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Clinician’s Corner: Nausea of Pregnancy Prescription Treatment

Last week we discussed using two rather common over the counter medications (with physician’s approval) Vitamin B-6 and Doxylamine.  As discussed, this combo could be used instead of the very expensive Diclegis®. Diclegis is the only FDA approved drug for treatment of nausea of pregnancy.  The other prescription drugs we talk about today are being used off label for treatment of nausea and vomiting of pregnancy. This week we can discuss the prescription treatment of nausea of pregnancy, and the more intensive form: hyperemesis gravidarum.

DRUG THERAPY FOR NAUSEA OF PREGNANCY/ HYPEREMESIS GRAVIDARUM Pregnancy Category (“A” is safest) Comments
Doxylamine  (Unisom®) A Very safe combined with B-6
Pyridoxine  (Vitamin-B6®) A First line. Alone or in combo with Doxylamine
Diclegis® 10mg/10mg

(doxylamine succinate and pyridoxine hydrochloride delayed-release tablets)

A Only FDA approved treatment for nausea of pregnancy; not for hyperemesis gravidarum
Dramamine (Dimenhydrinate)

Diphenhydramine (Benadryl)

Meclizine (Antivert/Bonine/Dramamine-II)

B Generally safe- may cause drowsiness. None are considered to be teratogenic
Dolasetron (Anzemet®)

Granisetron (Kytril®)

Ondansetron (Zofran)

B Limited human data- animal data suggests low risk. Zofran –most studied-
Metoclopramide (Reglan®) B Watch Mom for drug induced movement disorder. Monitor baby for movement symptoms at birth.
Hydroxyzine (Atarax & Vistaril®) C Caused 5.8% rate major birth defects
Chlorpromazine (Thorazine®)

Perphenazine (Trilafon®)

Prochlorperazine (Compazine®)

Promethazine (Phenergan®)

C All considered as 3rd line agents
Corticosteroids C

D-1st trim

Oral clefting first trimester exposure.  Last resort.

All of the prescription drugs do have side effects, but most obstetricians feel the very small risk of these side effects are superseded by all of the well-known problems of prolonged dehydration caused by nausea and vomiting.

According to the American College of Obstetrics and Gynecology (ACOG) prenatal vitamins in the preconception period may reduce the severity of nausea and vomiting in early pregnancy.  Be sure to take your prenatal vitamins BEFORE you become pregnant.  Most clinicians do not recommend ginger supplements, due to lack of standardization, but will recommend ginger containing food such as lollipops, candy, and tea.

Excess vomiting may lead to dehydration, vitamin deficiency, and weight loss; therefore, adequate hydration, vitamin replacement, nutrition, and anti-vomiting therapy is critical to avoid illness in the pregnant mother.  Most physicians feel the risk of prescription therapy is worth the benefit.