What is the preferred treatment between domperidone and maxolon (metoclopramide) for nausea and vomiting in early pregnancy?

Metoclopramide is Preferred Over Domperidone for Nausea and Vomiting in Early Pregnancy

Metoclopramide is the preferred antiemetic treatment over domperidone for nausea and vomiting in early pregnancy due to its established safety profile and extensive clinical evidence. 1

Safety and Efficacy Comparison

Metoclopramide

• Safety profile: Meta-analysis of six cohort studies including 33,000 first-trimester women showed no significant increased risk of major congenital defects (odds ratio 1.14,99% CI 0.93-1.38) 1
• Dosing: 5-10 mg orally every 6-8 hours 1
• Efficacy: Commonly used and effective for nausea and vomiting of pregnancy 1
• Recommendation status: Recommended by American College of Obstetricians and Gynecologists (ACOG) as part of step-up approach for patients who don't respond to first-line therapy 1

Domperidone

• Safety data: Limited evidence regarding safety in pregnancy 2
• Available research: A small prospective cohort study (n=120) suggested domperidone does not appear to be a major teratogen, but authors noted findings require confirmation in larger studies 2
• Regulatory status: Not specifically endorsed by major obstetric guidelines for first-line use in pregnancy

Treatment Algorithm for Nausea and Vomiting in Early Pregnancy

1. First-line treatment:

   • Vitamin B6 (pyridoxine) supplementation
   • Consider adding doxylamine if pyridoxine alone is insufficient

2. Second-line treatment (if first-line fails):

   • Metoclopramide 5-10 mg orally every 6-8 hours 1
   • Monitor for extrapyramidal side effects (rare but possible)

3. Alternative second-line options:

   • Ondansetron (use on case-by-case basis before 10 weeks gestation due to small risk of orofacial and cardiac defects) 1
   • Promethazine (consider if metoclopramide is contraindicated)

4. Third-line treatment (for severe, refractory cases):

   • Methylprednisolone (after 10 weeks gestation to avoid potential risk of cleft palate) 1
   • Consider hospitalization for IV hydration if dehydration occurs

Important Considerations

• Extrapyramidal effects: Both metoclopramide and phenothiazines can cause extrapyramidal side effects; discontinue if symptoms occur 1
• Severity assessment: Use the Motherisk Pregnancy-Unique Quantification of Emesis (PUQE) score to objectively assess severity and guide treatment decisions 1
• Timing: Most nausea and vomiting of pregnancy begins at 4-6 weeks, peaks at 8-12 weeks, and typically resolves by week 20 1

Special Populations

• Adolescents: Domperidone can be used for nausea in adolescents aged 12-17 years, though oral administration is unlikely to prevent vomiting 1
• Cancer patients: For pregnant cancer patients receiving chemotherapy, metoclopramide is considered safe and effective for chemotherapy-induced nausea and vomiting 1

While both medications can be effective for nausea and vomiting in pregnancy, metoclopramide has more robust safety data and is specifically recommended in major obstetric guidelines, making it the preferred choice over domperidone for early pregnancy nausea and vomiting.