BCBST Tennessee Logo, Plans for Better Health, Plans for a Better Life
UM Guidelines
Hyperemesis Gravidarum

Home Care (HC)

BCBST last reviewed August 23, 2017*


No deletions were made.

Added to RN Treatment Plan: Treatments and Procedures

 Commonly Prescribed Anti-emetics for the Treatment of Hyperemesis Gravidarum









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; 25 mg PR BID

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

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.


  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 2017.
  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. 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.
  5. 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.
  6. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2015, November). Trimethobenzamide. Retrieved January 25, 2016. From MICROMEDEX Healthcare Series.
  7. MICROMEDIX Healthcare Series. Drugdex Drug Evaluations. (2017, January). Prochlorperazine. Retrieved January 13, 2017 from MICROMEDEX Healthcare Series.



Download Acrobat Reader