Home poison aid falls out of favor
A medicine-cabinet staple for millions of parents, syrup of ipecac may soon disappear from drugstore shelves.
The Food and Drug Administration is considering evidence that ipecac, the long-standing home remedy for poisonings, may be doing more harm than good.
The agency could decide to revoke the syrup’s over-the-counter status by the end of the year.
After several quiet decades on the market, the syrup is at the center of a medical debate. Many doctors want to keep ipecac readily available to treat children who have ingested certain poisonous substances or medications. But some doctors and poison control experts say there’s no proof it is an effective way to get poisons out of the digestive system.
Others say the liquid is being abused by bulimics because it’s so readily obtained. Dr. Pauline Powers, president-elect of the National Eating Disorders Assn. and professor of psychiatry at the University of South Florida College of Medicine, said that several thousand bulimics are estimated to use ipecac for purging.
The trend has led to at least four deaths and probably is responsible for many more, said Dr. Anthony Manoguerra, director of the San Diego division of the California Poison Control System, who spoke before an FDA advisory committee meeting on the subject in June.
Ipecac also has been used by parents with a rare condition called Munchausen syndrome by proxy, in which they harm their children to get attention from doctors, Manoguerra said at the meeting.
“Our opinion is, if [ipecac] doesn’t work, it doesn’t work,” he said in an interview. But, he added, “a number of physicians don’t want this option taken away from them.”
Ipecac’s use in treating poisonings has declined in recent years.
Dr. Milton Tenenbein, professor of pediatrics and pharmacology at the University of Manitoba, Canada, said ipecac was used in about 15% of poisoning cases 15 years ago. Now it’s used in fewer than 1%.
Part of the reason for the decline, said Manoguerra, is that “we understand the toxicity of chemicals a lot better than we did 10 to 15 years ago.” Doctors and poison experts now know it takes a lot more than accidentally ingested Tylenol or houseplant leaves, for example, to harm a child than previously thought, he added.
Ipecac’s frequent and unpleasant side effects also are behind the debate. The drug causes drowsiness, diarrhea, persistent vomiting and, in rare cases, tears in the stomach or esophagus.
Although vomiting is ipecac’s desired effect, it also can be a drawback, Manoguerra said. It can prevent children who have swallowed something especially harmful -- such as prescription blood pressure or heart disease medications -- from keeping down the antidote, a drink of activated charcoal.
Hospitals often give the activated charcoal drink to poison victims, and many poison control centers are considering recommending that parents keep the compound in the home for the same purpose. Many doctors say the compound is more effective than ipecac and a proven method for removing poisons from the digestive tract.
The American Academy of Pediatrics and the American Assn. of Poison Control Centers, two groups that have long advocated home use of ipecac, are reevaluating their policies.
The FDA’s nonprescription drug advisory committee voted 6 to 4 last month in favor of revoking ipecac’s over-the-counter status. An FDA official said the agency was considering a range of options for the syrup, from leaving it as an over-the-counter remedy to making it a prescription drug. An intermediate option under consideration is a labeling change that would warn users against taking ipecac for weight loss.
