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 Q4-6H
10-50 mg IM Q4-6H
25 mg PO/IM Q4-6H or 50 mg PO/IM Q6-8H
Max 400 300 mg/day if used alone; If used in combination with doxylamine, the total dose of diphenhydramine should not exceed 100mg/day |
|
Metoclopramide (Reglan®) |
|
·
|
·
|
|
|
|
5-10 mg PO/IM Q6-8H PRN |
|
Chlorpromazine (Thorazine®) |
|
·
|
·
|
|
|
|
10-25 mg PO Q4-6H
25-50 mg IM (refer to Additional Information) |
|
Prochlorperazine (Compazine®) |
|
|
· |
· |
|
|
5-10 mg PO Q6-8H PRN
25
mg PR Q12H PRN |
|
Promethazine (Phenergan®) |
|
· |
·
|
· |
|
|
12.5-25 mg PO/PR/IM Q4-6H
|
|
Pyridoxine
(Vitamin B6)
|
|
|
· |
|
|
|
Monotherapy: 10-25 mg PO Q6-8H PRN
In combination with Doxylamine: 25 mg QHS initially, up to 4 tablets per day (refer to Additional Information) Pyridoxine max daily dose 200 mg |
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.
- Doxylamine-pyridoxine available as a combination extended-release doxylamine 10 mg/pyridoxine 10 mg tablet. Take two tablets QHS. May increase to four tablets orally over the course of the day for more severe nausea. A higher dose extended-release tablet containing 20 mg doxylamine/20 mg pyridoxine is also available. Take one tablet QHS, and if symptoms persist, take one additional tablet QAM. The 25 mg tablet is also available OTC, which can be taken up to four times a day along with 12.5 mg doxylamine.
References
- BlueCross BlueShield of Tennessee network physicians. July - September 2026.
- Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gyncol 2018: 131:e15. Reaffirmed 2026.
- MICROMEDIX Healthcare Series. Drugdex Drug Evaluations. (2026, June). Prochlorperazine. Retrieved July 6, 2026 from MICROMEDEX Healthcare Series.
- MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2026, June). Chlorpromazine Hydrochloride. Retrieved July 6, 2026 from MICROMEDEX Healthcare Series.
- Smith JA, et. al. Nausea and vomiting of pregnancy: Treatment and outcome. In: UpToDate, Waltham, MA. (Last Updated April 2, 2026. Accessed on July 6, 2026).
- Lexi-Comp Online. (2026, July). AHFS DI. Diphenhydramine. Retrieved July 2026 from Lexi-Comp Online with AHFS.
- MICROMEDIX Healthcare Series. Drugdex Drug Evaluations. (2026, June). Pyridoxine. Retrieved July 6, 2026 from MICROMEDEX Healthcare Series.
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