Is it safe to take Dramamine (dimenhydrinate) during pregnancy?

Can You Take Dramamine During Pregnancy?

Yes, Dramamine (dimenhydrinate) is considered safe to take during pregnancy and is recommended as a first-line pharmacologic treatment for nausea and vomiting when non-pharmacologic measures fail. 1, 2

FDA Classification and Safety Profile

• Dimenhydrinate is classified as FDA Pregnancy Category B, meaning reproduction studies in rats (at doses up to 20 times the human dose) and rabbits (at doses up to 25 times the human dose) have revealed no evidence of impaired fertility or harm to the fetus. 3

• Clinical studies in pregnant women have not indicated that dimenhydrinate increases the risk of abnormalities when administered in any trimester of pregnancy, and the possibility of fetal harm appears remote. 3

• The American College of Obstetricians and Gynecologists (ACOG) specifically identifies dimenhydrinate as a safe first-line H1-receptor antagonist for treating nausea and vomiting in pregnancy when non-pharmacologic approaches are insufficient. 1, 2

Treatment Algorithm for Nausea and Vomiting in Pregnancy

Step 1: Non-pharmacologic measures first

• Start with dietary modifications (small, frequent, bland meals; BRAT diet), avoidance of specific triggers, ginger (250 mg capsule 4 times daily), and vitamin B6 (pyridoxine 10-25 mg every 8 hours). 1

Step 2: First-line pharmacologic options if symptoms persist

• Add dimenhydrinate, doxylamine, or promethazine as first-line pharmacologic antiemetic therapy. 1, 2
• All three H1-receptor antagonists have comparable safety profiles and are FDA-approved for this indication. 1, 2

Step 3: Second-line options for inadequate response

• Consider metoclopramide, which has similar efficacy to promethazine but with fewer adverse events (less drowsiness and dizziness). 1, 2

Step 4: Severe cases requiring hospitalization

• Reserve ondansetron and methylprednisolone for hyperemesis gravidarum on a case-by-case basis. 1, 2

Comparative Efficacy Evidence

• Dimenhydrinate was more effective than vitamin B6 alone in reducing nausea and vomiting scores in early pregnancy (mean score reduction from 8.3 to 2.8 with dimenhydrinate versus 8.6 to 3.8 with vitamin B6). 4

• Dimenhydrinate and ginger showed equivalent efficacy for nausea control, though dimenhydrinate caused significantly more drowsiness (77.64% versus 5.88%). 5

• Historical safety data from multiple epidemiological studies confirm that dimenhydrinate presents a low risk of teratogenicity and is considered among the safest antiemetics for pregnancy. 6

Important Caveats and Monitoring

• Drowsiness is common with dimenhydrinate use, so counsel patients against operating automobiles or dangerous machinery while taking this medication. 3

• Small amounts of dimenhydrinate are excreted in breast milk, requiring a decision about continuing nursing versus discontinuing the drug based on the importance of the medication to the mother. 3

• Reports indicate dimenhydrinate may have an oxytocic effect (stimulating uterine contractions), so use caution during labor and delivery when this effect is unwanted. 3

• For patients with severe symptoms or hyperemesis gravidarum, monitor for signs of dehydration, electrolyte imbalances, weight loss >5% of prepregnancy weight, and nutritional deficiencies. 1

• Early intervention with dimenhydrinate may help prevent progression from simple nausea and vomiting of pregnancy to hyperemesis gravidarum. 1

Key Distinction from Other Medications

• Avoid oral decongestants (phenylephrine, pseudoephedrine) during the first trimester due to conflicting reports of associations with gastroschisis and small intestinal atresia. 1

• While diphenhydramine (another first-generation antihistamine) is frequently used during pregnancy, it has been associated with cleft palate development, making dimenhydrinate a preferable choice. 1, 7