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Clinician’s Corner: Nausea of Pregnancy

Often referred to as “morning sickness” 75-80% of pregnant patients complain of morning or evening nausea. The peak time for morning sickness is in the first trimester between weeks 5-12 of pregnancy. Most women experience this discomfort, and by adjusting diet or routines, have minimal difficulty as resolution occurs at the beginning of the second trimester.

Hyperemesis gravidarum – the worst kind of morning sickness: 15% of pregnancies experience nausea and vomiting until delivery. Persistent vomiting to cause weight loss, dehydration and electrolyte imbalance.

The exact cause of nausea and vomiting during pregnancy is unknown. Elevated levels of human chorionic gonadotropin produced by the placenta is believed to play a part.  High-fat diets and Helicobacter pylori infection (which causes stomach ulcers) also contributes to the incidence and severity of hyperemesis gravidarum.

  • Reassurance and dietary advice is all that is required in most instances.
  • Place patient on “dry diet” plus clear liquids 1 hour after eating.
  • Get plenty of rest.
  • Avoid smells that bother you.
  • Eat five or six small meals each day instead of three large meals.
  • Eat a few crackers before you get out of bed in the morning to help settle your stomach.
  • Eat small snacks high in protein (such as a glass of milk or a cup of yogurt) throughout the day.
  • Avoid spicy foods and fatty foods.

First line (always weigh risks versus benefits).


  • Vitamin-B-6 (pyridoxine) 10-25mg every six hours. Most often dosed at night before bed, then additional doses in the morning and in the late afternoon, IF NEEDED
  • Doxylamine (Unisom®) use 12.5 to 25mg along with the dose of pyridoxine at bedtime, then in the morning and late afternoon if needed. Just make sure to  buy the “Sleep-tabs®” which contain doxylamine, and not SleepGels® which contain diphenhydramine.

DICLEGIS (RX): is a fixed dose combination drug product (Delayed-release tablets containing 10mg doxylamine succinate and 10 mg pyridoxine hydrochloride) cost is nearly $800 per 100 tablets Dosage: Take two tablets daily at bedtime. The dose can be increased to a maximum recommended dose of four tablets daily one in the morning, one mid-afternoon and two at bedtime.

With your physician’s approval YOUR THOMPSON PHARMACIST can easily save you over $600.00 per month by substituting these over-the-counter recommendations if your doctor approves. Go ahead and ASK…. At Thompson Pharmacy its all for YOU (and your baby too!)