UM Guidelines
Hyperemesis Gravidarum

Home Care (HC) ORG: M-2195

BCBST modification effective August 19, 2014*

Deleted:
   
 

No deletions were made.


Added to RN Treatment Plan: Treatments and Procedures
   

 Commonly Prescribed Anti-emetics for the Treatment of Hyperemesis Gravidarum

AGENT

IV

IM

PO

PR

SQ

Topical

DOSAGE

Doxylamine (Unisom)

   

     

25 mg PO HS or 12.5 mg PO BID

Dimenhydrinate (Dramamine)

     

50-100 mg PO Q4H;
50-100 mg IV/IM Q4-6 H

Diphenhydramine (Benadryl)

     

50 mg PO TID/QID;
25-50 mg IM/IV Q2-3H

Meclizine (Antivert)

   

     

25-50 mg PO Q24H

Metoclopramide (Reglan)

 

·

5-10 mg PO/IV/IM Q6H

Chlorpromazine (Thorazine)

   

10-25 mg PO Q4-6H;
50-100 mg PR Q6-8H

Prochlorperazine (Compazine)

   

5-10 mg PO/IM TID-QID;
10-25 mg PR Q4-6H

Promethazine (Phenergan)

·

12.5-25 mg IM/PO Q4-6H; 25 mg PR Q4-6H; Topical  50mg/ml  (refer to Additional Information)

Scopolamine Patch (Transderm Scop)

       

·

Transdermal Patch 1.5 mg: 1 patch applied Q1-3 days

Trimethobenzamide (Tigan)

 

   

250 mg PO Q6-8H; 100-200 mg IM Q6-8H

Ondansetron (Zofran)

Up to 8 mg IV or PO every 6 hours, not to exceed 32 mg/day

Pyridoxine (Vitamin B6)

·

          10 to 30 mg IV daily
Doxylamine
Succinate/Pyridoxine
Hydrochloride
(Diclegis®)

·

20/20 mg PO HS; not to
exceed 40/40 mg per day

Additional Information

The use of steroids (e.g., Decadron 4 mg IV, along with other antiemetics) is being used post anesthesia to help control nausea.

Promethazine topical is not commercially available but is a compounded product. It can be made in varying doses but it seems that the most common dose is 50 mg/ml of Promethazine in Pluronic Lecithin Organogel (PLO) and it is applied to the ventral surface of the non-dominant wrist and then covered with a dressing. The beyond use date is 14 days from preparation.

References

BlueCross BlueShield of Tennessee network physicians. April - June 2014.

Dickman A, Schneider J, & Varga J. The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care 2nd Edition. Oxford University Press; 2005: 76-88

Lexi-Comp Online. (2009). AHFS DI. Pyridoxine hydrochloride. Retrieved February 8, 2010 from Lexi-Comp Online with AHFS.

MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2003, November). Doxylamine succinate/pyridoxine hydrochloride. Retrieved January 31, 2014 from MICROMEDEX Healthcare Series.

National Guideline Clearinghouse NGC-5719. (2004, April). “Nausea and vomiting of pregnancy.” Retrieved January 10, 2012 from http://www.guideline.gov/summary/summary.aspx?doc_id=10939&nbr=005719&string=nau sea+and+vomiting.

U. S. Food and Drug Administration. (2013, April). Center for Drug Evaluation and Research. FDA announces that companies must stop marketing suppository products containing trimethobenzamide. Retrieved January 31, 2014 from http://www.fda.gov/newsevents/newsroom/pressannouncements/2007/ucm108882.htm.