Ipecacuanha

Ipecacuanha

The drug is chiefly collected in the interior, in the province of Matto Grosso and near the German colony of Philadelphia, north of Rio de Janeiro. It is also found in New Granada and in Bolivia.

Fibrous rootlets are given off from the knots, and some of them develop an abnormally thick bark, in which much starch is deposited.

The thickened rootlets alone are collected and dried for medicinal use, since the active constituents of the drug are found chiefly in the bark.

Ipecacuanha roots are collected, chiefly by the Indians, during the months of January and February, when the plant is in flower and are prepared by separation from the stem, cleaning and hanging in bundles to dry in the sun.

The drug is known in commerce as Brazilian or Rio Ipecacuanha.

History: The name of the plant is the Portuguese form of the native word, i-pe-kaa-guéne, which is said to mean 'road-side sick-making plant.'

In an account of Brazil, written by a Portuguese friar who had resided in that country from about 1570 to 1600, mention is made of three remedies for the bloody flux, one of which is called Igpecaya, or Pigaya, which is probably this root.

Although in common use in Brazil, Ipecacuanha was not employed in Europe prior to the year 1672, when a traveller named Legros brought a quantity of the root to Paris from South America. In 1680, a merchant of Paris named Garnier became possessed of 150 lb. of Ipecacuanha, and informed his assistant and the physician Helvetius of its usefulness in treating dysentery.

Helvetius prescribed the new drug, and it formed the basis of a patent medicine for dysentery. Trials were made of the composition, and Helvetius was granted by Louis XIV the sole right of vending the remedy. A few years after, the secret was bought from him by the French Government for 1,000 louis d'or and the formula was made public in 1688.

The botanical source of Ipecacuanha was the subject of much dispute, until it was finally settled by Gomez, a physician of the Portuguese Navy, who brought authentic specimens from Brazil to Lisbon in 1800.

Ipecacuanha occurs in commerce as slender and somewhat tortuous closely annulated pieces, which seldom exceed 6 inches in length and 1/4 inch in thickness. It varies in colour from very dark brown to dark red, the latter colour being partly due to adhering particles of earth. Difference in colour may also be due to difference of age or mode of drying. The bark is constricted at short intervals, so as to give the root the appearance of a number of discs somewhat irregularly strung together. The constrictions are sometimes quite shallow in Brazilian or Rio Ipecacuanha, though they may penetrate nearly to the wood. The root is hard and breaks with a very short fracture, the fractured surface exhibiting a thick, dark grey bark or cortex, with a horny, resinous or starchy appearance and a hard, wiry centre - small dense wood, in which no distinct pores or pith can be discerned; when examined with a lens though it is radiate.

The drug has a bitter taste, but only a slight, rather musty odour.

It is generally mixed with more or less of the slender subterranean stem, which has only a very thin bark, surrounding a ring of wood which encloses a distinct pith, and is thus easily distinguished from the root. The activity of the drug resides chiefly in the cortical portion, hence the presence of the stem diminishes its value.

The variety imported from Colombia and known as Cartagena Ipecacuanha, the product of Psychotria acuminata, differs only in its larger size and in being less conspicuously annulated, the constrictions of the bark assuming the form of narrow merging ridges.

Substitutes: In addition to the Cartagena Ipecacuanha, various other roots have been offered as substitutes, but all differ considerably.

East Indian Ipecacuanha, from Cryptocarpus spiralis, exhibits a typically monocotyledous structure in transverse section, scattered bundles running the pith, and a white starchy bark.

The name poaya is applied in Brazil to emetic roots of several genera belonging to the natural orders Rubiaceae, Violaceae and Polygalaceae, and hence several roots have from time to time been sent over to England as Ipecacuanha, but none of them possess the ringed or annulated appearance of the true drug. Of these, the root of Ionidium Ipecacuanha, Richardsonia scabra and P. emetica are those which have most frequently been exported from Brazil or Colombia.

Undulated Ipecacuanha, from R. scabra, is only lightly annulated, the wood is porous and the starchy bark often has a violet colour.

Lesser Striated Ipecacuanha from another species of Richardsonia is dark purplish brown in colour, longitudinally wrinkled, not annulated, and has porous wood.

Greater Striated Ipecacuanha from P. emetica, known as Black or Peruvian Ipecacuanha, closely resembles the preceding, but contains no starch and has dense wood. It grows in Peru and New Grenada, and in earlier days was for a long time considered as the source of the new drug, but is much less active.

White Ipecacuanha, from I. Ipecacuanha is greyish-white, or yellowish in colour and is also free from starch. This likewise was for long believed to be the plant which produces the genuine drug. It is a member of the order Violaceae. The root is almost insipid and inodorous and is used in Brazil as an emetic, though it has been considered doubtful whether it possesses any well-defined properties.

The roots of several species of Borreria, as B. ferruginia and B. Poaya, are also used in Brazil as substitutes for Ipecacuanha.

Constituents: The chief constituents of Ipecacuanha root are the alkaloids Emetine, Cephaelin and Psychotrine, of which the bark may contain from 1.5 to 2 per cent, of which about 72 per cent consists of Emetine and 26 per cent of Cephaelin, while only 2 per cent consists of Psychotrine.

Emetine, to which Ipecacuanha owes its properties and which, with the exception of traces, occurs only in the cortical portion of the root, is an amorphous white powder, but it forms crystalline salts. It has a bitter taste, no odour and turns yellow when exposed to air and light.

Other constituents are a crystalline saponin- like glucoside, an amorphous, bitter glucoside, which is a modification of tannin, and is known as Ipecacuanhic acid, choline, resin, pectin, starch, sugar, calcium oxalate, odorous, fatty matter and a disagreeable-smelling volatile oil.

Cartagena Ipecacuanha contains 2 to 3 per cent more alkaloidal matter than the Brazilian drug, but a smaller proportion of Emetine, Cephaelin being the alkaloid present in largest quantities.

East Indian Ipecacuanha and White Ipecacuanha contain minute quantities of emetic principles, which differ from the alkaloids of true Ipecacuanha, but the Undulated and Striated Ipecacuanha contain Emetine.

Medicinal Action and Uses: In large doses, Ipecacuanha root is emetic; in smaller doses, diaphoretic and expectorant, and in still smaller, stimulating to the stomach, intestines and liver, exciting appetite and facilitating digestion.

The dose of the powdered root is 1/4 to 2 grains when an expectorant action is desired (it is frequently used in the treatment of bronchitis and laryngitis, combined with other drugs, aiding in the expulsion of the morbid product), and from 15 to 30 grains when given as an emetic, which is one of its most valuable functions.

The Pharmacopoeias contain a very large number of preparations of Ipecacuanha, most of which are standardized.

Ipecacuanha has been known for more than a century to benefit amoebic (or tropical) dysentery, and is regarded as the specific treatment, but the administration of the drug by mouth was limited by its action as an emetic. Sir Leonard Rogers showed in 1912 that subcutaneous injections of the alkaloid Emetine, the chief active principle present in Ipecacuanha usually produced a rapid cure in cases of amoebic dysentery. The toxic action of Emetine on the heart must be watched. A preparation from which the Emetine has been removed, known as de-emetized Ipecacuanha, is also in use for cases of dysentery.

The great value of the drug in dysentery and its rapid increase in price from an average of 2s. 9 1/2d. per lb. in 1850 to about 8s. 9d. per lb. in 1870, led to attempts to acclimatize the plant in India, but without much commercial success, owing to the difficulty of finding suitable places for its cultivation and to its slowness of growth. It is grown to a limited extent in the Malay States, at Johore, near Singapore. In December, 1915, the Brazil root was valued at 24s. per lb. and the Johore root at 20s. per lb. At the same time, Cartagena root sold for 16s. per lb. It would probably pay to grow this plant more extensively in the British Colonies.

The diaphoretic properties are employed in the Pulvis Ipecacuanhaea compositus, or Dover's Powder, which contains 1 part of Ipecacuanha powder and 1 part of Opium in 10.

When applied to the skin, Ipecacuanha powder acts as a powerful irritant, even to the extent of causing pustulations.

When inhaled, it causes sneezing and a mild inflammation of the nasal mucous membrane.

Toxic doses cause gastro-enteritis, cardiac failure, dilation of the blood-vessels, severe bronchitis and pulmonary inflammation.

Preparations and Dosages: Powdered root, 5 to 30 grains. Fluid extract, B.P., 2 to 20 drops. Comp. Tinct. (Dover's), U.S.P., 8 drops. Wine, B.P., 10 drops to 6 drachms. Syrup, U.S.P., 1/4 to 4 drachms. Dover's Powder, B.P., 5 to 15 grains.

Other plants possessing emetic properties to a greater or less degree, to which the name of Ipecacuanha has been popularly applied are: American Ipec., Gillenia stipulacea; Wild Ipec., Euphorbia Ipecacuanha; Guinea Ipec., Boerhavia decumbens; Venezuela Ipec., Sarcostemma glaucum; Ipecacuanha des Allemands, Vincetoxicum officinale, and the Bastard Ipecacuanha, Asclepias cuirassavica, of the West Indies. This plant is used by the negroes as an emetic and the root is purgative; the juice of the plant, made into a syrup, is said to be a powerful anthelmintic, and as such is given to children in the West Indies.