Cephaelis ipecacuanha (Carapichea ipecacuanha) - Ipecacuanha
"CONSTITUENTS: Emetine, the emetic principle existing in the stem, leaves and root, cholin and cephaeline in the root, ipecacuanhic acid, and a nauseating ethereal oil.
PREPARATIONS: Extractum Ipecac Fluidum, Fluid Extract of Ipecac; dose: from one to forty minims. Syrupus Ipecac, Syrup of Ipecac; dose: from ten to sixty minims. Pulv. Ipecac et Opii, Powder of Ipecac and Opium, composed of Ipecac and opium of each ten parts, Sugar of Milk, eighty parts; dose: from three to ten grains. Specific Medicine Ipecac; dose: for gastric, intestinal or bronchial irritation, five drops in four ounces of water; a tablespoonful every hour. As an emetic, from five to twenty minims in hot water.
Alcresta Ipecac is prepared by the action of Lloyd's reagent on the solution of the alkaloids of ipecac. It represents the medicinal properties of the ipecac, but will not produce nausea or emesis. It is superior to emetine in its general use because it is not hypodermic. One tablet represents ten grains of the powdered ipecac. It may be given in doses of one, two or three tablets three times per day, before meals.
Therapy: For its emetic influence ipecac is one of the most satisfactory of the emetics. When there is undigested food in the stomach, causing irritation, when mild poisons are taken, when emesis is demanded to relieve sick headache, this agent is used in preference to others. If promptness of action be demanded the full dose should be given in a bowl of warm water—not hot—or a single full dose of lobelia may be given with it. This produces immediate emesis without prostration. If powerful poisons are taken, and active emesis is demanded, the sulphate of zinc or lobelia in persistent doses, or some other emetic more immediate in its influence, is usually used, although the writer has always been able to adjust ipecac with such adjuvants as warm water, mustard, or tickling of the throat, to every case. In cases where foreign bodies are lodged in the esophagus, and in the threatened suffocation of mucous croup, or in membranous croup, ipecac is the remedy, especially in childhood. No emetic more harsh should be used with children. In the developing stage of malarial fevers it was once the practice to produce active diaphoresis by a hot pediluvium and hot drinks, the patient being wrapped in warm blankets, and to produce profound emesis with ipecac. Often the most desirable results were obtained, and in some cases where an acute cold had been contracted or where there was a severe chill, in strong, previously healthy patients, the disease, was suddenly terminated by this course. The author has had this experience. In the bronchitis of childhood occurring often suddenly, with a dry, hoarse, stridulous or croupal cough, without secretion, ten drops of the syrup of ipecac given every half hour, hour, or two hours until nausea in induced, will sometimes abort the condition in a few hours, the influence of the agent dissipating the conditions essential to the progress of the disease. This form of bronchitis is common in furnace-heated houses, and in close, hot, unventilated apartments, in the beginning of the winter when the furnace fire is first started, and in the spring.
Ipecac in small doses given in conjunction or in alternation with aconite or bryonia or belladonna, is of great service in pneumonia, especially that of childhood. Five drops in a half glass of water, a teaspoonful every hour, may be given with the best of results. In acute bronchitis it may be prescribed in the same manner.
Ipecac is of value also in the after stages of pneumonia. In the stage of active inflammation it is useful as stated, but is not given in the same. form as in the later stages. It is an excellent remedy to assist in clearing up hepatization and in restoring normal conditions in the lung cells. The author, when the temperature has subsided, gives one-fourth to one-half a grain of powdered ipecac to an adult, every two or three hours in a capsule, with two grains of the bisulphate of quinine. The tonic influence of the quinine assists the influence of the ipecac.
Ipecac is of value in coughs when there is a deficient secretion, whatever the cause. Emetic doses are not desirable if the agent is to be continued for a length of time.
It has been beneficial in spasmodic asthma, whooping cough and in laryngismus stridulus.
This agent is advised in irritation of the bowels resulting in acute inflammation. In small doses it is given with good results in cholera infantum and in diarrheas, but is of no benefit beyond the acute stage.
While ipecac has been known as a cure for certain forms of dysentery for more than a century, the use of its active principle emetine as a cure for amebic dysentery is just now coming into prominence. Our writers have always advised ipecac for this disease, but not all have given it in sufficiently large doses. Administered now in the form of alcresta ipecac or emetine hypodermically, the cures are prompt and highly satisfactory. In fact, the remedy is already being classed with quinine for malaria, and antitoxin for diphtheria, as one of the great specifies.
If the dysenteric tenesmus is relieved with prompt doses of gelsemium—and we have a no more efficient remedy in the materia medica for this condition than that agent—the beneficial effects of the ipecac upon the local inflammatory processes will be more plainly marked.
Recent observers in the general hospital in Calcutta, India, have found that large doses of ipecac have most beneficial effects in amebic hepatitis and hepatic abscess. If the diagnosis be made before the formation of pus, this is prevented by the agent. It should be given when the patient suffers with a general feeling of lassitude, foul tongue, pain in the right shoulder and in the right hypochondrium. The liver is enlarged and tender on pressure. There is marked leukocytosis but the polynuclear increase is not great. Ipecac is given in these cases in single large doses, usually from twenty to thirty grains, given at least two hours after eating and best taken at bedtime. Occasionally this dose is given twice daily in capsules.
Frazier claims that ipecac in large doses is an excellent addition to the treatment of typhoid fever. In five cases where he used it, the temperature dropped suddenly so that within four days it was normal. In the earlier stages he gave thirty grains on the first day; twenty-five the next; twenty the next and so on down until ten. He gave small doses of opium to keep the patient from vomiting. The results were pronounced. This course is worth trying.
The successful use of this common remedy, in the treatment of epilepsy has been reported, since our first edition. Persistent cases have been treated, with ten minim doses of a strong fluid extract, increased to forty minims. This has been persisted in according to the susceptibility of the patient. The action of emetine or alcresta ipecac should be at once determined for the above conditions.
In hemorrhages Ipecac has exercised a satisfactory influence. Its action upon the circulation is quite prompt. It is given by some physicians in small doses for this purpose, and by others in full doses to prompt emesis. It has controlled postpartum hemorrhage, menorrhagia, metrorrhagia, epistaxis and hemoptysis, and will exercise a beneficial influence in hematuria."
(Finley Ellingwood: The American Materia Medica, Therapeutics and Pharmacognosy, 1915)