Medications for nausea & vomiting in pregnancy

When it comes to medications and supplements for nausea and vomiting in pregnancy, I’ve been recommending the following to my patients for years:

  • Doxylamine (Unisom SleepTabs) 1/2 tablet (12.5 mg) orally up to 4 times daily.
  • Vitamin B6 25 mg orally up to 4 times daily.
  • Ginger-containing foods, such as ginger tea, ginger candy, and pickled ginger. You may also consider ginger supplements: 250 mg capsule orally up to 4 times daily.

These are based on recommendations from ACOG, The American Congress of Obstetricians and Gynecologists.  Each medical specialty has an equivalent organization that among other things regularly puts out practice management recommendations.  For women who have more severe symptoms, we go to prescription medications like promethazine (Phenergan), metoclopramide (Reglan), and ondansetron (Zofran).  In some cases, these need to be given in intravenous form and/or with steroids, and some unlucky women like Kate Middleton need to be hospitalized for hyperemesis gravidarum.

There is a prescription medication called Diclegis which is used for nausea and vomiting in pregnancy.  It’s a delayed-release form of 10 mg each of doxylamine (Unisom) and pyridoxine (vitamin B6).  Since it’s expensive and not covered by insurance for my patients, I tell them to do the over-the-counter regimen above.  I hear it works well.

It’s not exactly ethical to perform research studies of medications on pregnant women- let’s give half of these pregnant women the drug, and the other half the placebo, and see what happens!  As a result, there are very few medications that are Category A- safety established using human studies.  Doxylamine is one of these medications.

Most medications that we prescribe in pregnancy are Category B- presumed safety based on animal studies, or Category C- uncertain safety; no human studies and animal studies show an adverse effect.

Medications that we avoid in pregnancy are Category D- unsafe; evidence of risk that may in certain clinical circumstances be justifiable, or Category X- highly unsafe; risk of use outweighs any possible benefit.

These are the most commonly used categories, but there are other resources that can inform us more specifically about each drug and the evidence behind its safety.  There are also separate guidelines for use of medications in breastfeeding.

I recently found out that there is a number that the general public can call to find out about specific medication safety in pregnancy and lactation: 866-626-6847.  They also have a helpful website for patients:

http://www.mothertobabyca.org/resources/fact-sheets/

I feel very fortunate that my symptoms have been uncomfortable and annoying, but certainly not so severe as to require prescription medications.  I fully support use of those medications for appropriate patients.  When these symptoms are severe, they can be really debilitating.  Even when they’re not severe, it can be rough, causing missed work days.

Now that I’m pregnant, I do think more about what I put into my body.  Even knowing the safety, I must be honest that I had second thoughts about trying doxylamine.  So far I’ve tried it once and it made me sleepy.  Since then, it hasn’t been practical to take it if I know I’ll be driving or working.

Even from before, I’ve made changes that are in alignment with the Paleo/Primal Blueprint lifestyle.  I’ve always loved yummy-scented body products, so I’ve now switched to using 100% Pure products.  I try to avoid using the microwave, and definitely avoid microwaving in plastic containers.  I even recently decided to try a Primal tooth powder that I alternate using with regular toothpaste.

What I discovered thanks to the nausea of pregnancy was that chewing gum made me feel better.  I found whatever standard chewing gum I’d had around for ages, since I normally don’t chew gum regularly.  Well, when I finally checked the ingredients, they included a host of sugar alcohols, as well as aspartame.

Here’s what Mark Sisson has to say about sugar alcohols:

http://www.marksdailyapple.com/sugar-alcohols/#axzz3QhddhCpa

For now, I’ve settled on a gum I found at Whole Foods that is sweetened with xylitol only.  The flavor doesn’t last as long, and interestingly it doesn’t help as much with nausea as the standard chewing gum did, but ultimately I feel better avoiding too many questionable artificial sweeteners.

Ultimately, I’m lucky that my symptoms are not severe and I don’t need prescription medications.  For myself as well as for my patients, I try to avoid unnecessary medications.  But everyone is different, and in appropriate situations, prescription medications are needed, whether it’s for nausea/vomiting or other medical conditions.  I try to inform my patients of the pros and cons the best I can, and ultimately it’s each woman’s personal choice.

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