be given in doses of one, two or three tablets three times per day, before meals,

Physiological Action of Ipecac, (J. U. Lloyd, Ph.D., LL.D., Ph. M., Western Druggist).—Ipecacuanha root, from its first appearance in our materia medica, has been prized as an emetic and anti-dysenteric remedy.

The peculiar effect that the dust of ipecacuanha powder exerts upon the respiratory organs of some persons has been noted by early observers. Lewis, in 1761, makes the following statement: "Geoffroy observed that in pulverizing considerable quantities, the finer powder that flies off, unless great care be taken to avoid it, is apt to afflict the operator with difficulty of breathing, spitting of blood and bleeding at the nose, or swelling and inflammation of the eyes and face, and sometimes of the throat, adding that these symptoms disappear in a few days, usually spontaneously. Poisoning in this manner may be treated by blood-letting and the taking of a decoction of uva ursi and extract of rhatany; in another more recent instance, relief was afforded by a dose of extract of quebracho."

Powdered ipecac applied to the skin produces irritation and redness, followed finally by small isolated pustules, which increase in size to small ulcers.

The powdered ipecac in one-sixth of a grain doses is a stomachic tonic, stimulating the salivary and gastric secretions. In doses of ten grains it will act as a nauseating, emetic, but the emesis occurs slowly and is not extreme, persistent nor prostrating like that of lobelia or tartar emetic.

In some cases continued repetition of the emetic dose produces a toleration, when the emetic effect ceases, but there is diarrhea—an active cathartic influence, with stools characteristic of this agent. In some children the persistent use of the syrup of ipecac will invariably produce diarrhea often persistent and difficult to cure.

The agent is also diaphoretic and actively expectorant.

Emetine was first isolated as the emetic principle of ipecac in 1867. In 1894 the other alkaloid cephaeline was discovered. In 1912 it was determined that emetine destroyed the ameba which has been known to be the cause of epidemic amebic dysentery, of a form of hepatitis, and also as the cause of pyorrhea, commonly called Rigg's disease, and other conditions of less importance. This important discovery has placed this alkaloid (like the hypodermic use of lobelia has placed that important remedy) in a most conspicuous position, making it at once a specific for the conditions named. Alcresta ipecac is exercising the same specific influence.

Dr. H. Barlow, Chief Surgeon to the Hospital at Cuyamel, Honduras, now using these preparations, says: "My impressions are that while Alcresta ipecac cannot replace emetine in cases which can be seen daily, or in severe cases, it has certain uses in which it is superior to emetine. These are:

1. Cases in which there is an insuperable objection to hypodermic injections;
2. Cases living at such a distance or too poor to make daily visits to a physician;
3. In the after treatment of cases which have been relieved by the treatment of emetine;
4. In the treatment of carriers; and
5. In the treatment of cases of Craigiasis, which indeed cannot be treated so well with emetine alone as with emetine combined with some preparation of ipecac which can be administered orally."

The endameba which is the specific cause of Pyorrhea Alveolaris is almost invariably destroyed by Alcresta Ipecac. Bass and Johns found that the germ would disappear from all lesions in from one to three days in ninety per cent of the cases, and in six days from ninety-nine per cent of the cases. They found it as efficient in most cases as emetine. The peculiar combination involved in this substance prevents the alkaloids from being dissolved in acid or neutral solutions. Thus it passes unchanged through the stomach without inducing nausea in any form. The alkaloids are permitted full activity in the intestinal tract. The local influence of this agent upon the endameba in the mouth is very prompt and satisfactory.

In extreme inactive conditions of the stomach and bowels, with or without pain—the inactivity shown by a broad, pallid tongue, covered very thickly with a dirty white coat, which finally becomes sleek on the top, increasing from tip to base in dirtiness, to a brown color-full emetic doses of the common forms of ipecac persisted in for a short time will quickly correct almost the entire train of symptoms.

Specific Symptomatology—Persistent irritation in mucous membranes, with deficient secretion, demand ipecac in small closes.

Persistent nausea and vomiting, with pale, relaxed membranes, white-coated, broad tongue, will often yield most readily to minute doses (1/10 of a drop) frequently repeated.

Bronchial gastric or intestinal irritations are benefited by its use. It is indicated also in croup, with sudden dypsnea and threatening suffocation, extreme secretion, without ability to dislodge. Half teaspoonful may be given.

Therapy—For its emetic influence ipecac is one of the most satisfactory of the emetics. When there is undigested food in the stomach, causing irritation, when mild poisons are taken, when emesis is demanded to relieve sick headache, this agent is used in preference to others. If promptness of action be demanded the full dose should be given in a bowl of warm water—not hot—or a single full dose of lobelia may be given with it. This produces immediate emesis without prostration. If powerful poisons are taken, and active emesis is demanded, the sulphate of zinc or lobelia in persistent doses, or some other emetic more immediate in its influence, is usually used, although the writer has always been able to adjust ipecac with such adjuvants as warm water, mustard, or tickling of the throat, to every case. In cases where foreign bodies are lodged in the esophagus, and in the threatened suffocation of mucous croup, or in membranous croup, ipecac is the remedy, especially in childhood. No emetic more harsh should be used with children. In the developing stage of malarial fevers it was once the practice to produce active diaphoresis by a hot pediluvium and hot drinks, the patient being wrapped in warm blankets, and to produce profound emesis with ipecac. Often the most desirable results were obtained, and in some cases where an acute cold had been contracted or where there was a severe chill, in strong, previously healthy patients, the disease, was suddenly terminated by this course. The author has had this experience. In the bronchitis of childhood occurring often suddenly, with a dry, hoarse, stridulous or croupal cough, without secretion, ten drops of the syrup of ipecac given every half hour, hour, or two hours until nausea in induced, will sometimes abort the condition in a few hours, the influence of the agent dissipating the conditions essential to the progress of the disease. This form of bronchitis is common in furnace-heated houses, and in close, hot, unventilated apartments, in the beginning of the winter when the furnace fire is first started, and in the spring.

Ipecac in small doses given in conjunction or in alternation with aconite or bryonia or belladonna, is of great service in pneumonia, especially that of childhood. Five drops in a half glass of water, a teaspoonful every hour, may be given with the best of results. In acute bronchitis it may be prescribed in the same manner.

Ipecac is of value also in the after stages of pneumonia. In the stage of active inflammation it is useful as stated, but is not given in the same. form as in the later stages. It is an excellent remedy to assist in clearing up hepatization and in restoring normal conditions in the lung cells. The author, when the temperature has subsided, gives one-fourth to one-half a grain of powdered ipecac to an adult, every two or three hours in a capsule, with two grains of the bisulphate of quinine. The tonic influence of the quinine assists the influence of the ipecac.

Ipecac is of value in coughs when there is a deficient secretion, whatever the cause. Emetic doses are not desirable if the agent is to be continued for a length of time.

It has been beneficial in spasmodic asthma, whooping cough and in laryngismus stridulus.

This agent is advised in irritation of the bowels resulting in acute inflammation. In small doses it is given with good results in cholera infantum and in diarrheas, but is of no benefit beyond the acute stage.

While ipecac has been known as a cure for certain forms of dysentery for more than a century, the use of its active principle emetine as a cure for amebic dysentery is just now coming into prominence. Our writers have always advised ipecac for this disease, but not all have given it in sufficiently large doses. Administered now in the form of alcresta ipecac or emetine hypodermically, the cures are prompt and highly satisfactory. In fact, the remedy is already being classed with quinine for malaria, and antitoxin for diphtheria, as one of the great specifies.

If the dysenteric tenesmus is relieved with prompt doses of gelsemium—and we have a no more efficient remedy in the materia medica for this condition than that agent—the beneficial effects of the ipecac upon the local inflammatory processes will be more plainly marked.

Recent observers in the general hospital in Calcutta, India, have found that large doses of ipecac have most beneficial effects in amebic hepatitis and hepatic abscess. If the diagnosis be made before the formation of pus, this is prevented by the agent. It should be given when the patient suffers with a general feeling of lassitude, foul tongue, pain in the right shoulder and in the right hypochondrium. The liver is enlarged and tender on pressure. There is marked leukocytosis but the polynuclear increase is not great. Ipecac is given in these cases in single large doses, usually from twenty to thirty grains, given at least two hours after eating and best taken at bedtime. Occasionally this dose is given twice daily in capsules.

Frazier claims that ipecac in large doses is an excellent addition to the treatment of typhoid fever. In five cases where he used it, the temperature dropped suddenly so that within four days it was normal. In the earlier stages he gave thirty grains on the first day; twenty-five the next; twenty the next and so on down until ten. He gave small doses of opium to keep the patient from vomiting. The results were pronounced. This course is worth trying.

The successful use of this common remedy, in the treatment of epilepsy has been reported, since our first edition. Persistent cases have been treated, with ten minim doses of a strong fluid extract, increased to forty minims. This has been persisted in according to the susceptibility of the patient. The action of emetine or alcresta ipecac should be at once determined for the above conditions.

In hemorrhages Ipecac has exercised a satisfactory influence. Its action upon the circulation is quite prompt. It is given by some physicians in small doses for this purpose, and by others in full doses to prompt emesis. It has controlled postpartum hemorrhage, menorrhagia, metrorrhagia, epistaxis and hemoptysis, and will exercise a beneficial influence in hematuria.

The American Materia Medica, Therapeutics and Pharmacognosy, 1919, was written by Finley Ellingwood, M.D.
It was scanned by Michael Moore for the Southwest School of Botanical Medicine.