Ipecac losing favor as poison treatment

The old standby doesn't really help in a lot of cases, studies say, and is used less often.

[Times photo: James Borchuck] New studies say that ipecac syrup may be abused by bulimics and now the government may stop over the counter sales of the vomit inducing medicine.

TAMPA - Poison control expert Vincent Speranza spent years handing out freebies to parents: a number for the poison control center and a bottle of syrup of ipecac.

But no more.

Generations of parents have been told to always, always keep syrup of ipecac in the house, ready to dose adventurous children who ingested a potential poison. Ipecac would make them throw the nasty substance right back up.

Now, it soon may be off drugstore shelves.

Studies say using ipecac to induce vomiting doesn't really help in many poisoning cases, and poison control centers are recommending it less often - down to 16,000 cases in 2001 from 150,000 cases in 1986.

"It's probably not that effective, and it's not without side effects," said Speranza, managing director of the Florida Poison Information Center at Tampa General Hospital.

The Food and Drug Administration may reclassify syrup of ipecac, available over the counter since 1965, as a prescription drug. An FDA advisory committee voted to recommend that change last month. National medical groups are considering new guidelines as well.

Doctors always have warned parents only to give syrup of ipecac after calling a poison control center. Vomiting some poisons can do more harm than good. Caustic substances can burn the esophagus, while other poisons, such as oils, can be aspirated into the lungs.

In other cases, syrup of ipecac is very effective - at making people vomit. But experts say more recent studies have shown it doesn't often help in treating poisoning.

Even "under ideal conditions" - if there are, in fact, any ideal conditions for children to throw up - it only gets about 30 percent of the substance out of the body, said Dr. Jim Hillman, physician consultant to the Florida Poison Information Center at TGH, one of Florida's three poison control centers.

Once patients who have taken ipecac arrive in an emergency room, it's more difficult to treat them with more effective medicines because they are vomiting. There are antidotes to some poisons, and activated charcoal helps in many other cases by binding to the poison so less is absorbed into the bloodstream.

Repeated vomiting from ipecac also makes it more difficult for doctors to observe other symptoms of poisoning.

Scientists also worry that ipecac can be misused by people with eating disorders or by those who have Munchausen syndrome by proxy - where a parent intentionally makes a child sick to get attention. There still are few studies, but at least four deaths have been linked to ipecac abuse, an eating disorders expert from George Washington University told the FDA advisory committee. Abusing ipecac can lead to intestinal problems, heart arrhythmias and other cardiac damage.

There are rare poisoning cases where ipecac is a good alternative, Speranza said. But he probably recommends it only once or twice a year.

More frequently, parents give it to children who don't really need it, he said.

"Say Johnny gets a double dose, or even a triple dose," of common medications that aren't very toxic, Speranza said. "When it's on hand, and the parent's frantic, they forget to call us first. We always feel bad when they do something like that."

The end result: A child who would have been fine suffers a few hours of misery.

Ipecac is still a staple of most pediatricians' checklists, right up there with putting children in car seats and covering up electric outlets. But both the American Academy of Pediatrics and the American Association of Poison Control Centers are reviewing their recommendations that it be kept in the home.

Some local pediatricians said they recommend parents keep ipecac, but that they always caution not to use it without consulting poison control.

St. Petersburg pediatrician Stephen Karges said his partners will have to decide whether to routinely prescribe ipecac for patients if the FDA changes its over-the-counter status.

"I think we would, just because if they did witness (a poisoning), and poison control said go ahead, it would be real frustrating not to have it," he said.

But Karges also said such prescriptions would be more important for rural families than those in the Tampa Bay area, where most people are within a few minutes of an emergency room.

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