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a medicinal drug used to evoke vomiting (especially in cases of drug overdose or poisoning)

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トコン(南米産のアカネ科の低木) / 吐根剤(トコンの乾燥根で吐剤,下剤に用いる)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/13 09:11:13」(JST)

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Syrup of ipecac (/ˈɪpɨkæk/), commonly referred to as ipecac, is a drug that was once used as a cough syrup and to induce vomiting. It is obtained from the dried rhizome and roots of Carapichea ipecacuanha from which it derives its name.

Preparation

The commercial preparation of ipecac consists of 1/14 of an alcoholic extract of the roots and rhizomes of ipecac root. The rest is composed of glycerin, sugar syrup, and methylparaben. Ipecac root itself is a poison, but in this diluted form, its ability to induce immediate vomiting means that the syrup is seldom fatal.^[1]

Use

Ipecac was used in cough mixtures as an expectorant or an emetic from the 18th until the early 20th century. Ipecac and opium were used to produce Dover's powder, which was used in syrup form.

In 1965, the FDA approved the sale of up to one ounce of syrup of ipecac without a prescription. At the time it was approved, its use was recommended by the AAP, AAPCC, AMA, and the FDA's medical advisory board as a method to induce vomiting "for quick first-aid use in the home, under medical supervision", for use in cases of accidental poisoning.^[1]^[2]

Current guidelines from the American Academy of Pediatrics, however, strongly advise against this and in fact recommend the disposal of any syrup of ipecac present in the home.^[3] Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons,^[4] because of a lack of evidence that syrup of ipecac actually helps improve the outcome in cases of poisoning. Moreover, accidental overdose of ipecac can result when administered in the home.^[5] When dealing with poisoning cases in hospital, it became difficult to obtain a differential diagnosis when syrup of ipecac had been administered, as this can add further symptoms.

A 2005 review by an HRSA-funded scientific panel concluded that vomiting alone does not reliably remove poisons from the stomach. The study suggested that indications for use of ipecac syrup were rare, and patients should be treated by more effective and safer means. Additionally, its potential side effects, such as lethargy, can be confused with the poison's effects, complicating diagnosis. The use of ipecac may also delay the use of other treatments (e.g., activated charcoal, whole bowel irrigation, or oral antidotes) or make them less effective.^[6]

Misuse

Ipecac has been used by individuals with bulimia nervosa as a means to achieve weight loss through induced vomiting. Repeated use in this manner is believed to cause damage to the heart and muscles, which can ultimately result in the user's death.^[7] Misuse of ipecac has been blamed for the death of well-known singer Karen Carpenter in 1983.^[8] It has also been used as an agent for Münchausen syndrome by proxy.^[9]

Mechanism of action

The actions of ipecac are mainly those of major alkaloids, emetine (methylcephaeline) and cephaeline. They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting.

Discontinuation

Ipecac has been found to have minimal health benefits, and ultimately ineffective at purging the body of poisonous substances, and as such global production of the syrup has been stopped. As the ASHP puts it, "Ipecac syrup is no longer recommended for routine management of outpatient ingestions of medications or other chemicals." Humco and Paddock Laboratories, the only two remaining manufacturers, both stopped production of ipecac syrup in 2010.^[10]

A heavily cited position statement outlines critical details of its effectiveness:

"In experimental studies the amount of marker removed by ipecac was highly variable and diminished with time. There is no evidence from clinical studies that ipecac improves the outcome of poisoned patients and its routine administration in the emergency department should be abandoned. There is insufficient data to support or exclude ipecac administration soon after poison ingestion. Ipecac may delay the administration or reduce the effectiveness of activated charcoal, oral antidotes, and whole bowel irrigation. Ipecac should not be administered to a patient who has a decreased level or impending loss of consciousness or who has ingested a corrosive substance or hydrocarbon with high aspiration potential."^[11]

References

^ ^a ^b Gardner, H. G.; American Academy Of Pediatrics Committee On Injury, Violence (2007), "Office-Based Counseling for Unintentional Injury Prevention", Pediatrics 119 (1): 202–6, doi:10.1542/peds.2006-2899, PMID 17200289
^ Galton, Lawrence (1966-01-09). "New Lifesaver For Your Medicine Chest". Parade. Retrieved 2015-06-04.
^ American Academy Of Pediatrics Committee On Injury, Violence (2003), "Poison Treatment in the Home", Pediatrics 112 (5): 1182–5, doi:10.1542/peds.112.5.1182, PMID 14595067
^ American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists (2004), "Position Paper: Ipecac Syrup", Clinical Toxicology 42 (2): 133–43, doi:10.1081/CLT-120037421, PMID 15214617
^ Bateman, D N (1999), "Gastric decontamination—a view for the millennium", Emergency Medicine Journal 16 (2): 84–6, doi:10.1136/emj.16.2.84, PMC 1343284, PMID 10191436
^ Manoguerra, Anthony; Cobaugh, Daniel; Panel, Guidelines for the Management of Poisoning Consensus Panel (2005), "Guideline on the Use of Ipecac Syrup in the Out-of-Hospital Management of Ingested Poisons", Clinical Toxicology 43 (1): 1–10, doi:10.1081/CLT-200046735, PMID 15732439
^ Silber, Tomas J. (2005), "Ipecac syrup abuse, morbidity, and mortality: Isn't it time to repeal its over-the-counter status?", Journal of Adolescent Health 37 (3): 256–60, doi:10.1016/j.jadohealth.2004.08.022, PMID 16109351
^ Schmidt R (24 October 2010), "Karen Carpenter's tragic story", The Guardian
^ Shannon, M. (2003), "The Demise of Ipecac", Pediatrics 112 (5): 1180–1, doi:10.1542/peds.112.5.1180, PMID 14595066
^ "Ipecac Syrup". Discontinued Drug Bulletin.
^ Krenzelok, EP; McGuigan, M; Lheur, P (1997), "Position Statement: Ipecac Syrup", Clinical Toxicology 35 (7): 699–709, doi:10.3109/15563659709162567, PMID 9482425

External links

AAP policy on Poison Treatment in the Home
Chemical Poisoning and Syrup of Ipecac

UpToDate Contents

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1. 中毒患者における胃洗浄 gastrointestinal decontamination of the poisoned patient
2. 薬物誘導性ミオパシー drug induced myopathies
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4. 成人における薬物中毒への一般的アプローチ general approach to drug poisoning in adults
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English Journal

Cyclotide discovery in Gentianales revisited-identification and characterization of cyclic cystine-knot peptides and their phylogenetic distribution in Rubiaceae plants.

Koehbach J, Attah AF, Berger A, Hellinger R, Kutchan TM, Carpenter EJ, Rolf M, Sonibare MA, Moody JO, Wong GK, Dessein S, Greger H, Gruber CW.Author information Center for Physiology and Pharmacology, Medical University of Vienna, Schwarzspanierstrasse 17, 1090, Vienna, Austria.AbstractCyclotides are a unique class of ribosomally synthesized cysteine-rich miniproteins characterized by a head-to-tail cyclized backbone and three conserved disulfide-bonds in a knotted arrangement. Originally they were discovered in the coffee-family plant Oldenlandia affinis (Rubiaceae) and have since been identified in several species of the violet, cucurbit, pea, potato, and grass families. However, the identification of novel cyclotide-containing plant species still is a major challenge due to the lack of a rapid and accurate analytical workflow in particular for large sampling numbers. As a consequence, their phylogeny in the plant kingdom remains unclear. To gain further insight into the distribution and evolution of plant cyclotides, we analyzed ∼300 species of >40 different families, with special emphasis on plants from the order Gentianales. For this purpose, we have developed a refined screening methodology combining chemical analysis of plant extracts and bioinformatic analysis of transcript databases. Using mass spectrometry and transcriptome-mining, we identified nine novel cyclotide-containing species and their related cyclotide precursor genes in the tribe Palicoureeae. The characterization of novel peptide sequences underlines the high variability and plasticity of the cyclotide framework, and a comparison of novel precursor proteins from Carapichea ipecacuanha illustrated their typical cyclotide gene architectures. Phylogenetic analysis of their distribution within the Psychotria alliance revealed cyclotides to be restricted to Palicourea, Margaritopsis, Notopleura, Carapichea, Chassalia, and Geophila. In line with previous reports, our findings confirm cyclotides to be one of the largest peptide families within the plant kingdom and suggest that their total number may exceed tens of thousands. © 2013 Wiley Periodicals, Inc. Biopolymers (Pept Sci) 100: 438-452, 2013.
Biopolymers.Biopolymers.2013 Sep;100(5):438-52. doi: 10.1002/bip.22328.
Cyclotides are a unique class of ribosomally synthesized cysteine-rich miniproteins characterized by a head-to-tail cyclized backbone and three conserved disulfide-bonds in a knotted arrangement. Originally they were discovered in the coffee-family plant Oldenlandia affinis (Rubiaceae) and have sinc
PMID 23897543

Effectiveness of emetics to study plastic ingestion by Leach's Storm-petrels (Oceanodroma leucorhoa).

Bond AL, Lavers JL.Author information Department of Biology, University of Saskatchewan, and Environment Canada, 11 Innovation Boulevard, Saskatoon, Saskatchewan S7N 3H5, Canada. alex.bond@usask.caAbstractMost plastic ingestion studies rely on dissection of dead birds, which are found opportunistically, and may be biased. We used Leach's Storm-petrels (Oceanodroma leucorhoa) in Newfoundland to study the effect of dose volume, and the efficacy of emesis using syrup of ipecac as an emetic. Ipecac is a safe method of non-lethally sampling stomach contents, and recovered all ingested plastic. Almost half the storm-petrels sampled had ingested plastic, ranging from 0 to 17 pieces, and weighing 0.2-16.9 mg. Using the Ecological Quality Objective for Northern Fulmars, adjusted for storm-petrels smaller size, 43% exceeded the threshold of 0.0077 g of plastic. Many adult seabirds offload plastic to their offspring, so storm-petrel chicks likely experience a higher plastic burden than their parents. The ability to study plastic ingestion non-lethally allows researchers to move from opportunistic and haphazard sampling to hypothesis-driven studies on a wider range of taxa and age classes.
Marine pollution bulletin.Mar Pollut Bull.2013 May 15;70(1-2):171-5. doi: 10.1016/j.marpolbul.2013.02.030. Epub 2013 Mar 15.
Most plastic ingestion studies rely on dissection of dead birds, which are found opportunistically, and may be biased. We used Leach's Storm-petrels (Oceanodroma leucorhoa) in Newfoundland to study the effect of dose volume, and the efficacy of emesis using syrup of ipecac as an emetic. Ipecac is a
PMID 23507234

Home safety education and provision of safety equipment for injury prevention (Review).

Kendrick D, Young B, Mason-Jones AJ, Ilyas N, Achana FA, Cooper NJ, Hubbard SJ, Sutton AJ, Smith S, Wynn P, Mulvaney C, Watson MC, Coupland C.Author information Division of Primary Care, University of Nottingham, UK. denise.kendrick@nottingham.ac.ukAbstractBACKGROUND: In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group.
Evidence-based child health : a Cochrane review journal.Evid Based Child Health.2013 May;8(3):761-939. doi: 10.1002/ebch.1911.
BACKGROUND: In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic
PMID 23877910

Japanese Journal

Molecular Cloning of an O-Methyltransferase from Adventitious Roots of Carapichea ipecacuanha

Cheong Bo Eng,Takemura Tomoya,Yoshimatsu Kayo [他],SATO Fumihiko
Bioscience, biotechnology, and biochemistry 75(1), 107-113, 2011-01-23
… Carapichea ipecacuanha produces various emetine-type alkaloids, known as ipecac alkaloids, which have long been used as expectorants, emetics, and amebicides. …
NAID 10027896875

私のカルテから催吐剤イペカック(トコン)により心筋障害を来した神経性食欲不振症の1例

中井義勝
精神医学 53(1), 93-96, 2011-01
NAID 40017407293

Karyotype and nuclear DNA content of Psychotria ipecacuanha : a medicinal species

ROSSI Ana Aparecida Bandini,CLARINDO Wellington Ronildo,CARVALHO Carlos Roberto,DE OLIVEIRA Luiz Orlando
Cytologia : international journal of cytology 73(1), 53-60, 2008-03-25
NAID 10020837300