Ipecacuanha, Rio Ipecac, Uragoga Ipecacuanha. Universally official. Also called Cephaelis Ipecacuanha and C. acuminata, or Cakthagena.

Ipecac. This latter is, more properly, a species of Psychotria.

Pharmacology

Ipecac contains emetine (6 3/4% of the total alkaloidal content), cephaeline (nearly 1/4 of the total alkaloidal content), and psychotrine (a trace). Ipecac is an irritant to mucous membranes and is a prompt emetic, in smaller doses than those producing emesis increasing tracheal and bronchial secretion. The flow of saliva and sweat is stimulated. Parenteral administration of the alkaloids produce emesis, probably not by direct action on the vomiting center in the medulla, and this action is slower when taken by mouth. In this ipecac differs from apomorphine. This has a practical importance since it allows adequate doses of emetine to be administered hypodermatically in ameboid dysentery, etc., without producing the nausea and vomiting the same doses would induce if administered by mouth.

Given by mouth in emetic doses, salivation, perspiration, and depression are followed by emesis, and but little systemic effect. A toxic dose injected hypodermatically will, after an interval, induce the same symptoms; but purgation also follows, the heart weakens progressively, the mucous discharges become tinged with blood, and the individual goes into a state of collapse.

Cephaeline acts much as does emetine, but is many times more toxic. Psychotrine, on the other hand, is much less toxic than emetine. The whole drug, or cephaeline, should be used for the emetic properties, emetine being reserved for the amebicidal properties it possesses in so marked a degree.

Emetine hydrochloride acts similarly to ipecac, but is relatively more nauseant and less emetic, and causes less renal irritation but more cardiac depression. Overdoses may have serious effects. It is expectorant in doses of 1-12 to 1-6 grain; emesis is apt to be caused by doses over 1-6 grain, and the drug should not be employed as an emetic. Hypo-dermically 1/2 grain may be given. The drug is marketed in ampules and hypodermic tablets.

Emetine is a powerful amebicide, but is not a bactericide. It is valuable in the treatment of amebic dysentery, according to the technic of Leonard Rogers, since improved upon. Sterile ampules containing the drug dissolved in isotonic salt solution are the most certain form in which the drug is offered.

Most cases of amebic dysentery in the United States are not severe in type and readily enough yield to a few doses of emetine, even in keratin-coated pills, or preferably "Alcresta" ipecac tablets, which, owing to the drug being incorporated with hydrated aluminum silicate passes unchanged through the stomach. Each tablet represents 10 grains of ipecac, and 2 or 3 tablets are given three times a day for from 4 to 6 days, discontinuing temporarily if the laxative effect becomes too pronounced.

In severe tropical cases the drug (emetine) may be used intravenously, doses of 1 grain being given in 5 cc. of normal saline.

Children require relatively large doses.

Emetine is not of value in bacillary dysentery, and it is very questionable if it should be used in an effort to restrain hemorrhage, as in typhoid fever. The drug does not favor blood coagulation nor lower blood pressure. But it must be admitted that in the respiratory tract ipecac has an effect upon pulmonary congestion and indirectly upon hemorrhage. Here ipecac, not emetine, should be used.

Pyorrhea alveolaris (Riggs's disease) may, and often does, depend partly upon ameboid infection. Emetine is not a "specific" in pyorrhea, as has been claimed; but it materially aids, in conjunction with dental surgery and proper antisepsis, in clearing up Cephaeline has a true ipecac action but is relatively more emetic and less nauseant and causes relatively more renal irritation and less cardiac depression, thus differing markedly from emetine.

Cephaeline is employed as an emetic and expectorant in doses of 1-24 to 1-6 grain, in pill, trituration, or syrup.

It is asserted that ipecac, or cephaeline, is of value applied to the pustules of anthrax.

Ipecac itself is emetic, expectorant, and diaphoretic.