From the Guidelines
Methylprednisolone (Solumedrol) should be administered at a dosage of 16 mg intravenous (IV) every 8 hours for up to 3 days, followed by tapering over 2 weeks to the lowest effective dosage, as a last resort in patients with severe Hyperemesis Gravidarum. This treatment approach is based on the most recent guidelines from the American College of Gastroenterology, as outlined in the 2024 study published in Gastroenterology 1. The use of methylprednisolone in Hyperemesis Gravidarum is generally reserved for severe cases that have failed first-line treatments, and its administration should be done with caution, particularly in the first trimester, due to the potential increased risk of cleft palate.
Key considerations for the use of methylprednisolone in Hyperemesis Gravidarum include:
- The dosage and duration of treatment, which should be limited to 6 weeks 1
- The potential risks and benefits of corticosteroid use during pregnancy, including the risk of cleft palate and other congenital defects 1
- The importance of proper hydration and electrolyte replacement before initiating treatment 1
- The need for monitoring for potential side effects, including hyperglycemia, mood changes, and increased infection risk 1
It is essential to note that methylprednisolone should only be used as a last resort in patients with severe Hyperemesis Gravidarum, and other treatment options, such as antiemetics, IV hydration, and vitamin supplementation, should be tried first. The decision to use methylprednisolone should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.
From the Research
Treatment of Hyperemesis Gravidarum
- The dose of Methylprednisolone (Solumedrol) for the treatment of Hyperemesis Gravidarum is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, it is mentioned that corticosteroids, including methylprednisolone, can be used in the treatment of hyperemesis gravidarum 3, 6.
- A study found that methylprednisolone was associated with better control of hyperemesis gravidarum symptoms than standard of care 3.
- Another study compared prednisolone with promethazine and found that those receiving prednisolone had increased nausea at 48 hours, but not at 17 days 6.
- Steroids, including methylprednisolone, were only prescribed following readmissions in a retrospective cohort study 5.
Antiemetic Treatment
- The most commonly prescribed antiemetics for hyperemesis gravidarum include cyclizine, prochlorperazine, metoclopramide, and ondansetron 4, 5, 6.
- The use of meclizine, prochlorperazine, and ondansetron increased during the study period 4.
- Metoclopramide was the most used antiemetic in pregnancy at the time the European Medical Agency warning was implemented in the Norwegian hyperemesis guidelines 4.
Guidelines and Recommendations
- The European Medical Agency issued a warning on metoclopramide limiting treatment to a maximum of five days 4.
- Local and national guidelines recommend the use of antiemetics, including metoclopramide, ondansetron, and prochlorperazine, for the treatment of hyperemesis gravidarum 5.
- The management of hyperemesis gravidarum mainly followed local and national recommendations, providing reassurance within the health professional community 5.