Plant of the Month: June 2014 Ipecac
Ransom Naturals Ltd produces two main herbal drug preparations containing Ipecacuanha root. These are IP/06 – Ipecacuanha Liquid Extract BP and IP/19 – Ipecacuanha Tincture BP 1999. Both these products are respectively standardised to contain about 8.0% and 2.0% total alkaloids expressed as emetine. Cephaelis ipecacuanha more commonly known as Ipecacuanha, Ipecac, Rio, Matto Grosso or Brazilian Ipecac is a plant native to tropical South and Central America. The plant is a member of the Rubiaceae family and has a slender stem which grows partly underground and is often procumbent at the base, the lower portion being knotted. It tends to favour a moist shady wooded habitat where it can be found growing in clumps. The part used medicinally is the root which is collected during the flowering season in January and February and it is prepared by separation from the stems followed by drying in bundles in the sun. The root has a slender reddish brown appearance and is characteristically annular with a diameter of about 4mm. The name of the plant is derived from the Portuguese form of the native word, i-pe-kaa-guéne, which is said to mean ‘road-side sick-making plant’. The root has a long traditional medicinal use. In large doses, the root is a potent emetic; in smaller doses, diaphoretic and expectorant, whilst in small amounts it is stimulating to the stomach and aids digestion. It has also been traditionally used to treat dysentery; a property that has not been successfully exploited due to its emetic action which limits its oral administration. Ipecacuanha was introduced into Europe in the late 1600s, when a traveller brought a quantity of the root to Paris from South America, where it subsequently found its way into the apothecaries of Paris as a treatment for dysentery. A formerly used popular herbal drug preparation was Syrup of Ipecac which was used to induce vomiting is cases of suspected poisoning. It was largely used in the 18th and 19th Century for this purpose but the herbal drug preparation has been largely discontinued due to insufficient evidence of its attributed efficacy. However Ipecacuanha can still be obtained as an OTC medicine in the UK where it is found in licenced medicinal products such as Covonia Herbal Mucus Cough Syrup (Thornton & Ross Ltd). It is also an ingredient of several other products available on prescription only. The herbal drug is listed in the Ph. Eur. as Ipecacuanhae radix along with four herbal drug preparations namely (1) Ipecauanha Liquid Extract, Standardised (Ipecacuanhae extractum fluidum normatum), (2) Ipecacuanha, Prepared (Ipecacuanhae pulvis normatus) (3) Ipecacuanha Tincture, Standardised (Ipecacuanhae tincture normata) and (4) Paediatric Ipecacuanha Emetic Mixture. Ipecacuanhae pulvis is the powdered root. The active constituents of Ipecacuanhae radix are alkaloids, principally the isoquinoline alkaloids emetine (1) and cephaeline (2). They both act locally by irritating the gastric mucosa and centrally by stimulating the medullary chemoreceptor trigger zone to induce vomiting. The herbal drug should contain a minimum of 2.0% total alkaloids whilst the Ph. Eur. standardised liquid extract, tincture and paediatric emetic oral solution should respectively contain between 1.80-2.2%, 0.18-0.22% and 0.12-0.16% total alkaloids respectively. Ipecacuanha Liquid Extract BP is standardised to contain between 1.90-2.10% total alkaloids. In all cases the total alkaloid content is expressed as emetine.