None of the information provided by PSS is meant to suggest any medical course of action. Instead the information is intended to inform and to raise awareness so that these issues can be discussed by / with qualified Health Care Professionals. The responsibility for any medical treatment rests with the prescriber.
Contrary to popular belief, there are a number of effective anti-emetic (anti-sickness) medications that can be taken in the first trimester of pregnancy. Hyperemesis Gravidarum (HG) is typically at it's worst in the first trimester and it is important that treatment is begun without delay. Research indicates that anti-emetics are more effective the sooner they are begun, and the most recent treatment protocols recommend quick intervention. There is a tendency for GPs to leave women without help until they have lost weight and require IV fluids for dehydration. This is not considered to be best practice. HG can be managed so that no in-patient treatment is required. Weight loss and IV fluid therapy should not be a pre-requisite for either diagnosis or treatment.
Unfortunately many GPs in the UK are unaware of modern treatment protocols for the management of HG. If your GP is unable to or unwilling to give you medication and you want to pursue this treatment option please contact us for information. If you want to avoid taking prescription medication, or want to try additional treatments, see our information about Alternative Therapies on the FAQ's page.
Most effective medications for nausea and vomiting are not licensed in pregnancy because pharmaceutical companies usually exclude pregnant women from drug trials. This is not a situation which is likely to change as drug companies do not want to risk lawsuits which may arise if a woman in a trial gives birth to a baby with a birth defect. This is not to say that these drugs are harmful in pregnancy, it's to say that safety has not overwhelmingly been established. In order to assess their safety in pregnancy, other sources of information are required such as cases where women have taken them not knowing they were pregnant, or where their sickness has been so severe that they took them as the benefit outweighed the likely risk.
That said, there are a number of drugs which are considered safe to take in pregnancy. Typically, the most common anti-emetic drugs used for HG are
- Diclectin (made of antihistamine Doxylamine and B6 in slow release form)
- Pyridoxone (vitamin B6)
- Promethazine (an antihistamine, brand name Avomine)
- Cyclizine (an antihistamine, brand name Valoid)
- Prochlorperazine (brand name Stemetil)
- Metoclopramide (brand name Maxolon)
- Ondansetron (brand name Zofran)
- Domperidone (brand name Motilium)
- Prednisolone (this is a steroid)
Many of the medications work in different ways and can compliment each other; for example, cyclizine is an anti-histamine and works on the vomit centre in the brain whereas Domperidone works on the stomach to speed up the emptying process.
As with treatment for most conditions it is sensible to start on the 'first rung of the ladder' and work upwards if relief is not achieved. There is excellent evidence for using cyclizine (50mg, 1 tablet 3 x a day) or promethazine (avomine 25mg 1 tablet 4 x a day), which are very similar, both being anti-histamines, in conjunction with pyridoxone (B6, 10mg 1 tablet 4 x per day) as the first step on the ladder. If this treatment is started early enough then further treatment may not be needed. In second and subsequent pregnancies this treatment should be used as a prophylactic (taken before hand to prevent you getting ill), pre-empting the severity experienced previously. It is most effective when used as early as possible but unfortunately with many first pregnancies it is often a number of weeks before treatment is started and therefore too late for the 'first step' medications to have much impact, meaning that women need to move on to stronger medication to obtain adequate symptom control.
If you are not managing to take medications orally or are throwing them up after taking them then many of the drugs can be taken in suppository form (put inside your back passage and absorbed into your blood stream that way). Some can be given first off as an injection by your doctor in the hope you would then keep the next dose down orally. Some medications such as Ondansetron have 'oro-dispersal' versions, i.e. it melts on your tongue, which some women find easier to manage.
For a basic introduction about the medications above please click on the relevant drug name. However, if you would like further information and to read the research about the various treatments then please refer to our resources section and our information for health care professionals.
Sadly, many women with the more severe form of pregnancy sickness, Hyperemesis Gravidarum, actually end up terminating their much wanted pregnancies due to the severity of the condition and many more (if not most women with hyperemesis) consider termination as an option to end their relentless suffering. If you are considering termination as a treatment then please contact us first or see our page on termination for other sources of support.
If you are currently breastfeeding and suffering with NVP / HG please click here for more information on safe medications you can take.This information is provided by Wendy Jones, PhD MRPharmS, Breastfeeding and Medication.