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Accession Number
Small Molecule
Approved, Withdrawn

Ipecac is obtained from the plant Cephaelis ipecacuanha and contains a number of emetic alkaloids including emetine and cephaeline.9 Ipecac was approved by Health Canada as an OTC but all those products are now discontinued.7 The FDA does not have currently any approved product containing ipecac, however, ipecac as an ingredient is accepted to be sold over the counter in packages of 1 fluid ounce (30 ml) for the emergency use to cause vomiting in poisoning.8

  • Ipecac syrup
  • Ipecacuanha
  • Ipsatol
Over the Counter Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Ipecac SyrupSyrupOralD.C. Labs Limited1964-12-312003-07-11Canada
Ipecac Syrup 1.8gm/30ml USPSyrupOralMeta Pharmaceuticals Inc.1991-12-311998-11-05Canada
PMS-ipecac SyrupSyrupOralPharmascience Inc1988-12-312009-12-02Canada
Additional Data Available
  • Application Number
    Application Number

    A unique ID assigned by the FDA when a product is submitted for approval by the labeller.

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  • Product Code
    Product Code

    A governmentally-recognized ID which uniquely identifies the product within its regulatory market.

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Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing End
Robol TabIpecac (4.32 mg) + Alloin (16.2 mg) + Belladonna (5.4 mg) + Phenolphthalein (64.8 mg)TabletOralLabs Anglo French1979-12-311997-08-05Canada
Trousse Antipoison Pour Enfants LiqIpecac (30 ml) + Activated charcoal (120 ml)LiquidOralProdemdis Enr.1988-12-312010-07-15Canada
CAS number



Ipecac is indicated as an emetic agent for the induction of vomiting in poisoning victims who ingested systemic poison in order to prevent absorption of the chemicals through the gastrointestinal tract. In low doses, ipecac was also used as an expectorant.9

Reports have suggested that ipecac was vastly used in patients with eating disorders to produce vomiting.5


An effective and safe dose of ipecac may cause vomiting within 20 minutes of the administration.9 In prospective studies with children, the mean time to vomit was reported to be of 21.7 minutes.10

Mechanism of action

The emetic components of ipecac, emetine and cephaeline, act centrally and locally in the gastrointestinal tract to cause vomiting.9 The mechanism by which ipecac performs his effect is by irritating the stomach lining and chemically stimulating the chemoreceptor trigger zone.6

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The main components of ipecac are rapidly absorbed from the GI tract, this absorption depends on the amount of emesis produced by the administered dose. The peak plasma concentration of 10-16 ng/ml is attained 20 minutes after first administration.5 The bioavailability of ipecac is reduced over time from 67-11% after 5-60 minutes of administration.3

Volume of distribution

The volume of distribution is thought to be large based on the prolonged excretion.5

Protein binding

This pharmacokinetic property is not relevant as the absorbed dose of ipecac is minimal.


The main components of ipecac have been shown in microsomal enzyme systems that emetine is converted to cephaeline and 9-O-demethylemetine by CYP2D6. On the other hand, CYP3A4 produces the transformation of emetine to 9-O-demethylemetine and 10-O-demethylemetine. In preclinical studies, it was shown that cephaline is conjugated with glucuronice to form cephaeline-6'-O-glucuronide for biliary excretion whereas emetine gets demethylated to cephaline and 9-O-demethylemetine before glucuronidation.5

Route of elimination

Due to the emetic function, even 76% of the administered dose is vomited. From the absorbed dose, the elimination from plasma is relatively rapid. In some clinical trials, the alkaloids were not observed in plasma 6 hours after administration. When the patient does not vomit any part of the administered dose, there could be traces in plasma after 24 hours. The component alkaloids are eliminated via the bile and urine as it has been observed a persistence in urine after chronic administration.5 Biliary and urinary excretion of ipecac corresponds to 57.5% and 16.5% of the administered dose respectively. From the excreted dose, unchanged cephaeline accountd for 42.4% of the eliminated dose in feces.4

Half life

The effect of ipecac is done in about 20 minutes and the elimination of the little-absorbed dose is reported to be very rapid. Thus, the half-life is thought to be of about 0.5-1 hour.5


The urinary excretion of the main components of ipecac accounts for 75% of the administered dose 48 hours after initial administration.6


An overdose of an ipecac preparation may cause serious poisoning. If emesis is not provoked after two doses of ipecac, a gastric lavage is recommended.9 The overdose of the components such as emetine is reported to cause the onset of myopathy. Chronic use of this drug has been indicated to produce muscle weakness, waddling gait, dyspnea, left atrial enlargement and reduced left ventricular ejection fraction.5

Affected organisms
  • Humans
Not Available
Pharmacogenomic Effects/ADRs
Not Available


Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
1-(2-Phenylethyl)-4-phenyl-4-acetoxypiperidineThe metabolism of Ipecac can be decreased when combined with 1-(2-Phenylethyl)-4-phenyl-4-acetoxypiperidine.
4-MethoxyamphetamineThe metabolism of Ipecac can be decreased when combined with 4-Methoxyamphetamine.
5-methoxy-N,N-dimethyltryptamineThe metabolism of 5-methoxy-N,N-dimethyltryptamine can be decreased when combined with Ipecac.
AbacavirAbacavir may decrease the excretion rate of Ipecac which could result in a higher serum level.
AbirateroneThe metabolism of Ipecac can be decreased when combined with Abiraterone.
AcarboseAcarbose may decrease the excretion rate of Ipecac which could result in a higher serum level.
AcebutololThe metabolism of Ipecac can be decreased when combined with Acebutolol.
AceclofenacAceclofenac may decrease the excretion rate of Ipecac which could result in a higher serum level.
AcemetacinAcemetacin may decrease the excretion rate of Ipecac which could result in a higher serum level.
AcetaminophenAcetaminophen may decrease the excretion rate of Ipecac which could result in a higher serum level.
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Food Interactions
Not Available


General References
  1. Lee MR: Ipecacuanha: the South American vomiting root. J R Coll Physicians Edinb. 2008 Dec;38(4):355-60. [PubMed:19227966]
  2. Axelsson P, Thorn SE, Wattwil M: Betamethasone does not prevent nausea and vomiting induced by ipecacuanha. Acta Anaesthesiol Scand. 2004 Nov;48(10):1283-6. [PubMed:15504189]
  3. Saincher A, Sitar DS, Tenenbein M: Efficacy of ipecac during the first hour after drug ingestion in human volunteers. J Toxicol Clin Toxicol. 1997;35(6):609-15. [PubMed:9365428]
  4. Asano T, Watanabe J, Sadakane C, Ishihara K, Hirakura K, Wakui Y, Yanagisawa T, Kimura M, Kamei H, Yoshida T, Fujii Y, Yamashita M: Biotransformation of the ipecac alkaloids cephaeline and emetine from ipecac syrup in rats. Eur J Drug Metab Pharmacokinet. 2002 Jan-Mar;27(1):29-35. [PubMed:11996324]
  5. Barceloux D.G. (2012). Medical toxicology of drug abuse: Synthesized chemicals and psychoactive plants.. Wiley.
  6. Benzoni T. and Gossman W. (2017). Ipecac. Treasure Island: StatPearls Publishing.
  7. Health Canada [Link]
  8. FDA code of federal regulations [Link]
  9. FDA federal register [Link]
  10. FDA Poisonous Plant Database [Link]
External Links
PubChem Substance
ATC Codes
R05CA04 — IpecacuanhaV03AB01 — Ipecacuanha
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Clinical Trials

Clinical Trials
Not Available


Not Available
Not Available
Dosage forms
StickNot applicable50 kg/50kg
Not Available
Not Available


Experimental Properties
water solubilitySoluble'MSDS'
logP5.0Barceloux D. Medical Toxicology of Drug Abuse. (2012)
pKa6.64-6.77Purich D. The inhibitor index. (2017)
Predicted Properties
Not Available
Predicted ADMET features
Not Available


Mass Spec (NIST)
Not Available
Not Available


Not classified


Pharmacological action
General Function
Steroid hydroxylase activity
Specific Function
Responsible for the metabolism of many drugs and environmental chemicals that it oxidizes. It is involved in the metabolism of drugs such as antiarrhythmics, adrenoceptor antagonists, and tricyclic...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 2D6
Molecular Weight
55768.94 Da
  1. Barceloux D.G. (2012). Medical toxicology of drug abuse: Synthesized chemicals and psychoactive plants.. Wiley.
Pharmacological action
General Function
Vitamin d3 25-hydroxylase activity
Specific Function
Cytochromes P450 are a group of heme-thiolate monooxygenases. In liver microsomes, this enzyme is involved in an NADPH-dependent electron transport pathway. It performs a variety of oxidation react...
Gene Name
Uniprot ID
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
  1. Asano T, Kushida H, Sadakane C, Ishihara K, Wakui Y, Yanagisawa T, Kimura M, Kamei H, Yoshida T: Metabolism of ipecac alkaloids cephaeline and emetine by human hepatic microsomal cytochrome P450s, and their inhibitory effects on P450 enzyme activities. Biol Pharm Bull. 2001 Jun;24(6):678-82. [PubMed:11411558]
  2. Barceloux D.G. (2012). Medical toxicology of drug abuse: Synthesized chemicals and psychoactive plants.. Wiley.

Drug created on June 23, 2017 14:39 / Updated on November 02, 2019 03:10