Emetine Health Dictionary

(Brot.) A. Rich.

Psychotria ipecacuanha

Family: Rubiaceae.

Habitat: Native to tropical America. Now cultivated in Darjeeling, Assam, in the Nilgiris, and in Sikkim.

English: Ipecac, Ipecacuanha.

Action: Root—Antiprotozal, expectorant (in low doses), diaphoretic, emetic (in high doses); used in amoebic dysentery, stubborn cough, whopping cough (for liquefying bronchial phlegm).

Key application: As expectorant, emetic. (The British Herbal Pharmacopoeia.)

The root contains isoquinoline alkaloids (consisting mainly of emetine and cephaeline); tannins (ipecacuanha and ipecacuanhic acid; glycosides including a monoterpene isoquinoline derivative); saponins; a mixture of glycoproteins; starch; choline; resins.

The alkaloids are clinically useful in the treatment of amoebiasis.

Emetine and cephaeline are emetic due to their irritating effect on stomach; cephaeline is more toxic. Emetine is a standard antiamoebic principle. In smaller doses, both are expectorant.

The fluid extract is 14 times stronger than the syrup of the crude drug. The powder is toxic at 1-2 g.

Emetine accumulates in liver, lungs, kidneys and spleen; traces are detectable after 40-60 days. (Francis Brinker.)... cephaelis ipecacuanha

A clinical state arising from invasive colo-rectal disease; it is accompanied by abdominal colic, diarrhoea, and passage of blood/mucus in the stool. Although the two major forms are caused by Shigella spp. (bacillary dysentery) and Entamoeba histolytica (amoebic dysentery), other organisms including entero-haemorrhagic Escherichia coli (serotypes 0157:H7 and 026:H11) and Campylobacter spp. are also relevant. Other causes of dysentery include Balantidium coli and that caused by schistosomiasis (bilharzia) – Schistosoma mansoni and S. japonicum infection.

Shigellosis This form is usually caused by Shigella dysenteriae-1 (Shiga’s bacillus), Shigella ?exneri, Shigella boydii, and Shigella sonnei; the latter is the most benign and occurs in temperate climates also. It is transmitted by food and water contamination, by direct contact, and by ?ies; the organisms thrive in the presence of overcrowding and insanitary conditions. The incubation is between one and seven days, and the severity of the illness depends on the strain responsible. Duration of illness varies from a few days to two weeks and can be particularly severe in young, old, and malnourished individuals. Complications include perforation and haemorrhage from the colo-rectum, the haemolytic uraemic syndrome (which includes renal failure), and REITER’S SYNDROME. Diagnosis is dependent on demonstration of Shigella in (a) faecal sample(s) – before or usually after culture.

If dehydration is present, this should be treated accordingly, usually with an oral rehydration technique. Shigella is eradicated by antibiotics such as trimethoprimsulphamethoxazole, trimethoprim, ampicillin, and amoxycillin. Recently, a widespread resistance to many antibiotics has developed, especially in Asia and southern America, where the agent of choice is now a quinolone compound, for example, cipro?oxacin; nalidixic acid is also e?ective. Prevention depends on improved hygiene and sanitation, careful protection of food from ?ies, ?y destruction, and garbage disposal. A Shigella carrier must not be allowed to handle food.

Entamoeba histolytica infection Most cases occur in the tropics and subtropics. Dysentery may be accompanied by weight loss, anaemia, and occasionally DYSPNOEA. E. histolytica contaminates food (e.g. uncooked vegetables) or drinking water. After ingestion of the cyst-stage, and following the action of digestive enzymes, the motile trophozoite emerges in the colon causing local invasive disease (amoebic colitis). On entering the portal system, these organisms may gain access to the liver, causing invasive hepatic disease (amoebic liver ‘abscess’). Other sites of ‘abscess’ formation include the lungs (usually right) and brain. In the colo-rectum an amoeboma may be di?cult to di?erentiate from a carcinoma. Clinical symptoms usually occur within a week, but can be delayed for months, or even years; onset may be acute – as for Shigella spp. infection. Perforation, colo-rectal haemorrhage, and appendicitis are unusual complications. Diagnosis is by demonstration of E. histolytica trophozoites in a fresh faecal sample; other amoebae affecting humans do not invade tissues. Research techniques can be used to di?erentiate between pathogenic (E. dysenteriae) and non-pathogenic strains (E. dispar). Alternatively, several serological tests are of value in diagnosis, but only in the presence of invasive disease.

Treatment consists of one of the 5nitroimidazole compounds – metronidazole, tinidazole, and ornidazole; alcohol avoidance is important during their administration. A ?ve- to ten-day course should be followed by diloxanide furoate for ten days. Other compounds – emetine, chloroquine, iodoquinol, and paromomycin – are now rarely used. Invasive disease involving the liver or other organ(s) usually responds favourably to a similar regimen; aspiration of a liver ‘abscess’ is now rarely indicated, as controlled trials have indicated a similar resolution rate whether this technique is used or not, provided a 5-nitroimidazole compound is administered.... dysentery

The root of Cephaëlis ipecacuanha, a Brazilian shrub. It contains an alkaloid, emetine, which acts as an irritant when brought into contact with the interior of the stomach, producing vomiting. Formerly used to induce vomiting among young children after poisoning and if still alert, but now of uncertain value, it was used in many traditional expectorant mixtures

(see EXPECTORANTS) given in the treatment of BRONCHITIS. (See POISONS.)... ipecacuanha

English Ivy. Hedera helix L. German: Efeu. French: Lierre. Spanish: Diedra o Yedra. Italian: Edera. Leaves, berries. Contains the saponins, hederine and emetine. Practitioner use.

Action: cathartic, diaphoretic, stimulant, antispasmodic, expectorant, febrifuge, anthelmintic, amoebicidal.

Uses: whooping cough, to liquefy bronchial phlegm. Berries macerated in vinegar to make an acid tincture used in the London plague. Hydrocephalus (single drop doses of fresh plant juice) traditional. Preparations. Locally, Ivy leaf poultice for swollen glands and chronic leg ulcer.

Ivy Leaf Corn Cure. ... ivy

Linn.

Synonym: H. rhombea Sieb. & Zucc.

Family: Araliaceae.

Habitat: Hills of Tamil Nadu. Grown in gardens as an ornamental.

English: Common Ivy, Bentwood.

Siddha/Tamil: Maravalai.

Action: Leaf—expectorant, anti- spasmodic, antineuralgic, vasocon- strictive.

Fruit—used in jaundice, haempt- ysis. Flower—antidysenteric. Leaf and resin—emmenagogue. Tender twigs—boiled in butter, used for sunburn. Extracts are used in some cosmetic preparations.

Key application: In catarrh of the upper respiratory passages, symptomatic treatment of chronic inflammatory bronchial conditions. (German Commission E.)

The stem and bark gave triterpene glycosides, named kizuta saponins. Oleanolic acid glycoside was also obtained from the plant but the presence of emetine could not be confirmed in subsequent work. The fruits gave hederagenin glycosides.

Emetin has been isolated from European and British plant. The fruit and hederagenin glycosides exhibit mollus- cacidal activity. Emetine-containing plant is amoebicidal.... hedera helix

(Linn.) Wall.

Synonym: H. pubescens (Buch.- Ham.) Wall. ex G. Don.

Family: Apocynaceae.

Habitat: The tropical Himalayas, going up to an altitude of 1,100 m. Also found throughout many forests of India, in Travancore, Assam and Uttar Pradesh.

English: Easter tree, Ivory tree, Tellicherry Bark.

Ayurvedic: Kutaja, Girimallikaa, Kaalinga, Kalingaka, Indravrik- sha, Shakra, Vatsa, Vatsaka, Shakraahvya. Indrayava, Indrabija, Vatsabija (seed). Kurchi (bark).

Unani: Inderjo talkh, Teewaaj-e- Khataai.

Siddha/Tamil: Kudasappaalai-pattai, -vidai (bark, seed).

Action: Root and bark—used in amoebic dysentery. Bark—astringent, anthelmintic, amoebicidal, diuretic. Used in colic, dyspepsia, piles, diseases of the skin and spleen. Seed—antibilious. Used for promoting conception, also for toning up vaginal tissues after delivery.

The bark contains the alkaloids, regholarrhenine-A, -B, -C, -D, -E and -F; pubescine, norholadiene, pubes- cimine, kurchinin, kurchinine, kur- chinidine, holarrifine, holadiene, kurchilidine, kurchamide, kurcholes- sine, kurchessine, conessine, cones- simine and isoconessimine, and the steroidal compounds kurchinicin and holadyson.

The alkaloid conessine is used as a therapeutic drug for the treatment of dysentery and helminthic disorders. Conessine and conimine inhibited the growth of Shigella sonnei, S. flexneri and Salmonella enteritidis strains in vitro. In chronic amoebiasis, Bi-iodide compound of total alkaloids, given orally, compare favourably with emetine Bi-iodide.

The plant possesses potent immuno- stimulant property.

The Kurchi seeds are sold as a substitute for Strophanthus sp. seeds in Indian market. (Seeds of Strophanthus sp. contain a toxic glucoside, strophan- thin, and are poisonous.)

Dosage: Stem bark—20-30 g for decoction. (API Vol. I); seed—3- 6 g powder; 20-30 g for decoction. (API Vol. III.)... holarrhena antidysenterica

(Burm. f.) Merrill.

Synonym: T. asthamatica Wight & Arn.

Family: Asclepiadaceae.

Habitat: Assam, West Bengal, Orissa and Peninsular India.

English: Emetic Swallow Wort, Indian or Country Ipecacuanha.

Ayurvedic: Antamuula, Muulini, Arkaparni.

Siddha/Tamil: Nay Palai, Nangilaip- piratti.

Action: Leaves—used for bronchial asthma and allergic rhinitis.

The whole plant yielded alkaloids including tylophorine, tylphorinine, desmethyltylophorine and desmethyl- tylophorinine, and a flavonoid kaem- pferol. The root yielded alkaloids, tylophorinidine and gamma-fagarine. The leaves gave tylophorinidine, d- septicine, d-iso-tylocrebrine; triterpe- noids alpha-and beta-amyrin; beta- sitosterol, stigmasterol and campes- terol; phenylalanine; and quercetin. Ceryl alcohol has also been reported from the plant.

The plant exhibited anti-amoebic activity against axenic and polyax- enic strains of Entamoeba histolytica. Tylophorine and 4-methoxy-14- hydroxytylophorine are 2 and 4 times more effective, respectively, than the standard drugs Emetine dihydrochlo- ride and Metroindazole. Tylophorine is found effective in intestinal as well as hepatic amoebiasis in test animals, but its gross toxicity excludes its potential use in humans.

Tylophorine also exhibits anti-inflammatory and anti-tumour properties.

Desmethyltylophorine gave promising results in leukaemia.

The drug irritates the digestive tract.... tylophora indica

Cephaelis ipecacuanha

Rubiaceae

Importance: Ipecac is a small evergreen herb with much branched beaded roots. It is used in powdered form or as liquid total extract, syrup and tincture. Ipecac syrup in small doses is used as an expectorant, as it is well tolerated by children. It is used in treatment of whooping cough. Ipecac with opium as in Dover’s powder is used as a diaphoretic, tincture and syrup. Emetine hydrochloride in the form of injection is used for treatment of amoebic dysentery. Emetine bismuth iodide is also given orally for amoebic dysentery. Ipecac is also used as gastric stimulant and as an anti-inflammatory agent in rheumatism.

Distribution: The plant is a native of Bolivia and Brazil. It is cultivated in Mungpoo, near Darjeeling and on the Nilgiris, especially New Kallar, and at the Rungbee Cinchona plantation in Sikkim.

Botany: Cephaelis ipecacuanha (Brot.) A. Rich. syn. Psychotria ipecacuanha Stokes. belongs to the family Rubiaceae. The plant grows upto 0.7m high, with slender cylindrical stem. When mature the roots are dark brown and have transverse furrows giving it a beaded appearance. Above ground stem is quadrangular and trailing with few or new branches. Leaves are opposite near the top of the plant and alternate below, 5-10x3-6cm area, dark green above and pale green underneath. Flowers are white, sessile, funnel-like, less than 1cm wide and are borne in dense clusters. Fruit is purple with two stones containing single seed (Husain, 1993).

Agrotechnology: Ipecac prefers an average rainfall ranging between 2000-3000mm and evenly distributed. Maximum temperature should not exceed 38 C and the minimum not below 10 C. It thrives well in tropical mild humid climates similar to Malaysian rain forests. Virgin forest soils rich in humus are ideal for Ipecac. It prefers deep medium fertile soils which are acidic and rich in humus, potash and magnesium. Soil should be well drained and protected from wind and storm. As Ipecac grows only in shade, it can be cultivated as an intercrop, or planted in artificially shaded beds. The plant is propagated both by seeds and vegetatively by root, stem and leaf cuttings. Vegetative propagation is preferred to maintain genetic uniformity of the plant. Most of the commercial plantations are raised by seeds. Raised seed beds of 2x6m size are made and are mi xed with well rotten leaf compost and sand. These are provided with shade on the top as well as on the sides. Seeds are drilled or broadcasted in the beds and watered regularly. Seeds take 3-5 months to germinate. Seed treatment with limewater for 48 hours or H2O2 improves germination. It has been observed that providing mulch or black polythene in nursery beds improves germination as well as results in control of weeds. The suitable season of planting is January-March in West Bengal. Seedlings are planted in production beds at a spacing of 10x10cm after they are 8-12 weeks old. In West Bengal, it is a practice to transfer seedlings to other nursery beds before being transferred to final production seedbeds. FYM and leaf compost application is required during second and third year. Super phosphate applications is found to improve root growth. Frequent irrigation is required. Waterlogging should be avoided. Both the seedbeds and production beds should be kept free from weeds. Seedlings are often attacked by damping off fungi like Rhizoctonia sp. in nursery. It is better to treat the seeds with a suitable seed dressing fungicide before planting. Fusarium wilt caused by F. moniliforme has been reported from India. The plants are ready for harvesting after 4 years. The roots should be dug out, washed and dried in the sun. Rhizome and root are the economical parts (Husain, 1993).

Properties and activity: Ipecac root contains 2.2-2.5% total alkaloids. The main alkaloids are cephaeline and emetine. In addition, it also contains psychotrine and psychotrine ethyl ether. The drug also contains a crystalline glucosidal tannin, starch and calcium oxalate (60-70% of the alkaloids is emetine). Root contains minor amounts of O-methyl psychotrine, emetamine, protoemetine and others. Other constituents of ipecac include choline, glycoside-ipecoside, saponins, resins, tannins-ipecacuanhin, an allergen composed of mixture of glycoproteins, ipecacuanhic acid, a neutral monoterpene acid and calcium oxalate. Cephaeline could be converted into emetine on methylation.

The powdered dried rhizome and root cause severe asthmatic attacks and vasomotorrhinitis. Emetine hydrochloride is anti-amoebic. Root is emetic, expectorant and diaphoretic (Husain et al, 1992).... ipecac

Cephaelis ipecacuanha (Brot.) A. Rich. German: Brachwurzel. French: Ipecacuanha. Spanish: Ipecacuanha. Italian: Ipecaquana. Rhizome and root. Practitioner use only. Contains alkaloid and saponin emetine, glycosides, tannins.

Action: expectorant, diaphoretic, antiprotozal BHP (1983), emetic (large doses). Acts upon the pneumogastric nerve. Antispasmodic. Stimulant to mucous membranes.

Uses: to liquefy bronchial phlegm and promote expectoration. Sore throat, whooping cough, stubborn cough. Amoebic dysentery. Expulsion of mucus from the chest. Alternative to a stomach pump to induce vomiting.

Combinations: with Lobelia for respiratory disorders. With Tincture Myrrh for bowel infection, orally or by enema.

Preparations: Average dose, rhizome and roots: 25-100mg. Thrice daily. Dose more accurately controlled by use of liquid extract or tincture rather than infusion or decoction.

Liquid extract BP 1973: dose 0.025 to 0.1ml. Emetic dose – 0.5 to 2ml.

Tincture BP (1973). Dose 0.25 to 1ml. Emetic dose 5 to 20ml.

Cough mixtures: an ingredient of. (Potter’s Balm of Gilead) etc. Contra-indications: shock, heart disease. ... ipecacuanha root

May follow inflammation of the liver from a number of causes, the most common being a manifestation of amoebic dysentery. Through blood infection it may appear on the surface of the liver or other organs.

Symptoms: pain under the right lower rib which may be referred to the right shoulder or under shoulder blades.

Treatment. Official treatment is aspiration or opening-up the abscess followed by drainage. Whether or not this is necessary, alternative anti-bacterials such as Myrrh, Goldenseal, Echinacea and Blue Flag may be used with good effect.

Alternatives. Teas: Milk Thistle. Grape leaves. 1 heaped teaspoon to each cup of water, thrice daily. Decoctions: Echinacea, Blue Flag, Goldenseal, Parsley root. One heaped teaspoon to each cup water gently simmered 20 minutes. Half a cup thrice daily.

Tablets/capsules: Blue Flag, Echinacea. Goldenseal. Wild Yam. Devil’s Claw.

Tinctures. Formula. Fringe Tree 3; Meadowsweet 2; Goldenseal 1. One to two 5ml teaspoons, thrice daily.

Practitioner. Ipecacuanha contains emetine which is specific for liver abscess; at the same time it is effective as an anti-amoebic-dysentery agent. Where dysentery is treated with Ipecacuanha liver abscess is rare. Tincture Ipecacuanha BP (1973). Dose: 0.25-1ml.

Diet. Fat-free. Dandelion coffee. Vitamins B6, C and K. Lecithin.

Treatment by or in liaison with a general medical practitioner. ... liver – abscess