RAPIDLY REVERSIBLE CARDIOMYOPATHY ASSOCIATED WITH CHRONIC IPECAC INGESTION

Ipecac, an over-the-counter emetic agent, has been a drug of choice fo r abuse by patients with eating disorders. Its alkaloid emetine has be en associated with serious cardiac toxicity; however, the dose effect has not been well established. We present a patient with anorexia and bulimia nervosa who ingested ipecac chronically and developed the char acteristic manifestations of ipecac toxicity. Unexpectedly, her induce d left ventricular dysfunction returned to normal after only 10 days o f withholding the drug. This finding, in contrast with the findings of other reports, establishes that ipecac cardiomyopathy can be readily reversible. The cumulative experience thus far, nonetheless, provides no discernible pattern of the effect of ipecac on the myocardium. Thus , in the continuum of poisoning, the point at which the myocardium bec omes irreversibly damaged is undetermined. With continued abuse, poten tially lethal outcome, and limited experience with ipecac cardiotoxici ty, further investigation and perhaps heightened restriction of the dr ug are warranted.