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February 23, 2004
News this month Once highly recommended as a home treatment for poisoning, syrup of ipecac is no longer considered effective and should not be used, according to a new study, which joins a growing body of evidence against its use. Use of ipecac did not reduce the need
for a child…to be taken to an emergency room for treatment
nor did it improve the child's outcome.
Because of its ability to make a person vomit, syrup of ipecac became widely used beginning in the 1960s as a way to rid the body of an ingested poison. By the 1980s, pediatricians were recommending at the sixth-month well-baby visit that all parents keep a bottle of the liquid in the home medicine cabinet. However, about the same time, doctors in the U.S. and Europe began to question whether syrup of ipecac actually helped the children who took it. Studying effectiveness Dr. Bond reviewed the experiences with ipecac of the 64 poison control centers in the U.S. for 2000 and 2001. This data is managed by the American Association of Poison Control Centers Toxic Surveillance System, which received more than 2.2 million calls in 2001 from across the country. These centers serve about 98 percent of the U.S. population. For the study, data was used only from calls made from a child's home that involved poisoning in children less than six years old. In all, these centers received more than 700,000 such calls. About 9 percent of callers (60,681) were told to bring their child to an emergency department, while another 14,404 brought the child in on their own. About 2 percent had used syrup of ipecac. Many cases [of poisoning] are now effectively
managed at home without any intervention.
Use of ipecac is dropping Ipecac was initially recommended because it was considered effective in emptying the stomach. However, through the years, researchers noted that each child responded very differently. While some children experienced a large reduction in the amount of poison in their system with ipecac, others had no dose reduction, even when they vomited. Therefore, giving ipecac was not always effective in removing the poison from the child's system. Additionally, poison control centers have learned a great deal about managing the ingestion of poisons in children in the past 20 years. Many cases are now effectively managed at home without any intervention. If a child is brought to the hospital, emergency departments have switched from using ipecac to using activated charcoal as the preferred form of decontamination when necessary. Syrup of ipecac should no longer be
used routinely in the home and parents should safely dispose of
any syrup of ipecac they have.
Conclusions In that same November issue, the AAP's Committee on Injury, Violence
and Poison Prevention issued a policy statement recommending that
all caregivers first call a poison control center if they suspect
a child has ingested poison. They also recommended that syrup of
ipecac no longer be used routinely in the home and advised pediatricians
and other professionals who care for children to recommend that
parents safely dispose of any syrup of ipecac they have. 
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 Call first for advice when a child ingests poison The new recommendations by the American Academy of Pediatrics that parents throw out the syrup of ipecac they have in the medicine cabinet is not surprising. In 1997, the American Academy of Clinical Toxicologists (AACT) issued a statement after reviewing evidence that said that while ipecac is effective at inducing vomiting, there was no evidence to suggest its use improved outcomes when children had taken poison. Plus, sometimes a child would vomit repeatedly, which would interfere with attempts to administer another form of treatment for the poisoning. “If you ever suspect a poisoning,
first call the poison center before doing anything else.”
It's important that this message reach both pediatricians, who should discuss poison prevention with parents during well-child visits, and also the parents. If a poisoning did occur in the home, the tendency is to grab something—anything—and that something could be the syrup of ipecac if it's left around. Discard syrup of ipecac There is another reason to get rid of the syrup of ipecac. Over the years, adolescents have occasionally used it to make themselves vomit. Because of this, the Food and Drug Administration is considering requiring a prescription for syrup of ipecac—which can be bought over the counter currently. Accidental poisoning still a problem “Poisonous substances should either be locked up, out of reach or both.”
Poisonings can and do occur, so it's important every parent take steps to make sure the home environment is as safe as possible. Poisonous substances should either be locked up, out of reach or both. What has helped Also, a number of highly toxic medications have been replaced over the years by safer ones. For example, the tricyclic antidepressants have been largely replaced by safer drugs such as Prozac. What to do If you suspect a poisoning, call the poison center first. Depending
on what was ingested, they may recommend you watch the child
carefully or that you bring the child to an emergency department.
It's also helpful if you have an idea of what the child ingested,
but it's not always possible to know. That's why prevention is
best. Carl Baum, MD, is an attending physician in the Pediatric Emergency Department of Yale-New Haven Children’s Hospital and an assistant professor of pediatrics at Yale University School of Medicine.
Yale-New Haven was recognized this year by U.S. News & World Report for its pediatric services. |
