Treatment of Nausea and Vomiting in Pregnancy
| Step of Treatment | Treatment |
|---|
| 1 | Nonpharmacologic options:
Transition from prenatal vitamins to folic acid only Ginger capsules, 250-mg tablets 4 times orally daily P6 acupressure wrist bands
| | 2 | Add one of the following medications:
Vitamin B6 (pyridoxine) 10-25 mg and/or doxylamine 12.5 mg orally 3-4 times a day Vitamin B6 10 mg/doxylamine 10 mg (Diclegis), two tablets orally at bedtime initially, up to four tablets a day (add one tablet in the morning and one tablet midafternoon) Vitamin B6 20 mg/doxylamine 20 mg (Bonjesta), one tablet orally at bedtime initially, up to two tablets per day (add one tablet in the morning)
| | 3 | Add any of the following:
Diphenhydramine 25-50 mg every 4-6 h orally Prochlorperazine 25-50 mg every 12 h rectally Promethazine 12.5-25 mg every 4-6 h orally or rectally Dimenhydrinate 25-50 mg every 4-6 h orally (not to exceed 200 mg/d if taken with doxylamine)
| | 4A (no dehydration) | Add any of the following:
Metoclopramide 5-10 mg every 6-8 h orally or IM Ondansetron 4 mg every 8 h orally Promethazine 12.5-25 mg every 4-6 h orally, rectally, or IM Trimethobenzamide 200 mg every 6-8 h IM
| | 4B (with dehydration) | Add intravenous fluid replacement AND any of the following:
Metoclopramide 5-10 mg every 8 h IV Ondansetron 8 mg every 12 h IV Promethazine 12.5-25 mg every 4-6 h IV Dimenhydrinate 50 mg every 4-6 h IV
| | 5 (with dehydration) | Continue intravenous fluid replacement AND add either of the following:
Chlorpromazine 25-50 mg every 4-6 h IV or IM Chlorpromazine 10-25 mg every 4-6 h orally Methylprednisolone 16 mg every 8 h for 3 days, orally or IV; taper over 2 wk to lowest effective dose; limit use to 6 wk
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Abbreviations: IM, intramuscularly; IV, intravenously.
aData from American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin Number 189: nausea and vomiting of pregnancy. Obstet Gynecol2018;131(1):e15-e30.
bIf no improvement, move to the next step for management.