June 5, 2017
WAC 246-869-200 requires Pharmacies have the Poison Control Center telephone number readily available and at least one one-ounce bottle of Ipecac syrup to be in stock at all times.
Lack of Availability of Syrup of Ipecac
Syrup of ipecac has been used for decades to provide gastrointestinal decontamination after overdose. While it has been shown to be effective in inducing vomiting, it has failed to improve outcomes of poisoned or overdosed patients in studies. Family, friends, and care providers may not recognize the potential of chronic toxicity, abuse, or undesired side effects. Due to the poor risk to benefit profile (the lack of demonstrated improved outcome coupled with the potential for toxicity and interference with other treatments), administration of syrup of ipecac has fallen from favor. The recommendation for the use of syrup of ipecac by Poison Centers has significantly declined to less than 1% of calls. The American Academy of Pediatrics has recently called for the removal of syrup of ipecac from homes. The American Academy of Clinical Toxicology and the American Association of Poison Control Centers jointly released a position paper stating that routine administration of syrup of ipecac at the site of ingestion and the emergency department should be avoided.
While specific, rare circumstances may still require the need for gastrointestinal decontamination in the home or in remote areas, these instances are exceedingly rare. In such circumstances, syrup of ipecac or another method of gastrointestinal decontamination may be indicated and should only be employed after the poison center is contacted for consultation.
Syrup of ipecac is no longer manufactured in the United States and increasingly difficult to acquire. Most health care agencies do not stock it. Studies have shown that syrup of ipecac retains much of its activity long beyond the posted expiration date on the bottle. Samples have shown near complete activity more than 20 years past the expiration date.
The Washington Poison Center recommends the following:
- Requirements for the stocking of syrup of ipecac by pharmacies, childcare businesses, and other agencies should be eliminated.
- Bottles of Syrup of Ipecac should be retained and can be used long past their expiration date.
- Family, friends, care providers, and others contemplating the need to provide gastrointestinal decontamination should contact the regional Poison Center at 1-800-222-1222. In most cases, such decontamination will not be indicated.
Professionals at the Poison Center can provide information on the risks, benefits, and alternatives to the use of Syrup of Ipecac.
Erica L. Liebelt MD FACMT
Alexander Garrard, PharmD, DABAT
Clinical Managing Director