Commonly Prescribed Anti-emetics for the Treatment
of Hyperemesis Gravidarum
AGENT |
IV |
IM |
PO |
PR |
SQ |
Topical |
DOSAGE |
|
Doxylamine/Pyridoxine (Bonjesta®, Diclegis®) |
|
|
· |
|
|
|
Bonjesta®: 1 tablet QHS initially, up to two tablets per day
Diclegis®: 2 tablets QHS initially, up to four tablets per day |
|
Doxylamine (Unisom®) |
|
|
· |
|
|
|
25 mg PO HS or 12.5 mg PO BID |
|
Dimenhydrinate (Dramamine®) |
|
|
· |
|
|
|
25-50 mg PO Q4–6H PRN
Max dose of 200 mg if taking Doxylamine concurrently |
|
Diphenhydramine (Benadryl®) |
|
· |
· |
|
|
|
25 - 50 mg PO TID/QID
10-50 mg IM Q4-6H
Max 400 mg/day |
|
Meclizine (Antivert®) |
|
|
· |
|
|
|
25 mg PO Q4-6H |
|
Metoclopramide (Reglan®) |
|
· |
· |
|
|
|
5-10 mg PO IM Q8H |
|
Chlorpromazine (Thorazine®) |
|
·
|
·
|
|
|
|
10-25 mg PO Q4-6H;
25-50 mg IM (refer to Additional Information) |
|
Prochlorperazine (Compazine®) |
|
|
· |
· |
|
|
5-10 mg PO TID-QID; 25
mg PR BID |
|
Promethazine (Phenergan®) |
|
|
· |
· |
|
|
12.5-25 mg PO/PR Q4-6H
|
|
Pyridoxine
(Vitamin B6)
|
|
|
· |
|
|
|
Monotherapy: 10-25 mg PO TID/QID
In combination with Doxylamine: 25 mg QHS initially, up to 4 tablets per day Pyridoxine max daily dose 200 mg |
|
Trimethobenzamide (Tigan®) |
|
· |
|
|
|
|
200 mg IM Q6-8H
|
Ondansetron
(Zofran®) |
|
|
· |
|
|
|
4 mg PO Q8H
|
Disclaimer: All BCBST member health policies are NOT the same. The list above includes commonly prescribed anti-emetics for the treatment of Hyperemesis Gravidarum and was compiled independent of BCBST pharmacy formulary status. Medications listed here are not guaranteed coverage.
Additional Information
Chlorpromazine IM dosing is 25 mg IM for the initial dose. If no hypotension occurs, the dose is 25 to 50 mg IM every 3 to 4 hours as needed until the vomiting stops. Then switch to oral dosage.
References
- BlueCross BlueShield of Tennessee network physicians. April - June 2023.
- Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gyncol 2018: 131:e15. Reaffirmed 2023.
- MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2023, April). Prochlorperazine. Retrieved January 13, 2021 from MICROMEDEX Healthcare Series.
- MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2021, January). Chlorpromazine Hydrochloride. Retrieved April 18, 2023. From MICROMEDEX Healthcare Series.
- MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2021, January). Trimethobenzamide. Retrieved April 18, 2023. From MICROMEDEX Healthcare Series.
- Smith JA, et. al. Nausea and vomiting of pregnancy: Treatment and outcome. In: UpToDate, Waltham, MA. (Last Updated Febuary 23, 2022. Accessed on May 19, 2022).
|
