The History and Demise of Syrup of Ipecac
Syrup of ipecac is an emetic, a substance designed to induce vomiting. Made from the dried roots of the ipecacuanha plant, which is native to Brazil, it was brought to Europe in the 17th century and used for treating dysentery and other ailments. By the 20th century, it became a common household item, widely recommended for managing accidental poisoning. The two main active compounds in the syrup, emetine and cephaeline, work by irritating the stomach lining and stimulating the chemoreceptor trigger zone in the brain, which triggers the vomiting reflex.
For decades, the standard first aid advice was to administer ipecac syrup after a potential poisoning. However, in the 1990s and early 2000s, a growing body of evidence began to question its effectiveness. Studies showed that the amount of poison removed by ipecac was inconsistent and often negligible, and it could delay the administration of more effective treatments, such as activated charcoal. Based on this overwhelming evidence, major medical bodies like the American Academy of Pediatrics and the American Association of Poison Control Centers officially recommended against the use of ipecac. By 2010, the last two manufacturers ceased production, and today, ipecac is no longer commercially available.
Why Inducing Vomiting with Syrup of Ipecac is Harmful
The reasons for abandoning ipecac are extensive and centered on patient safety. The risks associated with its use far outweigh any potential benefits.
- Ineffectiveness: Scientific reviews and a 2005 meta-study concluded that ipecac was unreliable and failed to improve patient outcomes in most poisoning cases. The amount of stomach contents it removes is highly variable and significantly less than initially believed.
- Increased Toxicity: For certain substances, vomiting can worsen the initial injury. If corrosive chemicals like bleach or strong acids are ingested, forcing them back up can cause a second round of severe burns to the esophagus, throat, and mouth. Similarly, vomiting after ingesting petroleum distillates like gasoline or kerosene poses a risk of aspiration pneumonia, a serious and potentially fatal lung infection.
- Serious Medical Complications: The active alkaloid in ipecac, emetine, is a cardiotoxin that can lead to heart damage and muscle weakness if absorbed into the body. This can occur if the syrup fails to induce vomiting or is used repeatedly. Other potential complications include esophageal tears (Mallory-Weiss tears), gastric rupture, and dangerous electrolyte imbalances.
- Abuse Potential: A major factor in ipecac's removal from shelves was its misuse by individuals with eating disorders like bulimia nervosa. The long-term effects of chronic ipecac abuse, including severe heart problems, led to the deaths of some individuals, including singer Karen Carpenter.
- Delaying Proper Care: The time spent administering ipecac and waiting for it to work delays the use of safer and more effective hospital treatments, such as activated charcoal or specific antidotes.
Comparison: Inducing Vomiting (Obsolete) vs. Modern Poisoning Treatment
| Feature | Obsolete Practice (Ipecac) | Modern Practice (Poison Control) |
|---|---|---|
| Efficacy | Inconsistent and often ineffective; removes only a small amount of toxin. | Highly effective; modern therapies like activated charcoal and specific antidotes are proven to improve outcomes. |
| Safety | High risk of dangerous side effects, including cardiac toxicity, aspiration, and esophageal damage. | Safer; focuses on expert medical assessment and targeted interventions tailored to the specific poison. |
| Risk Level | Elevated; can worsen injury, especially with corrosive substances or hydrocarbons. | Reduced; avoids dangerous complications associated with self-induced vomiting. |
| Speed | Slow onset of vomiting (20-30 minutes), delaying expert medical care. | Rapid response; immediate phone guidance saves critical time and avoids harmful delays. |
| Standard Recommendation | Formerly recommended for at-home first aid; now strongly discouraged by all major medical groups. | Call Poison Control immediately (1-800-222-1222) or 911 for severe symptoms. |
The Modern Protocol: What to Do Instead
If you suspect someone has been poisoned, your first course of action should be to seek immediate expert medical advice, not to induce vomiting.
- Call Poison Control: The national toll-free Poison Help line is 1-800-222-1222. This number connects you to a local poison expert who can provide confidential, free, and expert advice 24/7. Do not wait for symptoms to appear before calling.
- Call 911 for Emergencies: If the person is unconscious, having seizures, or having trouble breathing, call 911 immediately.
- Provide Key Information: When you call, have the poison container or substance readily available. Be prepared to provide the person's age, weight, symptoms, and the estimated time and amount of exposure.
- Follow Expert Instructions: Only follow the instructions given by the poison control expert or emergency responder. They may advise activated charcoal, observation at home, or an emergency room visit.
- First Aid Steps (If Advised): For inhaled poisons, move the person to fresh air. For skin exposure, remove contaminated clothing and rinse the skin. For eye exposure, flush the eyes with running water for 15–20 minutes.
Conclusion
While syrup of ipecac was once the answer to what kind of syrup makes you vomit, it is now an outdated and dangerous medical artifact. The practice of inducing vomiting for poisoning has been replaced by safer, more effective modern protocols that emphasize immediate contact with poison control experts. Disposing of any old ipecac bottles and prioritizing prevention are the best actions for home safety. In the event of a poisoning, the correct response is a phone call, not a trip to the medicine cabinet for a long-since-obsolete remedy. For further information, visit Poison Control.
