From the Guidelines
Hyperemesis gravidarum medications include first-line treatments such as doxylamine/pyridoxine, cyclizine, prochlorperazine, and promethazine.
First-line treatments
- Doxylamine/pyridoxine: a combination of 10 mg/10 mg and 20 mg/20 mg is safe and well-tolerated 1
- Cyclizine: compatible with all trimesters and breastfeeding 2
- Prochlorperazine: compatible with all trimesters and breastfeeding 2
- Promethazine: compatible with all trimesters and breastfeeding 2, 1 ### Second-line treatments
- Metoclopramide: has similar efficacy to promethazine, but with fewer adverse events 3
- Ondansetron: can be given primarily in severe cases, but should be used with caution due to potential risks of congenital heart defects 3, 4 ### Third-line treatments
- Corticosteroids: such as methylprednisolone, can be given as a last resort in patients with severe hyperemesis gravidarum, but should be used with caution due to potential risks 3 It's essential to note that the treatment of hyperemesis gravidarum should be guided by the severity of symptoms and may require a multidisciplinary team approach involving obstetricians, nutritionists, psychologists, and gastroenterologists 3.
From the Research
Medications for Hyperemesis Gravidarum
The following medications are used to treat hyperemesis gravidarum:
- Doxylamine and pyridoxine [ 5, 6 ]
- Ondansetron [ 6, 7 ]
- Dopamine antagonists such as metoclopramide or promethazine [ 6, 7 ]
- Mirtazapine [ 6 ]
- Antihistamines such as diphenhydramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), and doxylamine and pyridoxine (Diclectin/Bendectin) [ 5 ]
- Pyridoxine [ 7 ]
- Metoclopramide [ 7 ]
- Prochlorperazine [ 7 ]
- Prednisolone [ 7 ]
Treatment Options
Treatment options for hyperemesis gravidarum may include:
Notes
The effectiveness and safety of these medications and treatment options may vary, and the certainty of evidence for different treatments is often low or very low [ 8 ]. It is essential to use validated scoring systems and clear descriptions and measurements of core outcomes to establish more robust evidence [ 8 ].