PDR for Herbal Medicines

HERBAL MONOGRAPHS IPECAC 423

Ipecac

Cephaelis ipecacuanha

DESCRIPTION

Medicinal Parts: The medicinal parts are the pulverized

roots of the 3-to-4-year-old plant, which have been dug up

and dried quickly in the sun.

Flower and Fruit: The flowers are in terminal, capitulum-

shaped inflorescences surrounded by 4 to 6 bracts. The

individual florets have a 5-tipped calyx, ciliated at the tips

with a white campanulate-conical, 5-tipped corolla. A bitter,

dark purple, fleshy drupe develops from the 2-carpeled

ovary.

Leaves, Stem and Root: Cephaelis ipecacuanha is a perenni-

al, evergreen, leafy plant about 40 cm high with a 2 to 4 mm

thick rhizome from which sprout numerous 20 cm long

fibrous roots. Some of these roots develop into tubers. The

green stem may be creeping or ascending, simple or

branched. It is somewhat quadrangular, occasionally bears

adventitious roots. The opposite leaves are entire-margined,

and the leaf blade, narrows into the short petiole. There are

stipules at the base of the leaf, which are slit like awls and

fused together with the petiole-like leaf sheath.

Habitat: Indigenous to the sparser woods of Brazil; cultivat-

ed in India and on the Malaysian archipelago.

Production: Ipecac is the root of Cephaelis ipecacuanha. The

subterranean parts of the 3-to-4-year-old plants are quickly

dried in the sun and then cut into pieces of 5 to 10 cm in

length.

Other Names: Ipecacuanha, Ipecacuanha Rio, Matto Grosso

ACTIONS AND PHARMACOLOGY

COMPOUNDS

Isoquinoline alkaloids of the emetine type (2-4%): chief

alkaloids emetine and cephaelin

Starch (30 to 40%)

EFFECTS

Emetine hydrochloride and cephaelin hydrochloride, alka-

loids contained in the drug, have a locally irritating effect on

the gastric mucous membrane and are thus responsible for

the reflex increase of bronchial secretions and the expecto-

rant effect. The saponins probably support this effect.

The drug affects the sensory stomach nerves; it is secretory
in small doses and emetic in larger doses. It is also
spasmolytic and expectorant. It is partially effective in
amoebic dysentery due to the action of the alkaloid emetin
on the magna-form of the pathogen.

INDICATIONS AND USAGE

Unproven Uses: Ipecac is contained in expectorants and

secretory preparations; it is used for amoebic dysentery, as a

bronchial treatment and as an emetic in cases of poisoning. It

is also used as an expectorant and to soothe and assist in

coughing up of thick phlegm and in the treatment of

croupous bronchitis in children.

Homeopathic Uses: Ipecae is used to treat bronchitis.

asthma, whooping cough, gastrointestinal inflammations.

disorders in blood pressure and bleeding of the mucous

membranes.

PRECAUTIONS AND ADVERSE REACTIONS

General: No health hazards or side effects are known in

conjunction with the proper administration of designated

therapeutic dosages as an expectorant. Administration over

extended periods can lead to myopathias. Frequent contact

with the drug can trigger allergic reactions of the skin and

the mucous membranes ("druggist's asthma," the allergen is

a glycoprotein).

Pregnancy: Not to be used during pregnancy.

OVERDOSAGE

Higher dosages of the drug (1 to 2 gm) have a nauseate

effect (therapeutically used as an emetic). Toxic dosages can

lead to mucous membrane erosion in the gastrointestinal

tract, tachycardia, drop in blood pressure and cardiac rhythm

disorders, as well as disorders in respiratory function and

possibly to convulsions, shock and coma.

Following intestinal emptying (sodium sulfate), the treatment

for poisonings consists of the administration of generous

amounts of liquids (warm tea), instillation of activated

charcoal and shock prophylaxis (quiet, warmth), me treat-

ment of spasms with diazepam (i.v.), electrolyte substitution

and the countering of any acidosis imbalance that may

appear through sodium bicarbonate infusions. In the event of

shock, plasma volume expanders should be infused. Moni-

toring of kidney function is necessary. Intubation and oxygen

respiration may also be required.

DOSAGE

Mode of Administration: Ipecac is used orally as a tincture.

extract and fluid extract and in medicinal preparations with a

standardized alkaloid content.

Preparation: Ipecac extract: After the alkaloids have been

determined the powder is stabilized with lactose or dextrin,

(DAB 10).

Tincture: 1 part root powder with 8 to 12 parts 70% ethanol

(DAB 10).

These preparations are stabilized to a standardized alkaloid

content.