Is Emetrol (dextromethorphan) safe to use during pregnancy?

Emetrol Safety in Pregnancy

Emetrol (phosphorated carbohydrate solution) is not specifically recommended for nausea and vomiting in pregnancy, and first-line treatments with better established safety profiles should be used instead. 1

First-Line Treatment Options for Nausea and Vomiting in Pregnancy

The American College of Obstetricians and Gynecologists and European guidelines recommend the following safer alternatives:

1. Vitamin B6 (pyridoxine) - Safe and effective for all gestational ages 1
2. Doxylamine-pyridoxine combination - First-line treatment with established safety profile 1, 2
3. Antihistamine (H1) blockers - Safe and effective throughout pregnancy 1, 3
4. Phenothiazines - Considered safe for use in pregnancy 1, 2

Second-Line Treatment Options

If first-line treatments fail to provide adequate relief:

• Metoclopramide - Has a better established safety profile with no significant increase in congenital defects 1

  • Dosage: 10-20 mg orally or IV every 6-8 hours
  • Caution: Monitor for extrapyramidal symptoms 1

• Ondansetron - Should only be used after 10 weeks gestation and on a case-by-case basis 1, 2

  • Associated with small absolute increase in risk of orofacial clefts (0.03%) and ventricular septal defects (0.3%) 1
  • More effective for controlling severe vomiting compared to metoclopramide 4

Management Algorithm for Nausea and Vomiting in Pregnancy

1. Start with non-pharmacological approaches:

   • Small, frequent meals
   • Avoiding triggers
   • Ginger supplements

2. If symptoms persist, initiate first-line medications:

   • Vitamin B6 (pyridoxine) 10-25 mg every 6-8 hours
   • Consider adding doxylamine 12.5 mg
   • Antihistamine H1 blockers if additional relief needed

3. For moderate-severe symptoms unresponsive to first-line therapy:

   • Add metoclopramide as second-line therapy (after 10 weeks gestation)
   • Consider ondansetron only if other options fail (preferably after 10 weeks)

4. For severe hyperemesis gravidarum:

   • IV hydration with normal saline (0.9% NaCl) with potassium chloride
   • Thiamine supplementation (100 mg three times daily)
   • Consider combination therapy with different antiemetic classes
   • Methylprednisolone as last resort 1, 2

Important Considerations

• A validated assessment tool like PUQE (Pregnancy-Unique Quantification of Emesis) should be used to classify severity 2
• Ketonuria is not a reliable indicator of dehydration severity 2
• 97.7% of prescriptions for nausea and vomiting in pregnancy in the US are with medications not labeled for use in pregnancy 5
• The safety profile of Emetrol specifically in pregnancy has not been well-established in the current literature
• Combinations of different antiemetic classes may be more effective for refractory cases 2

Given the availability of medications with established safety profiles in pregnancy, these should be prioritized over medications with limited safety data such as Emetrol.