It can also mean that signs of accidental overdose would be delayed. You can treat mild cases of hyperemesis gravidarum with changes to your diet, additional rest, and medications like antacids. More severe cases, though, may require a stay in the hospital. Vitamin B6, also known as pyridoxine, is a B-complex vitamin involved in over enzyme reactions.
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Health Information Library. Antihistamines for Morning Sickness. Topic Overview Certain antihistamines such as dimenhydrinate or doxylamine, taken as your doctor advises, may relieve morning sickness. Common side effects of these medicines may include: Drowsiness. Dry mouth, nose, or throat. Stomach upset. References Citations Committee on Obstetric Practice Hyperemesis gravidarum.
Clin Obstet Gynecol ;— If the findings of the history and physical examination suggest a specific cause, testing is directed toward confirming that cause. For example, the findings may suggest pyelonephritis, a common condition in pregnancy. Ultrasonography may be helpful in ruling out gallbladder, liver, and kidney disorders. In addition to hyperemesis gravidarum, pregnancy-related causes of persistent vomiting include acute fatty liver and preeclampsia. Nonpregnancy-related causes include gastrointestinal, genitourinary, metabolic, and neurologic disorders.
The management of nausea and vomiting of pregnancy depends on the severity of the symptoms. Treatment measures range from dietary changes to more aggressive approaches involving antiemetic medications, hospitalization, or even total parenteral nutrition TPN. We prefer to start with dietary changes and then add medications as necessary.
A Cochrane review of various nonpharmacologic and pharmacologic treatments for nausea and vomiting of pregnancy and hyperemesis gravidarum was recently published.
Initial treatment of women with mild nausea and vomiting of pregnancy i. Affected pregnant women should be instructed to eat frequent, small meals and to avoid smells and food textures that cause nausea. Solid foods should be bland tasting, high in carbohydrates, and low in fat. Salty foods e. Family members should be informed that pregnant women with nausea and vomiting of pregnancy may need to alter mealtimes and other home routines.
Although nausea and vomiting of pregnancy and hyperemesis gravidarum are not strongly associated with psychologic illness, some women may become depressed or exhibit other affective changes. It is important that these women receive appropriate support from family members and medical and nursing staff. Consultation is indicated if a pregnant woman is depressed, domestic violence is suspected, or evidence of substance abuse or psychiatric illness exists.
Several studies 17 , 18 have suggested acupressure as a treatment for nausea. The most common location for acupressure is the pericardium 6 or Neiguan point, which is located three fingerbreadths above the wrist on the volar surface.
Various commercial products for relieving motion sickness e. One review 19 of data from seven trials involving Neiguan point acupressure indicated that these products are helpful for controlling morning sickness in early pregnancy; however, a recent study 20 demonstrated no benefit for acupressure in pregnant women.
Further data are necessary to determine whether acupressure is a viable treatment for nausea and vomiting of pregnancy. However, acupressure is a nonpharmacologic intervention without known adverse side effects.
Some physicians may wish to offer it to their patients. A popular alternative treatment for morning sickness, ginger has been used in teas, preserves, ginger ale, and capsule form. One European study 21 demonstrated that ginger powder 1 g per day was more effective than placebo in reducing the symptoms of hyperemesis gravidarum. There have been no published reports of fetal anomalies associated with the use of ginger.
However, one investigator 22 warned that ginger root contains thromboxane synthetase inhibitor, which may interfere with testosterone receptor binding in the fetus.
Other investigators 23 noted that although safety data are lacking, people in many cultures use ginger as a spice; the amounts used are similar to those commonly prescribed for the treatment of nausea and vomiting of pregnancy. Pyridoxine can be used as a single agent or in conjunction with doxylamine. One small study demonstrated that vitamin B 6 in a dosage of 25 mg taken orally every eight hours 75 mg per day was more effective than placebo for controlling nausea and vomiting in pregnant women.
A single mg doxylamine Unisom tablet taken at night can be used alone or in combination with pyridoxine 25 mg three times daily. In the s, a medication combining pyridoxine and doxylamine Bendectin commonly was used to treat women with nausea and vomiting of pregnancy. Although multiple studies showed no increased risk of birth defects, the manufacturer voluntarily withdrew Bendectin from the market in because of litigation.
Pyridoxine-doxylamine is still the only medication that the U. Food and Drug Administration has specifically labeled for the treatment of nausea and vomiting of pregnancy. Pyridoxine-doxylamine is available in Canada under the trade name Diclectin 10 mg of pyridoxine and 10 mg of doxylamine in a delayed-release tablet. Diclectin typically is prescribed in a dosage of two tablets at night for mild symptoms and in a dosage of up to four tablets per day for more severe symptoms.
If the previously discussed therapies are unsuccessful, a trial of antiemetics is warranted. The phenothiazines prochlorperazine Compazine and chlorpromazine Thorazine have been shown to reduce nausea and vomiting of pregnancy compared with placebo. If treatment with prochlorperazine or promethazine is unsuccessful, some physicians try other antiemetics, such as trimethobenzamide Tigan or ondansetron Zofran.
In a small study 26 of intravenous therapy in women with hyperemesis gravidarum, no increased benefit was demonstrated for ondansetron over promethazine. Although one study 27 of pregnant women demonstrated a slightly increased risk of birth defects when phenothiazines were given during the first trimester, a larger study 28 showed no association with fetal malformations. Women with severe nausea and vomiting of pregnancy or hyperemesis gravidarum may benefit from droperidol Inapsine and diphenhydramine Benadryl.
One study 29 found that continuous intravenous administration of both droperidol and diphen-hydramine resulted in significantly shorter hospitalizations and fewer readmissions compared with a variety of other inpatient antiemetic therapies. Meclizine Antivert , dimenhydrinate Dramamine , and diphenhydramine have been used to control nausea and vomiting during pregnancy.
All have been shown to be more effective than placebo. Metoclopramide Reglan acts by increasing pressure at the lower esophageal sphincter, as well as speeding transit through the stomach. This drug has been shown to be more effective than placebo in the treatment of hyperemesis gravidarum.
A randomized, double-blind, controlled study 33 found no hospital readmissions for recurrent vomiting in women with hyperemesis gravidarum who were treated with orally administered methylprednisolone Medrol , compared with five readmissions in those who received oral promethazine therapy. The authors of the study suggested that methylprednisolone, in a dosage of 16 mg three times daily 48 mg per day followed by tapering over two weeks, is a worthwhile treatment for women with refractory hyperemesis gravidarum.
Of note, these and other authors have found that almost all women with hyperemesis gravidarum can tolerate oral corticosteroid therapy. We have used the two-week tapering regimen in pregnant women who have been refractory to standard antiemetic therapy and have noted a subjective decrease in hospitalization rates and readmissions.
Corticosteroid therapy generally is considered safe during pregnancy. However, a recent meta-analysis 34 demonstrated a marginally increased risk of major malformation and a 3. Pharmacologic treatments for nausea and vomiting of pregnancy and hyperemesis gravidarum are summarized in Table 2.
Chlorpromazine Thorazine. Prochlorperazine Compazine. Promethazine Phenergan. Trimethobenzamide Tigan. Ondansetron Zofran. Droperidol Inapsine. Diphenhydramine Benadryl. Meclizine Antivert. Dimenhydrinate Dramamine. Metoclopramide Reglan.
Methylprednisolone Medrol. The product remains available in Canada under the trade name Diclectin 10 mg of pyridoxine and 10 mg of doxylamine in a delayed-release tablet. Diclectin typically is prescribed in a dosage of two tablets at night for mild symptoms and in a dosage of up to two tablets three times daily six tablets per day for more severe symptoms.
Information from references 16 , 23 , 35 , 36 ,and Pregnant women who, despite the previously discussed treatments, are unable to keep down liquids will probably require intravenous fluids. Normal saline or lactated Ringer's solution is the mainstay of intravenous fluid therapy. Many physicians use solutions that contain dextrose; however, it may be advisable to give thiamine vitamin B 1 first,5 because of the theoretic risk of Wernicke's encephalopathy.
Intravenous fluid may provide relief from nausea and vomiting, but many pregnant women also require an antiemetic administered orally, rectally, or by infusion with the fluid.
Depending on the severity of the symptoms, intravenous fluid therapy may be given in the hospital or at home by a visiting nurse. Enteral tube feeding and TPN are last-resort treatments for pregnant women who continue to vomit and lose weight despite aggressive treatment with any or all of the previously discussed modalities.
Few studies have evaluated enteral nutrition, although all seven women in one small study 38 tolerated feedings using an 8-French Dobbhoff nasogastric tube and infusion rates of up to mL per hour. TPN is administered through a central venous catheter.
Its content is determined by the pregnant woman's daily caloric requirements and any existing electrolyte abnormalities.
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