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UM Guidelines
Hyperemesis Gravidarum

Home Care (HC)

BCBST last reviewed August 1, 2018*

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 Q4-6H

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;
25-50 mg IM (refer to Additional Information)

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.

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.

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 2018.
  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. MICROMEDIX Healthcare Series. Drugdex Drug Evaluations. (2017, January). Prochlorperazine. Retrieved January 13, 2017 from MICROMEDEX Healthcare Series.
  6. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2018, February). Chlorpromazine Hydrochloride. Retrieved February 20, 2018. From MICROMEDEX Healthcare Series.
  7. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2015, November). Trimethobenzamide. Retrieved January 25, 2016. From MICROMEDEX Healthcare Series.
  8. 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.
  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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