Editing Syrup of ipecac (section)

== Use ==
{{Globalize|section|USA|2name=the United States|date=October 2016}}
[[File:Ipecac.jpg|thumb|Ipecac plant]]
Ipecac was used in cough mixtures as an [[expectorant]] or an [[emetic]] from the 18th until the early 20th century.{{citation needed|date=February 2017}} For instance, ipecac and [[opium]] were used to produce [[Dover's powder]], which was used in syrup form.{{citation needed|date=February 2017}}

In 1965, the [[Food and Drug Administration]] (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 [[American Academy of Pediatrics]], [[American Association of Poison Control Centers]], [[American Medical Association]], 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 [[poison]]ing.<ref>{{Cite news|url = https://news.google.com/newspapers?id=3wUrAAAAIBAJ&pg=4879%2C4587550|title = New Lifesaver For Your Medicine Chest|last = Galton|first = Lawrence |date = 1966-01-09|work = Parade|access-date = 2015-06-04}}</ref>

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.<ref>{{cite journal | title = Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention | journal = Pediatrics | volume = 112 | issue = 5 | pages = 1182–5 | date = November 2003 | pmid = 14595067 | doi = 10.1542/peds.112.5.1182 | author = American Academy Of Pediatrics Committee On Injury Violence | doi-access = free }}</ref>  Many toxicological associations have also issued position papers recommending against its use as a first-line treatment for most ingested poisons,<ref>{{cite journal | title = Position paper: Ipecac syrup | journal = Journal of Toxicology. Clinical Toxicology | volume = 42 | issue = 2 | pages = 133–43 | year = 2004 | pmid = 15214617 | doi = 10.1081/CLT-120037421 | last1 = American Academy Of Clinical Toxico | s2cid = 218865551 }}</ref> 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.<ref>{{cite journal | vauthors = Bateman DN | title = Gastric decontamination--a view for the millennium | journal = Journal of Accident & Emergency Medicine | volume = 16 | issue = 2 | pages = 84–6 | date = March 1999 | pmid = 10191436 | pmc = 1343284 | doi = 10.1136/emj.16.2.84 }}</ref> When dealing with poisoning cases in the 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 a [[Health Resources and Services Administration]]-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 [[Adverse effect (medicine)|side effects]], such as [[lethargy]], can be confused with the poison's effects, complicating [[medical diagnosis|diagnosis]]. The use of ipecac may also delay the use of other treatments (e.g., [[activated charcoal (medication)|activated charcoal]], [[whole bowel irrigation]], or oral [[antidote]]s) or make them less effective.<ref>{{cite journal | vauthors = Manoguerra AS, Cobaugh DJ | title = Guideline on the use of ipecac syrup in the out-of-hospital management of ingested poisons | journal = Clinical Toxicology | volume = 43 | issue = 1 | pages = 1–10 | year = 2005 | pmid = 15732439 | doi = 10.1081/CLT-200046735 }}</ref>

=== Misuse ===
Ipecac has been used by people 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.<ref>{{cite journal | vauthors = Silber TJ | title = Ipecac syrup abuse, morbidity, and mortality: isn't it time to repeal its over-the-counter status? | journal = The Journal of Adolescent Health | volume = 37 | issue = 3 | pages = 256–60 | date = September 2005 | pmid = 16109351 | doi = 10.1016/j.jadohealth.2004.08.022 }}</ref> 
Misuse of ipecac has been blamed for the death of singer [[Karen Carpenter]] in 1983 who suffered from anorexia nervosa.<ref>{{cite journal | vauthors = Schmidt R |title=Karen Carpenter's tragic story |journal=The Guardian |date=24 October 2010 |url=https://www.theguardian.com/books/2010/oct/24/karen-carpenter-anorexia-book-extract}}</ref> It has also been used as an agent for [[Münchausen syndrome by proxy]].<ref>{{cite journal | vauthors = Shannon M | title = The demise of ipecac | journal = Pediatrics | volume = 112 | issue = 5 | pages = 1180–1 | date = November 2003 | pmid = 14595066 | doi = 10.1542/peds.112.5.1180 }}</ref>