What are the medications for hyperemesis gravidarum?

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 1
• Prochlorperazine: compatible with all trimesters and breastfeeding 1
• Promethazine: compatible with all trimesters and breastfeeding 1

Second-line treatments

• Metoclopramide: has similar efficacy to promethazine, but with fewer adverse events 1
• Ondansetron: can be given primarily in severe cases, but should be used with caution due to potential risks of congenital heart defects 1

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 1 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 1.

From the Research

Medications for Hyperemesis Gravidarum

The following medications are used to treat hyperemesis gravidarum:

• Doxylamine and pyridoxine [ 2, 3 ]
• Ondansetron [ 3, 4 ]
• Dopamine antagonists such as metoclopramide or promethazine [ 3, 4 ]
• Mirtazapine [ 3 ]
• Antihistamines such as diphenhydramine (Benadryl), dimenhydrinate (Gravol), doxylamine (Unisom), hydroxyzine (Vistaril/Atarax), and doxylamine and pyridoxine (Diclectin/Bendectin) [ 2 ]
• Pyridoxine [ 4 ]
• Metoclopramide [ 4 ]
• Prochlorperazine [ 4 ]
• Prednisolone [ 4 ]

Treatment Options

Treatment options for hyperemesis gravidarum may include:

• Intravenous rehydration therapy [ 4 ]
• Acupressure [ 5, 4 ]
• Acupuncture [ 4 ]
• Ginger [ 4 ]

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 [ 5 ]. It is essential to use validated scoring systems and clear descriptions and measurements of core outcomes to establish more robust evidence [ 5 ].