Callicocca ipecacuanha Brot.

, Rubiaceae
Donetha Groover

Introduction
Ipecac, or Callicocca ipecacuanha Brot. is found in the plant family Rubiaceae. Rubiaceae,
commonly known as the coffee or bedstraw family, consists of over 6500 species. This makes it
one of the largest plant families. Ipecac has also been called Carapichea ipecacuanha,
Psychotria ipecacuanha, radix antidysenterica, and Cephaelis ipecacuanha (Kowalchik, Hylton).
In Brazil, where the plant is native, the name Ipecac breaks down as ipe: small, kaa: plant,
and quana: sick making (C. Jr. 1970). Portuguese called it the sick making plant or vomit
inducing plant. C. ipecacuanha has also been called golden root, not to be confused with the
golden root that comes from the plant Rhodiola rosea. Rhodiola rosea is used to treat poor
attention span and memory loss. There is also a plant native to the Coastal areas of the
eastern United States called Euphorbia ipecacuanhae L. that has the same vomit inducing
properties as its South American cousin (Forester, Duke, 2014).
It was not until 1800 that it was documented exactly where C. ipecacuanha came from. There
were many plants that also were emetic (vomit inducing), from different parts of the world that
were thought may be the same Ipecac plant. Finally the native location of Ipecac was settled
when a Portuguese Navy physician, Gomez, brought authentic specimens from Brazil to Spain
(Grieve, 1971).
The main use of C. ipecacuanha in recent years has been to induce vomiting in case of poison
by ingesting a syrup made of dried Ipecac roots and rhizomes. Ipecac has also been used to
treat dysentery, nausea, coughing, nosebleeds, asthma attacks, bronchitis, and diarrhea.
Emetine, psychotrine, and cephaeline are the main alkaloids found in Ipecac and have various
uses, some of which are still being studied and some which have yet to be confirmed.
Botanical Description
Callicocca ipecacuanha (figure 1) is a perennial native to Brazil, Nicaragua, Panama, and Costa
Rica, between latitude 7 and 20 south. It prefers shady, moist woods. It has been
transplanted and now grows in India and Malaysia, but not as well as in its native soil. C.
ipecacuanha is a straggly plant growing 3-12 inches tall with a thin stem. Towards the bottom
the stem becomes bulbous and knotted. Rootlets grow from these knots. These rootlets have
an extremely thick, pale brown bark where large quantities of starch is located. This bark is
where the alkaloids are found in highest concentrations. Leaves of the C. ipecacuanha plant
are ovate and hairy. They are generally found 4 to 6 per stem. At the top of the stem the leaves
are arranged in an opposite pattern, while further down the stem they become alternate.
Flowers from C. ipecacuanha are small and white (figure 2) occurring from December to March.
They form clumps of 8 to 12 flowers. Ipecac fruits from April to June. At that point the berry is
ovate and kidney bean sized and morphs from purple to a violet so deep it looks black as it
matures (King, Felter, Lloyd, 1898).
Ipecac is generally harvested from the roots and rhizomes of 3 year old plants in the wild during
the flowering months of January and February. The bark is separated, cleaned, and hung up to
dry in the sun. As the bark of C. ipecacuanha dries it changes from pale brown to grey, red, or

even black, depending on the technique used to dry it. Each plant produces 30 to 40 grams of
dried root that can be used for medicinal purposes. 100 tons of the plant are requested per
year, and only approximately 10 tons come from cultivated plants (Sousa,Martins, Pereira,
Oliveiria, 2006). C. ipecacuanha has a slight odor that is musty and nauseating, accompanied
by a bitter, acrid taste that is also nauseating.
There are two ways that C. ipecacuanha propagates. One is through asexual reproduction and
the other is through birds carrying seeds away. Ipecac is a slow growing plant and currently
now endangered because of being harvested for medicinal purposes, as well as loss of habitat
(Souza, Martins, Pereira, Oliveira, 2006).
Numerous other plants with emetic properties have been found, and at times have been
mistaken, either accidentally or on purpose (because of the cost of actual Ipecac plants), for C.
ipecacuanha. These include Psychotria emetica L.f., Gillenia stipulacea, Sarcostemma
glaucum (figure 3), and Vinctoxicum officinale to name a few. Ipecac is such a popular
ingredient in medications that there have been many companies trying to find adequate
substitutes as the supply dwindles.
Traditional Uses
Native South Americans in Brazil, called the Tupi, used Callicocca ipecacuanha long before
European settlers, namely the Portuguese, learned of it. In Brazil the plant was mainly used to
treat dysentery. Dysentery is a disease that causes inflammation of the intestine which leads to
abdominal pain, diarrhea, dehydration, and sometimes death. Samuel Petres published a book
called The Pilgrimes in 1625 which was a collection of travel essays. This was the first
mention of Ipecac in written form (Lloyd, 1897). In 1649 Ipecac was finally brought to Europe by
a Dutch physician named William Piso. However the quantities of the plant were extremely
small so it remained in the shadows.
A French doctor, Helvetius, then made the plant popular in Europe in 1682 after receiving 150
pounds of C. ipecacuanha. He did this by treating and curing King Louis XIVs son of dysentery
(or the flux as it was known then) with a secret mixture containing the plant (Reader's Digest
Association). Helvetius later sold his recipe for the mixture to the French government for a
fortune and soon after the secret of Ipecac was released to the public. It became a staple of
medicines used to purge and help balance out the humors that were believed to cause ill health
(Sumner, 2000). Dr. Thomas Dover, from England, took this recipe and created a dry powder
that was sold for the next 200 years as a cure for gout. Gout causes swelling, stiffness, and
pain in the joints of the individual suffering from an attack. Dovers powder was one part Ipecac,
and one part opium with other things thrown in. From there Ipecac was found in many
medicines meant to heal anything from dysentery (figure 3) to irritability.
In the United States Ipecac syrup was recommended by doctors in the 1940s to be kept on
hand. As such it became a mainstay in the medicine cabinet of every home up until the 1980s.
It was kept there as an insurance plan against accidental ingestion of poison. See table 1 for a
timeline of usage in the United States. See table 2 for dosage information.
The powdered form of C. ipecacuanha was used to induce sweating. When Ipecac powder is
rubbed onto skin it causes severe irritation, and sometimes pustules. One recipe for the
treatment of rheumatism called for an ointment of Ipecacuanha, sweet oil, and lard to be rubbed
onto joints and covered until eruptions are formed (King, Felter, Lloyd, 1898).

Most of the uses for C. ipecacuanha suggested taking it orally. It is slightly soluble in water, but
highly soluble in alcohol. In fact the preparation of Ipecac requires making a powder of the roots
and then macerating it in alcohol. In small doses Ipecac is added to cough syrups as an
expectorant. In higher doses the syrup induces vomiting.
One traditional recipe for using Ipecac was 10% alcohol, 10% Ipecac, and 80% white wine to
use as an expectorant. Another recipe required 10% Ipecac, 10% opium, and 80% milk sugar,
which is slightly better than the recipe that called for 10% Ipecac and 90% opium (Sajous &
Sajous, 1922)
In 1912 Sir Leonard Rogers used injections of C. ipecacuanha, specifically the alkaloid emetine
and its salts emetine hydrochloride and emetine hydrobromide, to treat dysentery. Injection of
the medicine makes the side effect of vomiting less severe. However, injection of the plant is
hard on the heart and caution must be used.
When inhaled Ipecac causes severe sneezing, irritation, and sometimes bleeding.
A relative of the C. ipecacuanha plant is the Euphorbia ipecacuanha L. which is found on the
eastern coast of the United States. Native Americans used the leaves to make tea to treat
diabetes. They also used the roots to make a tea to treat pinworms and rheumatism.
Snakebites were treated with a poultice of the roots (Forester, Duke, 2014).
C. ipecacuanha was transported to India and Pakistan. There it became a cure for bilharziasis,
a parasitic disease caused by flatworms (Readers Digest Association). It comes from ingesting
infected water. It is also known as schistosomiasis and causes liver, bladder, and intestinal
problems.
Chemistry and Pharmacology
Emetine (figure 4) was the first alkaloid to be discovered in Callicocca ipecacuanha. It was
discovered in 1817 by a French chemist named Pierre Joseph Pelletier. Other members of the
rubiaceae family also contain this alkaloid (Fisher, 1973). It is used to induce vomiting, and also
as an anti-protozoal. However, it can only be useful in the latter case if other drugs are
administered to keep the vomiting at bay. It has proven to be extremely effective against
amoebiasis. It is found in the roots of the Ipecac plant as a white powder and also in the form of
salts. When in contact with sunlight Emetine turns dark. The characteristic bitter taste of Ipecac
comes from this alkaloid. In 1966 Grolman found that Emetine inhibits protein synthesis. This
effect is irreversible. It also inhibits synthesis by viral RNA in polio infected cells (S. Akinboye,
2011)
Entamoeba histolytica, a protozoan, is inhibited by Emetine. This parasite not only causes
dysentery, but also amoebic liver and skin. Emetine inhibits the growth of this protozoan by
inducing cell death (S. Akinboye, 2011). This alkaloid is only slightly soluble in water and ether,
although it is highly soluble in alcohol and chloroform.
Dehydroemetine is a synthetically created agent that differs from Emetine only by a double bond
in the ethyl group. It is also an anti-protozoal, but has less side effects than the natural
chemical. In fact it was one of the chemicals prominent in researching how to treat and cure
cancer (Fisher, 1973).

Cephaeline (figure 4), another alkaloid found in Ipecac was discovered in 1894 by Paul and
Crowley, two English chemists. This alkaloid induces vomiting by irritating the lining of the
stomach and activates the vomiting center in the brain known as the medullary chemoreceptor
trigger zone, as does Emetine. Emetine actually demethylates to cephaeline (Barceloux. 2012).
It has been found that cephaeline is actually the stronger emetic of the two. Cephaeline yellows
when exposed to sunlight. Just like emetine it is highly soluble in alcohol and chloroform and
only slightly soluble in ether and water. The difference between the two alkaloids is that
cephaeline is soluble in a solution of sodium hydroxide while emetine is not (Lloyd, 1897)
Psychotrine (figure 4) is an alkaloid also found in Ipecac. Studies are still being done to
determine its usefulness. Light will decompose this alkaloid (De Clercq, 1993).
Only about 2% per weight of these active ingredients are found in the bark. Of that 2%, 72% is
Emetine, 26% Cephaeline, and only 2% is Psychotrine. Emetine is found in other parts of the
plant, however the greatest concentration is in the bark of the root and the rhizomes. For
instance, in the leaves emetine is found in concentration of only 0.5%. Emetine can be made by
chemically modifying cephaeline or psychotrine (Souza, Martins, Pereira, Oliveira, 2006).
Also found in C. ipecacuanha is a glucosid called ipecacuanhic acid. Ipecacuanhic acid
resembles caffetannic and quinic acids. There is also gum, resin, sugar, lignin, starch, and a
volatile oil found in the plant (Souza, Martins, Pereira, Oliveira, 2006).
Biological Activity
Numerous studies have been done on Callicocca ipecacuanha because it has been used
medicinally for centuries. At least 4 studies have been done on dogs to see how much of a
poison, such as barium could be recovered. The problem with these studies was that the dogs
were treated with other substances ranging from aspirin to ampicillin to prevent spontaneous
vomiting. It was found that if Ipecac was given within 5-10 minutes it was highly effective.
Waiting longer caused the efficiency to go down considerably because it gave the substances a
longer time to be broken down and absorbed. The average amount of poison brought up by
using Ipecac was 45% (Bellinger, 2013).
Studies have also been done on rats and ferrets. These studies have focused on determining
the modes and mechanisms of the emetic properties of Ipecac. It is suggested that the 5-HT3
may be important, as well as the fact that Ipecac has an affinity for receptors 5-HT4. Scientists
have also been testing the toxin potencies of emetine and cephaeline. The toxicity of these two
alkaloids after long term use is one of the barriers to being able to use Ipecac for purposes of
treating cancer (De Clercq, 1993).
One study has been done on the possibility of using Psychotrine, and some of the salts from C.
ipecacuanha, on the HIV-1RT. These substances seem to be inhibitors of the polymerase
activity in the virus. This may lead to some useful chemotherapeutic medicines with some more
research (De Clercq, 1993).
Some laboratory studies have shown that the alkaloid emetine found in C. ipecacuanha seems
to be effective against the dengue virus. At .5 M to 10 M Emetine is found to inhibit the virus
by 90%. It does this by inhibiting the replication cycle, although how it does so is not completely
understood (S. Akinboye, 2011).
Clinical Studies

Most of the clinical studies of Callicocca ipecacuanha have been done to determine if Ipecac
syrup was truly effective against accidental poisoning. In study after study it has been found
that Ipecac is effective if given within 10 minutes of ingestion of a poison. At 30 minutes after
ingestion of poison activated charcoal is more effective because the charcoal will absorb the
toxin and negate its effects (Krenzelok, 2004). Even when given Ipecac syrup at home, just as
many children end up in the emergency room for further treatment as those not given the
medicine (Lapus, Slattery, King, 2010).
It is difficult to take the data received from volunteers given simulated overdoses and
extrapolate that data to actual, toxic overdoses of drugs. Amounts of drugs (in one particular
study acetaminophen, aspirin, ampicillin, cyanocobalamin, and sucralfate) ingested will affect
absorption and dissolution rates so using a non-toxic dose may not truly simulate an overdose
of the drugs tested (Bellinger, 2013). At least 11 studies of volunteers have been done. The
rate recovery of the toxic substance was always higher when Ipecac was given at the 5 minute
mark. Percentages of material recovered varied wildly from 21% to 64% (Bellinger, 2013).
Studies have also been done to see if the alkaloid, Emetine, is effective against cancer. In one
study lung cancer patients were given a combination of Emetine and cyclophosphamide (a
medication used in chemotherapy). Significant responses were observed and it was found that
Emetine induces apoptosis (cell death). This same result was found in treating neuroendocrine
tumor cells in human subjects. The problem with this treatment is the high toxicity from
recurring treatments, however chemical modification may prove to make this treatment safe.
Specifically, it seems that slightly modifying the structure of emetine at the N2 position has
promising results (S. Akinboye, 2011).

Contraindications
With vomiting there is the possibility of aspiration if the airway is compromised. This is one of
the main contraindications with medicine from the Callicocca ipecacuanha plant. If the poison
ingested is one that is strongly acidic (such as toilet bowl cleaner), strongly alkaline (such as
lye), or comes from petroleum (such as gasoline or paint thinner) vomiting the substance up
could do more harm than good (Krenzelok, 2004). Ipecac should not be given to pregnant
women. It can cause uterine stimulation, which could lead to miscarriage.
Ipecac actually has a high safety margin. Between 1983 and 1996 over 3 million people were
given Ipecac (Bellinger, 2013).The most common side effects are diarrhea, drowsiness, and
prolonged vomiting, meaning vomiting occurs for more than one hour. Less common side
effects include profuse sweating, fever, and irritability. Tears in the esophagus (Mallory-Weiss
tears), air in the space between the lungs (pneumomediastinum), as well as aspiration
pneumonia are rare, but serious, complications that arise from the use of Ipecac.
Ipecac syrup is being reviewed currently to see if it will become available only by prescription
(table 1). A large reason for this was the abuse of the syrup by those who were suffering from
eating disorders such as anorexia (Pfister, 2010). The death of singer Karen Carpenter which
was due in part to overuse of Ipecac Syrup helped bring this into light. One study suggests that
18% of those suffering from disorders of this type used Ipecac syrup to purge (Steffen, Mitchell,
Roerig, Lancaster, 2007). There have also been documented cases of Ipecac syrup being used
in Munchausen Syndrome by Proxy (Barceloux, 2012). Munchausen Syndrome by Proxy is

where a parent or caretaker of a child causes them to be sick so as to garner sympathy and
attention. Long term use of Ipecac will bring about heart problems, seizures, and even death.
Studies have also determined that activated charcoal is often just as, or even more effective,
than a dose of Ipecac syrup. In addition to being more effective, there are less side effects
associated with the activated charcoal.
Activated charcoal, or other drugs, should not be administered in conjunction with, or for a while
after, Ipecac is taken (Krenzelok, 2004). Ipecac will cause them to be ineffective since much of
it will be vomited back up. Instances of complications go from 0.9% to 5.4% when Ipecac and
activated charcoal are administered together (Bellinger, 2013). Carbonated beverages should
also need to be avoided when Ipecac is administered because they can cause swelling of the
stomach. There are two different points of view on ingesting milk with Ipecac. One view
suggests drinking it because it may counteract the harmful effects caused by C. ipecacuanha.
The other view says that milk can cause more harm than good. No studies have been done
whether either viewpoint is true.
Emetine has been found to cause toxic myopathy (muscle weakness) and even death if taken
repeatedly in various ways. First is the fact that emetine blocks nerve cell transmissions.
Secondly, it inhibits dipeptidyl aminopeptidase IV which activates t-cells. Lastly, emetine
disrupts dopamine receptors. Emetine is eliminated by the kidneys slowly, and traces can still
be found in urine 60 days after a dose of Ipecac. A lethal dose is 20 mg/kg. 30 mL of Ipecac
contains 21 mg of the alkaloid (S. Akinboye, 2011).
Caution also needs to be taken when coming into contact with the whole of the C. ipecacuanha
plant. Juice from the plant can cause irritation and sores to form. Gloves should be worn if the
plant needs to be handled (King, Felter, Lloyd, 1898).
Current Use in Allopathic and CAM Therapies
Callicocca ipecacuanha is used in CAM therapies in an extremely diluted (30x) formula. Over
the counter formulas are 9 parts water or alcohol to 1 part Ipecac. Tablets are then made by
mixing this with sugar to make it easier to take. CAM usage distinguishes itself from allopathic
Ipecac syrup by using the name Ipecacuanha and is used for reasons completely opposite from
those of allopathic medicine. It is used for bloating, excessive gas, coughing (figure 5),
wheezing, heavy menstrual flow, migraines, and morning sickness.
Ipecacuanha is especially used to stop nausea, but there are conditions to when it is prescribed
for use. If a person feels worse when they lay down then Ipecacuanha is the right medicine.
Also, if there is heavy salivation, gagging, or if what is vomited is white and slimy then it would
be called for (King, Felter, Lloyd, 1898).
Discussion
Callicocca ipecacuanha has been used for centuries for many diverse medicinal purposes. It is
highly effective against certain types of dysentery. C. ipecacuanha has in recent times been
used mainly as a treatment for poison ingestion. Study after study has shown that while it can
be effective if given soon after ingestion, here in the United States access to care is such that it
is not needed. People end up in the emergency room for poison ingestion just as often now that
Ipecac is no longer found in households as they did when it was a common part of a home first
aid kit. However, in developing countries where medical care may be an hour or more away,

having Ipecac syrup around could save lives in the case of ingestion of a poisonous substance.
Ipecac has also proved to be effective against amoebic dysentery. Again, in the United States it
is not necessary thanks to the status of the United States as a developed country with a
relatively clean water supply. In third world countries C. ipecacuanha treatment is necessary
and can greatly affect the standard of living of many people by giving them a means to save
lives that otherwise would be lost because of insufficient medical care.
It is apparent this straggly little shrub has many more secrets hiding within its roots. Studies
are being done to determine if C. ipecacuanha can be used as a treatment for different types of
cancer, as well as HIV. It is a shame that the plant is endangered. There are so many
possibilities promised by the research done so far, that efforts should be made in cultivating it
and saving it. It is also puzzling why Ipecac is still mainly harvested only in the wilds of Brazil,
Nicaragua, Costa Rica, and Panama. Ipecac is yet another example of the medicines that have
been, and will probably continue to be, lost due to habitat destruction in South America.
As with any other drug there is a fine line between beneficial doses and toxicity of Ipecac. C.
ipecacuanha should continue to be studied so that the side effects can be canceled out. It is
hopeful that the plant continues to be around so that researchers can unlock all of the secrets it
holds. Stopping loss of habitat in South America should be of utmost importance to researchers
in the medical field.
References Cited
Barceloux, D. (2012). Medical toxicology of drug abuse. Hoboken, N.J.: John Wiley & Sons.
Bellinger, M. (2013). Position Paper Update: Ipecac Syrup for Gastrointestinal Decontamination.
The Journal Of Emergency Medicine, 45(2), 310-311.
http://dx.doi.org/10.1016/j.jemermed.2013.06.010
C., Jr., T. E. (1970). A brief history of Ipecac. Pediatrics, 46(1). Retrieved from
http://pediatrics.aappublications.org/content/137/6?current-issue=y
De Clercq, E. (1993). HIV-1-specific RT inhibitors: Highly selective inhibitors of human
immunodeficiency virus type 1 that are specifically targeted at the viral reverse transcriptase.
Medicinal Research Reviews, 13(3), 229-258. http://dx.doi.org/10.1002/med.2610130303
Drugs.com. (2016). Ipecac syrup: indications, side effects, warnings. Retrieved from
http://www.drugs.com/cdi/ipecac-syrup.html
Fisher, H. H. (1973). Origin and uses of ipecac. Econ bot, 27(2), 231-234.
doi:10.1007/bf02872992
Food and Drug Administration. (2003). Regulatory History for Ipecac Syrup. Retrieved from
http://www.fda.gov/ohrms/dockets/ac/03/briefing/3962B1_02_Regulatory%20History.htm
Forester, S., & Duke, J. A. (2014). Green flowers. In Petersen field guide to medicinal plants
and herbs of eastern and central North America (3rd ed., p. 276). New York, NY: Houghton
Mifflin Harcourt Publishing Company.
Frey, R. (2006). Ipecac. In Encyclopedia.com | free online encyclopedia (3rd ed.). Retrieved
from http://www.encyclopedia.com/topic/ipecac.aspx
Grieve, M. A Modern Herbal. New York: Dover Publications, 1971. Print.
King, John, Harvey Wickes Felter, and John Uri Lloyd. King's American Dispensatory.
Cincinnati: Ohio Valley Co., 1898. Print.
Kowalchik, C., Hylton, W. H., Carr, A., & Rodale Press. (1987). Healing with herbs. In Rodale's
illustrated encyclopedia of herbs (3rd ed., p. 281). Emmaus, PA: Rodale Press.
Krenzelok, E. P., McGuigan, M., & Lheureux, P. (2004). Position paper: Ipecac Syrup. Journal
of toxicology: clinical toxicology, 42(2), 133-143. doi:10.1081/clt-120037421
Lapus, R., Slattery, A., & King, W. (2010). Effects on a Poison Centers (PC) Triage and

Follow-up After Implementing the No Ipecac Use Policy. Journal Of Medical Toxicology, 6(2),
122-125. http://dx.doi.org/10.1007/s13181-010-0066-x
Lloyd, John Uri. Cephaelis Ipecacuanha. Chicago: [Engelhard], 1897. Print.
National Capital Poison Center. (2016). Ipecac. Retrieved from
http://www.poison.org/articles/ipecac
Pfister, R. L. (2010). Ipecac: a lesson in clinical guidelines. The internet journal of allied health
sciences and practice, 8(2). Retrieved from http://ijahsp.nova.edu
Reader's Digest Association. (1986). Gallery of medicinal plants. In Magic and medicine of
plants (7th ed., pp.374-375). Pleasantville, NY: Author.
Sajous, C. & Sajous, L.(1922). Sajous analytic cyclopedia of practical medicine. Philadelphia:
F.A.
Davis Co.
S. Akinboye, E. (2011). Biological Activities of Emetine. The Open Natural Products Journal,
4(1), 8-15. http://dx.doi.org/10.2174/1874848101104010008
Souza, M., Martins, E., Pereira, T., & Oliveira, L. (2006). Reproductive studies on ipecac
(Cephaelis ipecacuanha (Brot.) A. Rich; Rubiaceae): meiotic behavior and pollen viability.
Braz. J. Biol., 66(1a). http://dx.doi.org/10.1590/s1519-69842006000100019
Steffen, K., Mitchell, J., Roerig, J., & Lancaster, K. (2007). The eating disorders medicine
cabinet revisited: A clinician's guide to ipecac and laxatives. Int. J. Eat. Disord., 40(4),
360-368. http://dx.doi.org/10.1002/eat.20365
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Tables

1965

Ipecac allowed for over the counter sale in

one fluid ounce containers

1975

Ipecac classified as a class I emetic ( safe

and effective)

1982

Ipecac recommended as treatment for toxic

ingestion

1985

Dosages for Ipecac standardized

2003

Ipecac no longer recommended for home

usage

Table 1
Timeline of C. Ipecacuanha use in modern United States
(Lapus, Slattery, King, 2010) (Food and Drug Administration, 2003)

Syrup

70 mg of powdered Ipecac per mL

< 6 months of age

Only under supervision of doctor

6 months to < 12 months

5mL

1 < 12 years of age

15mL

>12 years of age

30 mL

Table 2
Preparation and dosage information for Ipecac syrup
https://www.drugs.com/monograph/ipecac-syrup.html
Figures

Figure 1
Illustration of C. ipecacuanha from a plant herbal
http://plantillustrations.org/illustration.php?id_illustration=82188

Figure 2
C. ipecacuanha in flower
http://plantasmedicinaisizildinha.blogspot.com/

Figure 3
Sarcostemma glaucum (often mistaken for C. ipecacuanha)
http://plantillustrations.org/illustration.php?id_illustration=58013

Figure 4
Some of the many different medicines sold containing C. ipecacuanha
http://www.henriettes-herb.com/eclectic/journals/nemaq1915/pics/nemaq-7-2-ad1.html

Figure 5
Chemical structure of emetine, ,cephaeline, and psychotrine
http://www.chemspider.com/

Figure 6
One of many CAM uses for C. ipecacuanha today
http://homeremedieslog.com/natural-products/medicinal-plants/ipecac-syrup/