By Jennifer Huget
Tuesday, July 8, 2003; Page HE01

Every parent knows the basics: Make sure your family's diet sort of resembles the Food Pyramid. Limit TV-viewing time. And keep a bottle of syrup of ipecac in the medicine chest in case somebody swallows poison.

The first two edicts aren't likely to change any time soon, though their nuances are always ripe for debate. As for the third, let's just say it may soon be time to kiss that long-familiar bottle goodbye.

Ipecac syrup is a plant-derived substance that's been available without prescription in the United States since 1965. Its only use is to induce vomiting. (It works both mechanically, irritating the stomach lining and causing a particularly unpleasant variety of puking action, and neurologically, stimulating the part of the brain that tells the body to hurl.)

A panel of physicians and poison control experts last month advised the Food and Drug Administration (FDA) to review ipecac syrup's status as an over-the-counter drug. One of their major concerns was abuse: It seems the substance has long been imbibed by people with bulimia (and other eating disorders) to facilitate the purging part of their condition.

Nobody knows just how widespread such abuse is, but its dangers are clear: If overused, ipecac can weaken muscles -- including the heart -- and eventually cause death. Tomas Silber, a specialist in adolescent medicine at the Children's National Medical Center in Washington who spoke before the FDA panel, says ipecac-induced vomiting by bulimics is usually carried out in secret and is nearly impossible to quantify. "We're seeing just the tip of the iceberg," he says.

Think that's unsettling? Well, it turns out that bulimics aren't the only ipecac abusers. Silber says that another uncountable number of people with a condition called "Munchausen's syndrome by proxy" use the stuff to sicken children -- so they can seek medical attention.

These are awful circumstances, to be sure. But should the actions of a relatively small number of abusers warrant making a product unavailable to those who would use it properly? After all, if nobody in the household is an abuser, there's little harm in keeping ipecac (which otherwise has few and rare negative side effects) handy, just in case.

Unless, of course, having a bottle on hand offers a sense of security that turns out to be false.

Even after close to 40 years of experience, nobody can say for sure whether ipecac actually helps people survive poisoning. Sure, it makes people vomit. But some experts question whether that ultimately helps them overcome the effects of the poison they've ingested. It's not clear whether the stuff acts fast enough -- it can take 20 minutes or longer to work its magic -- or removes enough of the poisonous substance from the stomach to make a difference.

Curtis Rosebraugh of the FDA's Division of Over-the-Counter Drugs says ethical concerns make it difficult for researchers to design studies to answer these questions. As for the findings that do exist, he says: "One group looking at the totality of the data will say that it appears that ipecac doesn't really benefit people. Another group can look at the same data and say it's not so clear; maybe it does help."

In 2001, the nationwide network of poison control centers handled 2,267,979 cases; callers were instructed to administer ipecac in just 16,058 of these cases. While recommendations for poison-related "gastrointestinal decontamination" vary according to circumstance, more common recommendations are dilution/irrigation and activated charcoal -- though the latter is nearly as controversial as ipecac.

Rose Ann Soloway of the American Association of Poison Control Centers (AAPCC) says that while her organization is in the process of reviewing its stance regarding ipecac, many state poison control centers have already ceased recommending its use.

It may take months or longer for the FDA to decide whether to strip ipecac of its OTC status. That change wouldn't mean that ipecac would simply move to prescription-only status; individual manufacturers would have to submit their products for FDA review. Silber speculates that ipecac might not meet the FDA's standards for prescription drugs' safety and efficacy. If that happens, ipecac may soon be a thing of the past.

So what would we do in its absence?

Same thing we're supposed to be doing now: When somebody ingests a poisonous substance, call the poison control center to talk to a trained professional who can evaluate the situation and offer accurate advice. The Association of Poison Control Centers has established a nationwide toll-free number that automatically connects callers to the closest poison control center.

So, parents, here are the new basics: follow the Food Pyramid, watch that TV time -- and memorize this number (and post it by all your phones, and take it along on vacation): 800-222-1222.•

The columns KidLife and MidLife, devoted to healthy handling of children and adulthood, appear in alternating weeks. Send comments, suggestions and questions to kidmid@washpost.com. For U.S. Mail, see address on Page F2. No calls, please.