Absolute contraindications to the use of ipecac:
(1) age < 6 months
(2) coma
(3) active seizures
(4) absent or impaired gag reflux with unprotected airway
(5) coingestion of a sharp solid object
(6) altered mental status
Relative contraindications to the use of ipecac:
(1) pregnancy
(2) bleeding diathesis
(3) poorly absorbed hydrocarbons
(4) intention to use whole bowel irrigation
(5) severe heart disease
(6) bradycardia (vomiting may worsen bradycardia through vagal nerve stimulation)
Nonindications for use:
(1) nontoxic ingestion
(2) toxin no longer in stomach (by 1 hour much of the toxin will have left the stomach, with very little left by 4-6 hours, unless there is delayed gastric emptying)
(3) patient has already vomited
Potential misuses of ipecac:
(1) bulemia to induce vomiting
(2) Munchausen syndrome by proxy
Complications of ipecac:
(1) aspiration pneumonia
(2) difficulty in subsequent use of activated charcoal or other oral remedies
(3) persistent vomiting
(4) lethargy
(5) diarrhea
