Aug 24, 2003: What is the status of Ipecac?

Due to the recent article about Ipecac in the Tennessean, a number of readers asked me to address Ipecac (again) in the Question of the Week.

Ipecac has gained attention because the FDA is considering removing it from OTC status.  This is a very interesting as there is no new data regarding ipecac.  What is even more interesting is the controversy that has been generated by the FDA’s consideration. One of the reasons for removing it from the market is the potential for abuse by bulimic patients.

 The incidence of administering Ipecac following ingestion has markedly decreased over the last 5 years.  Available data is limited, and there are no prospective studies comparing outcome following Ipecac administration to supportive care.  No benefit has been demonstrated following Ipecac administration, and there are morbidities and mortalities.  However, old traditions die-hard. 

A number of societies are “making statements”-the only available option when there is little data.  The American Academy of Clinical Toxicology (AACT) is currently reviewing the Position Paper of 1997.  I doubt that there will be any new recommendations.  The Position Paper said that Ipecac should not be routinely administered following an ingestion.  A second group was appointed last year by their respective societies in an attempt to gain greater consensus.  The AACT, American College of Medical Toxicology (ACMT) and American Association of Poison Control Centers (AAPCC) reviewed the literature and drafted another statement.   I think this group is going to say that Ipecac should be considered in rare situations such as when a person is several hours from medical care.  (I must admit, this doesn’t make sense to me.  If it doesn’t change outcome, why would one give it in this situation?)  The American Academy of Pediatrics (AAP) will be releasing a statement regarding Ipecac in November, at their annual meeting.  That statement is embargoed at the present time, but I believe it will reflect a similar approach.  

The Middle TN Poison Center does not recommend the administration of Ipecac.  If you have any questions about specific situations, please contact me.  

I am interested in any questions that you would like answered in “Question of the Week.”  Please e-mail me with any suggestions at

Donna Seger, M.D.
Medical Director, Middle Tennessee Poison Center