Identification

Name
Ipecac
Accession Number
DB13293
Type
Small Molecule
Groups
Approved, Withdrawn
Description

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]

Synonyms
  • Ipecac syrup
  • Ipecacuanha
  • Ipsatol
Over the Counter Products
NameDosageStrengthRouteLabellerMarketing StartMarketing End
Ipecac SyrupSyrup140 mgOralD.C. Labs Limited1964-12-312003-07-11Canada
Ipecac Syrup 1.8gm/30ml USPSyrup1.8 gOralMeta Pharmaceuticals Inc.1991-12-311998-11-05Canada
PMS-ipecac SyrupSyrup7 %OralPharmascience Inc1988-12-312009-12-02Canada
Mixture Products
NameIngredientsDosageRouteLabellerMarketing StartMarketing End
Trousse Antipoison Pour Enfants LiqIpecac (30 ml) + Activated charcoal (120 ml)LiquidOralProdemdis Enr.1988-12-312010-07-15Canada
Categories
UNII
62I3C8233L
CAS number
8012-96-2
Weight
Not Available
Chemical Formula
Not Available
InChI Key
Not Available
InChI
Not Available
IUPAC Name
Not Available
SMILES
Not Available

Pharmacology

Indication

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]

Pharmacodynamics

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]

Absorption

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.

Metabolism

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]

Clearance

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

Toxicity

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
Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
DrugInteractionDrug group
AbirateroneThe serum concentration of Ipecac can be increased when it is combined with Abiraterone.Approved
Acetyl sulfisoxazoleThe metabolism of Ipecac can be decreased when combined with Acetyl sulfisoxazole.Approved, Vet Approved
AmiodaroneThe metabolism of Ipecac can be decreased when combined with Amiodarone.Approved, Investigational
ApalutamideThe serum concentration of Ipecac can be decreased when it is combined with Apalutamide.Approved, Investigational
AprepitantThe serum concentration of Ipecac can be increased when it is combined with Aprepitant.Approved, Investigational
ArtemetherThe metabolism of Ipecac can be decreased when combined with Artemether.Approved
AtazanavirThe metabolism of Ipecac can be decreased when combined with Atazanavir.Approved, Investigational
AtomoxetineThe metabolism of Ipecac can be decreased when combined with Atomoxetine.Approved
BetaxololThe metabolism of Ipecac can be decreased when combined with Betaxolol.Approved, Investigational
BoceprevirThe metabolism of Ipecac can be decreased when combined with Boceprevir.Approved, Withdrawn
BortezomibThe metabolism of Ipecac can be decreased when combined with Bortezomib.Approved, Investigational
BosentanThe serum concentration of Ipecac can be decreased when it is combined with Bosentan.Approved, Investigational
CarbamazepineThe metabolism of Ipecac can be increased when combined with Carbamazepine.Approved, Investigational
CelecoxibThe metabolism of Ipecac can be decreased when combined with Celecoxib.Approved, Investigational
CeritinibThe serum concentration of Ipecac can be increased when it is combined with Ceritinib.Approved
ChloroquineThe metabolism of Ipecac can be decreased when combined with Chloroquine.Approved, Investigational, Vet Approved
ChlorpromazineThe metabolism of Ipecac can be decreased when combined with Chlorpromazine.Approved, Investigational, Vet Approved
CholecalciferolThe metabolism of Ipecac can be decreased when combined with Cholecalciferol.Approved, Nutraceutical
CinacalcetThe metabolism of Ipecac can be decreased when combined with Cinacalcet.Approved
CitalopramThe metabolism of Ipecac can be decreased when combined with Citalopram.Approved
ClarithromycinThe metabolism of Ipecac can be decreased when combined with Clarithromycin.Approved
ClobazamThe metabolism of Ipecac can be decreased when combined with Clobazam.Approved, Illicit
ClomipramineThe metabolism of Ipecac can be decreased when combined with Clomipramine.Approved, Investigational, Vet Approved
ClotrimazoleThe metabolism of Ipecac can be decreased when combined with Clotrimazole.Approved, Vet Approved
ClozapineThe metabolism of Ipecac can be decreased when combined with Clozapine.Approved
CobicistatThe serum concentration of Ipecac can be increased when it is combined with Cobicistat.Approved
CocaineThe metabolism of Ipecac can be decreased when combined with Cocaine.Approved, Illicit
ConivaptanThe serum concentration of Conivaptan can be increased when it is combined with Ipecac.Approved, Investigational
CrizotinibThe metabolism of Ipecac can be decreased when combined with Crizotinib.Approved
CurcuminThe metabolism of Ipecac can be decreased when combined with Curcumin.Approved, Investigational
CyclosporineThe metabolism of Ipecac can be decreased when combined with Cyclosporine.Approved, Investigational, Vet Approved
DabrafenibThe serum concentration of Ipecac can be decreased when it is combined with Dabrafenib.Approved, Investigational
DarifenacinThe metabolism of Ipecac can be decreased when combined with Darifenacin.Approved, Investigational
DarunavirThe serum concentration of Ipecac can be increased when it is combined with Darunavir.Approved
DasatinibThe serum concentration of Ipecac can be increased when it is combined with Dasatinib.Approved, Investigational
DeferasiroxThe serum concentration of Ipecac can be decreased when it is combined with Deferasirox.Approved, Investigational
DelavirdineThe metabolism of Ipecac can be decreased when combined with Delavirdine.Approved
DesipramineThe metabolism of Ipecac can be decreased when combined with Desipramine.Approved, Investigational
DexamethasoneThe serum concentration of Ipecac can be decreased when it is combined with Dexamethasone.Approved, Investigational, Vet Approved
DihydroergotamineThe metabolism of Ipecac can be decreased when combined with Dihydroergotamine.Approved, Investigational
DiltiazemThe metabolism of Ipecac can be decreased when combined with Diltiazem.Approved, Investigational
DosulepinThe metabolism of Ipecac can be decreased when combined with Dosulepin.Approved
DoxycyclineThe metabolism of Ipecac can be decreased when combined with Doxycycline.Approved, Investigational, Vet Approved
DronedaroneThe metabolism of Ipecac can be decreased when combined with Dronedarone.Approved
DuloxetineThe metabolism of Ipecac can be decreased when combined with Duloxetine.Approved
EliglustatThe metabolism of Ipecac can be decreased when combined with Eliglustat.Approved
EnzalutamideThe serum concentration of Ipecac can be decreased when it is combined with Enzalutamide.Approved
ErythromycinThe metabolism of Ipecac can be decreased when combined with Erythromycin.Approved, Investigational, Vet Approved
Fenofibric acidThe risk or severity of myopathy, rhabdomyolysis, and myoglobinuria can be increased when Ipecac is combined with Fenofibric acid.Approved
FluconazoleThe metabolism of Ipecac can be decreased when combined with Fluconazole.Approved, Investigational
FluvastatinThe risk or severity of myopathy and rhabdomyolysis can be increased when Ipecac is combined with Fluvastatin.Approved
FluvoxamineThe metabolism of Ipecac can be decreased when combined with Fluvoxamine.Approved, Investigational
FosamprenavirThe metabolism of Ipecac can be decreased when combined with Fosamprenavir.Approved
FosaprepitantThe serum concentration of Ipecac can be increased when it is combined with Fosaprepitant.Approved
FosphenytoinThe metabolism of Ipecac can be increased when combined with Fosphenytoin.Approved, Investigational
Fusidic AcidThe serum concentration of Ipecac can be increased when it is combined with Fusidic Acid.Approved, Investigational
HaloperidolThe metabolism of Ipecac can be decreased when combined with Haloperidol.Approved
IdelalisibThe metabolism of Ipecac can be decreased when combined with Idelalisib.Approved
ImatinibThe metabolism of Ipecac can be decreased when combined with Imatinib.Approved
ImipramineThe metabolism of Ipecac can be decreased when combined with Imipramine.Approved
IndinavirThe metabolism of Ipecac can be decreased when combined with Indinavir.Approved
IsavuconazoleThe serum concentration of Ipecac can be increased when it is combined with Isavuconazole.Approved, Investigational
IsavuconazoniumThe metabolism of Ipecac can be decreased when combined with Isavuconazonium.Approved, Investigational
IsoniazidThe metabolism of Ipecac can be decreased when combined with Isoniazid.Approved, Investigational
ItraconazoleThe metabolism of Ipecac can be decreased when combined with Itraconazole.Approved, Investigational
IvacaftorThe serum concentration of Ipecac can be increased when it is combined with Ivacaftor.Approved
KetoconazoleThe metabolism of Ipecac can be decreased when combined with Ketoconazole.Approved, Investigational
LopinavirThe metabolism of Ipecac can be decreased when combined with Lopinavir.Approved
LorcaserinThe metabolism of Ipecac can be decreased when combined with Lorcaserin.Approved
LorpiprazoleThe serum concentration of Ipecac can be increased when it is combined with Lorpiprazole.Approved
LovastatinThe metabolism of Ipecac can be decreased when combined with Lovastatin.Approved, Investigational
LuliconazoleThe serum concentration of Ipecac can be increased when it is combined with Luliconazole.Approved
LumacaftorThe metabolism of Ipecac can be increased when combined with Lumacaftor.Approved
LumefantrineThe metabolism of Ipecac can be decreased when combined with Lumefantrine.Approved
MethadoneThe metabolism of Ipecac can be decreased when combined with Methadone.Approved
MethotrimeprazineThe metabolism of Ipecac can be decreased when combined with Methotrimeprazine.Approved, Investigational
MibefradilThe metabolism of Ipecac can be decreased when combined with Mibefradil.Investigational, Withdrawn
MiconazoleThe metabolism of Ipecac can be decreased when combined with Miconazole.Approved, Investigational, Vet Approved
MidostaurinThe metabolism of Ipecac can be decreased when combined with Midostaurin.Approved, Investigational
MifepristoneThe serum concentration of Ipecac can be increased when it is combined with Mifepristone.Approved, Investigational
MirabegronThe metabolism of Ipecac can be decreased when combined with Mirabegron.Approved
MitotaneThe serum concentration of Ipecac can be decreased when it is combined with Mitotane.Approved
NefazodoneThe metabolism of Ipecac can be decreased when combined with Nefazodone.Approved, Withdrawn
NelfinavirThe metabolism of Ipecac can be decreased when combined with Nelfinavir.Approved
NetupitantThe serum concentration of Ipecac can be increased when it is combined with Netupitant.Approved, Investigational
NevirapineThe metabolism of Ipecac can be increased when combined with Nevirapine.Approved
NicardipineThe metabolism of Ipecac can be decreased when combined with Nicardipine.Approved, Investigational
NilotinibThe metabolism of Ipecac can be decreased when combined with Nilotinib.Approved, Investigational
OlaparibThe metabolism of Ipecac can be decreased when combined with Olaparib.Approved
OsimertinibThe serum concentration of Ipecac can be increased when it is combined with Osimertinib.Approved
PalbociclibThe serum concentration of Ipecac can be increased when it is combined with Palbociclib.Approved, Investigational
PanobinostatThe serum concentration of Ipecac can be increased when it is combined with Panobinostat.Approved, Investigational
PentobarbitalThe metabolism of Ipecac can be increased when combined with Pentobarbital.Approved, Investigational, Vet Approved
PhenobarbitalThe metabolism of Ipecac can be increased when combined with Phenobarbital.Approved, Investigational
PhenytoinThe metabolism of Ipecac can be increased when combined with Phenytoin.Approved, Vet Approved
PitolisantThe serum concentration of Ipecac can be decreased when it is combined with Pitolisant.Approved, Investigational
PosaconazoleThe metabolism of Ipecac can be decreased when combined with Posaconazole.Approved, Investigational, Vet Approved
PrimidoneThe metabolism of Ipecac can be increased when combined with Primidone.Approved, Vet Approved
PromazineThe metabolism of Ipecac can be decreased when combined with Promazine.Approved, Vet Approved
QuinidineThe metabolism of Ipecac can be decreased when combined with Quinidine.Approved, Investigational
QuinineThe metabolism of Ipecac can be decreased when combined with Quinine.Approved
RanolazineThe metabolism of Ipecac can be decreased when combined with Ranolazine.Approved, Investigational
RifabutinThe metabolism of Ipecac can be increased when combined with Rifabutin.Approved, Investigational
RifampicinThe metabolism of Ipecac can be increased when combined with Rifampicin.Approved
RifapentineThe metabolism of Ipecac can be increased when combined with Rifapentine.Approved, Investigational
RitonavirThe metabolism of Ipecac can be decreased when combined with Ritonavir.Approved, Investigational
RolapitantThe metabolism of Ipecac can be decreased when combined with Rolapitant.Approved, Investigational
RosuvastatinThe risk or severity of myopathy and rhabdomyolysis can be increased when Ipecac is combined with Rosuvastatin.Approved
RucaparibThe metabolism of Ipecac can be decreased when combined with Rucaparib.Approved, Investigational
SaquinavirThe metabolism of Ipecac can be decreased when combined with Saquinavir.Approved, Investigational
SarilumabThe therapeutic efficacy of Ipecac can be decreased when used in combination with Sarilumab.Approved, Investigational
SertralineThe metabolism of Ipecac can be decreased when combined with Sertraline.Approved
SildenafilThe metabolism of Ipecac can be decreased when combined with Sildenafil.Approved, Investigational
SiltuximabThe serum concentration of Ipecac can be decreased when it is combined with Siltuximab.Approved, Investigational
SimeprevirThe serum concentration of Ipecac can be increased when it is combined with Simeprevir.Approved
St. John's WortThe serum concentration of Ipecac can be decreased when it is combined with St. John's Wort.Approved, Investigational, Nutraceutical
StiripentolThe serum concentration of Ipecac can be increased when it is combined with Stiripentol.Approved
SulfisoxazoleThe metabolism of Ipecac can be decreased when combined with Sulfisoxazole.Approved, Vet Approved
TelaprevirThe metabolism of Ipecac can be decreased when combined with Telaprevir.Approved, Withdrawn
TelithromycinThe metabolism of Ipecac can be decreased when combined with Telithromycin.Approved
ThioridazineThe metabolism of Ipecac can be decreased when combined with Thioridazine.Approved, Withdrawn
TiclopidineThe metabolism of Ipecac can be decreased when combined with Ticlopidine.Approved
TipranavirThe metabolism of Ipecac can be decreased when combined with Tipranavir.Approved, Investigational
TocilizumabThe serum concentration of Ipecac can be decreased when it is combined with Tocilizumab.Approved
TranylcypromineThe metabolism of Ipecac can be decreased when combined with Tranylcypromine.Approved, Investigational
VemurafenibThe serum concentration of Ipecac can be decreased when it is combined with Vemurafenib.Approved
VerapamilThe metabolism of Ipecac can be decreased when combined with Verapamil.Approved
VoriconazoleThe metabolism of Ipecac can be decreased when combined with Voriconazole.Approved, Investigational
ZiprasidoneThe metabolism of Ipecac can be decreased when combined with Ziprasidone.Approved
Food Interactions
Not Available

References

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
347911447
ChEMBL
CHEMBL2108372
Wikipedia
Ipecacuanha
ATC Codes
V03AB01 — IpecacuanhaR05CA04 — Ipecacuanha
MSDS
Download (46.5 KB)

Clinical Trials

Clinical Trials
Not Available

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage forms
FormRouteStrength
SyrupOral140 mg
SyrupOral1.8 g
SyrupOral7 %
LiquidOral
Prices
Not Available
Patents
Not Available

Properties

State
Liquid
Experimental Properties
PropertyValueSource
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

Spectra

Mass Spec (NIST)
Not Available
Spectra
Not Available

Taxonomy

Classification
Not classified

Enzymes

Kind
Protein
Organism
Human
Pharmacological action
No
Actions
Substrate
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
CYP2D6
Uniprot ID
P10635
Uniprot Name
Cytochrome P450 2D6
Molecular Weight
55768.94 Da
References
  1. Barceloux D.G. (2012). Medical toxicology of drug abuse: Synthesized chemicals and psychoactive plants.. Wiley.
Kind
Protein
Organism
Human
Pharmacological action
No
Actions
Substrate
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
CYP3A4
Uniprot ID
P08684
Uniprot Name
Cytochrome P450 3A4
Molecular Weight
57342.67 Da
References
  1. 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 August 02, 2018 06:50