By Tony, and guest blogger Lisa Klodnicki
During the past 10-15 years, the use of syrup of ipecac (SOI) to induce vomiting as a treatment for poisoning has fallen out of favor. The American Academy of Pediatrics recommends that SOI “should no longer be used routinely as a poison treatment intervention in the home” and that everyone should safely dispose of any SOI currently in their homes. The American Association of Poison Control Centers (AAPCC) similarly published a position statement which recommended SOI use only under very limited, restricted circumstances. This change of direction has come about for several reasons, including the fact that no studies demonstrate beneficial outcomes from its use, the risk for serious complications if SOI is given for the wrong indication, and the potential for serious toxicity with chronic misuse and abuse by patients with bulimia or other appetite disorders. Statistics compiled by the AAPCC reveal that SOI was administered in 15% of all poisonings reported in 1985, while the incidence of its use has dramatically declined to 0.0484% in 2008.
Despite efforts to educate the general public by poison control centers, and others interested in poison prevention and safety, inquiries still come in to the Illinois Poison Center by callers wanting to know where they can purchase SOI. For example, recently a pharmacist from a long-term care facility in Illinois called us stating that he was updating his emergency drug supply. He was having trouble procuring SOI and asked where he could obtain some. I explained to him that SOI is no longer used for a variety of reasons and that the product is considered essentially obsolete. He replied jokingly, “Over here, we specialize in obsolete.” We laughed, but he got the picture.
This latest inquiry caused us to ask ourselves who, if any one, still manufacturers and distributes this product once considered to be a must to store in everyone’s medicine cabinet. We compiled a list of all known manufacturers and distributors of SOI and contacted them to see who still makes this product available for sale. To our surprise, all of these companies no longer produce or market SOI, except one, which has the product on backorder due to a shortage of raw materials. So for all practical purposes, the use of SOI as an emetic has become a moot point unless someone inadvertently uses an old bottle that has been stashed away for some years. If you have a one fluid ounce bottle of SOI in your home, you can do one of two things: either bring it to a local medication take back program or donate it to your favorite pharmacy museum.
For decades, SOI was considered a mainstay of poisoning management. The induction of projectile vomiting in accidentally poisoned children made us feel good because we thought were doing something beneficial for the patient, however, the time has come to recognize that SOI no longer has a place in the management of poisoning. Since overall interest in the utility of SOI has died, the time has finally come for everyone to face the truth and just let “syrup of ipecac rest in peace. Amen.”