Syrup of ipecac (SI) has been used medicinally since the 1500s; however, li
ttle is known about the pharmacokinetics in humans of SI's active ingredien
ts, emetine and cephaeline. The objective of this study was to evaluate the
rate of absorption and the rate of elimination of emetine and cephaeline.
Ten healthy, adult, human volunteers between 18 and 45 years of age who wer
e of ideal body weight (body mass index 20-25) completed this study. After
an overnight fast, 30 mt SI were ingested. Blood samples were collected 30,
45, 60, 90, 120, 150, and 180 minutes post-ingestion and urine was collect
ed throughout the study period. Plasma and urine concentrations of emetine
and cephaeline were measured by reverse-phase HPLC with fluorescence detect
ion. In virtually all subjects, emetine and cephaeline were detected within
5-10 minutes of dosing with the time to maximum concentration being approx
imately 20 minutes. The mean areas under the concentration-time curve (AUC)
for both emetine and cephaeline were similar; however, the ratio of mean c
ephaeline maximum concentration (C-max) to emetine C-max was approximately
1.5. Four of the ten subjects exhibited a type of concentration-time profil
e in which the levels of cephaeline were substantially higher than those of
emetine and the levels of cephaeline were substantially higher than noted
for the other six subjects. In these remaining six subjects, the levels of
emetine and cephaeline were lower than 10 ng/mL at all time-points. An init
ial elimination phase was noted in some subjects but nor in others. Individ
uals in whom an initial elimination phase was not observed also exhibited l
ow levels of both alkaloids as compared with the other subjects suggestive
of a slower distribution phase. Less than 0.15% of the administered emetine
and cephaeline was recovered in the urine at 3 hours. No relationship betw
een vomiting episodes and peak concentrations of emetine or cephaeline was
found. Administration of SI results in rapid appearance and disappearance o
f emetine and cephaeline in plasma becoming almost undetectable at 3 hours.
Very little of either alkaloid is eliminated in the urine within this lime
period, suggesting extensive distribution. The length of time that atl adm
inistered dose of SI can result in the detection of emetine and/or cephaeli
ne in the urine has not been determined; future studies in humans are requi
red.