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UM Guidelines
Hyperemesis Gravidarum

Home Care (HC)

BCBST last reviewed August 20, 2016*

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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 Q4-6H

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®)

 

   

300 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

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

  1. Badell ML, Ramin SM, Smith JA. Treatment options for nausea and vomiting during pregnancy. Pharmacotherapy 2006; 26:1273-1287.
  2. BlueCross BlueShield of Tennessee network physicians. April-June 2016.
  3. Dickman A, Schneider J, & Varga J. The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care 2nd Edition. Oxford University Press; 2005: 76-88.
  4. Lexi-Comp Online. (2009). AHFS DI. Pyridoxine hydrochloride. Retrieved February 8, 2010 from Lexi-Comp Online with AHFS.
  5. 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=nausea+and+vomiting
  6. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2003, November). Doxylamine succinate/pyridoxine hydrochloride. Retrieved January 31, 2014 from MICROMEDEX Healthcare Series.
  7. 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.
  8. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2015, November). Trimethobenzamide. Retrieved January 25, 2016. From MICROMEDEX Healthcare Series.
  9. 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.

 

 
   

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