Ipecac: Don't use it

What is ipecac syrup?

Ipecac syrup is a medicine that causes vomiting. In the past it was used to partially empty a person’s stomach after a poison. It is now rarely recommended. 

It is not necessary to keep ipecac syrup in your home. 

In case of a poisoning, use the webPOISONCONTROL^® tool for guidance or call your poison center at 1-800-222-1222.

What happened to ipecac syrup? 

For years, parents were told to keep ipecac syrup at home. This medicine was used to make a child vomit after swallowing poison. Now, your doctor doesn't tell you to keep it. Your poison center doesn't tell you to use it. You can’t even buy ipecac in the drugstore. 

What happened? And what should you do now? 

The short story: If you think someone has been poisoned - whether the poison was swallowed, breathed in, or splashed on someone’s skin or eyes - use the webPOISONCONTROL^® online tool to get help, or call your poison center at 1-800-222-1222. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day. Most of the time, you can stay safely at home. But, be prepared: 

• Order phone stickers and magnets with the poison center emergency number from your local poison center.

• Try the webPOISONCONTROL online tool before you need it. But be sure to check "this is not a real case" before you start, so your case won't be included in public health statistics.

• Follow first aid instructions for poisoning. Act fast to minimize the effects of poison.

The longer story: It seemed to make sense. If someone swallowed poison and then threw up, they shouldn't get sick. This treatment approach was used for decades. People who swallowed poison used to be given many ineffective remedies: 

• raw egg white; 

• mustard; 

• the "universal antidote" of burnt toast, tannic acid and milk of magnesia; 

• salt water; 

• tickling the back of the throat.

Sometimes, these remedies did cause vomiting. But they often caused problems of their own. For example, too much salt caused sodium poisoning, seizures and even death. Gagging someone often caused throat bleeding and swelling. Also, these home remedies were never reliable enough to be used to treat poisoning. And complicated charts about what remedy went with what poisoning were confusing. 

Small brown bottles of ipecac syrup seemed to solve these problems. When given to children or adults, ipecac made most of them throw up within 20-30 minutes. Starting around the 1960’s, standard parenting advice included keeping a bottle of ipecac syrup at home. In fact, many pediatricians and health clinics gave ipecac to parents, “just in case”. 

What we know now: It turns out that a big piece of the picture was missing. Yes, ipecac made people throw up, whether or not they swallowed poison. But did throwing up keep them from actually getting sick from the poison? 

After decades of ipecac use for poisoning, researchers looked at all of the evidence about ipecac syrup. They agreed that ipecac syrup reliably caused vomiting. They also agreed that this didn't make any difference! In other words, there was little research to show that people who swallowed ipecac after poisoning did any better than others. 

In addition, this review highlighted some problems with ipecac: 

There are times when ipecac is unsafe. It shouldn't be given to someone who swallowed chemicals that cause burns on contact or medicines that can cause seizures very quickly. It can be dangerous to people with some types of medical problems. When such poisoning victims got ipecac anyway, they developed serious complications or even died.  More and more people with eating disorders were using ipecac to make themselves throw up. Regular use of ipecac syrup is dangerous; for example, chronic users have died from heart problems. Sometimes people vomiting after ipecac could not keep down other drugs they needed to treat their poisonings.

Based on these facts, pediatricians, poison experts, and federal regulators re-evaluated the use of ipecac. Follow the links at the end for the fine print. 

Should you keep ipecac at home? 

The American Academy of Pediatrics recommends that ipecac syrup NOT be stocked at home.  Likewise, the American Association of Poison Control Centers no longer recommends that parents keep ipecac syrup at home.  The U.S. Food and Drug Administration is considering a recommendation from one of its expert panels to make ipecac syrup a prescription-only drug. To date, FDA has not acted on the panel's recommendation.  It is no longer recommended that parents stock ipecac syrup at home. In fact, ipecac syrup is no longer manufactured. 

I hear about activated charcoal . . . Activated charcoal is a medicine that is used to treat some serious poisonings. It is often given in emergency rooms and sometimes, but rarely, at home. 

Most poison centers also don't recommend that parents keep activated charcoal at home. It goes back to research. Most studies do not show a benefit to keeping and giving activated charcoal at home.  

The bottom line: Parents, child care providers, and everyone who spends time with children should make webPOISONCONTROL^® one of their browser favorites and post their poison center phone number on or near every phone. Use the webPOISONCONTROL^® tool or call your poison center at 1-800-222-1222 for a possible poisoning. Whether online or by phone, expert guidance is always free, confidential, and available 24 hours a day.

For historical background about ipecac syrup:

• In 2003, the US Food and Drug Administration FDA Nonprescription Drug Advisory Council held a hearing about the over-the-counter status of ipecac syrup. The advisory panel then recommended to FDA that ipecac syrup no longer be available as a non-prescription drug. FDA has not made a decision (as of 10/11), but documents from the hearing are available on the web site. Go to www.fda.gov and enter the search term "ipecac". You will find the regulatory history of ipecac and presentations and submissions for and against the over-the-counter availability of ipecac syrup. 

• In 2003, the American Academy of Pediatrics (AAP) issued a policy statement "Poison Treatment in the Home" which concluded that ipecac syrup should no longer be routinely used in the home. Instead, they recommended that the first action of a caregiver of a child who may have swallowed a poison is to call their poison center at 1-800-222-1222. Read a statement from AAP.

• In 2004, an expert panel of toxicologists issued its “Position Paper: Ipecac Syrup”. The American Association of Poison Control Centers, the American Academy of Clinical Toxicology and the American College of Medical Toxicology concluded that “There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients . . . ”.