UM Guidelines
Hyperemesis Gravidarum - Upcoming Changes

Home Care (HC)

To be effective June 30, 2021*

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/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®)

IV

IM

·

     

25-50 mg PO Q4–6H PRN

Max dose of 200 mg if taking Doxylamine concurrently

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

Diphenhydramine (Benadryl®)

IV

·

·

     

25 - 50 mg PO TID/QID

10-50 mg IM IV Q2-3H Q4-6H

Max 400 mg/day

Meclizine (Antivert®)

   

·

     

25-50 mg PO Q24H

Metoclopramide (Reglan®)

IV

·

·

 

5-10 mg PO IV IM Q6H Q8H

Chlorpromazine (Thorazine®)

 

·

·

   

10-25 mg PO Q4-6H;
25-50 mg IM (refer to Additional Information)

Prochlorperazine (Compazine®)

IM

·

·

   

5-10 mg PO IM TID-QID; 25 mg PR BID

Promethazine (Phenergan®)

IM

·

·

Topical

12.5-25 mg IM PO Q4-6H;

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

Scopolamine Patch (Transderm Scop®)

       

Topical

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

Pyridoxine (Vitamin B6)

   

·

     

Monotherapy: 10-25 mg PO TID/QID

In combination with Doxylamine: 25 mg QHS initially, up to 4 tablets per day

Pyridoxine max daily dose 200 mg

Trimethobenzamide (Tigan®)

 

·

PO

   

200 mg IM Q6-8H

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

Ondansetron (Zofran®)

IV

·

4 mg PO Q8H

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. BlueCross BlueShield of Tennessee network physicians. January - April 2021.
  2. Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 189: Nausea and Vomiting of Pregnancy. Obstet Gyncol 2018: 131:e15. Reaffirmed 2020.
  3. ROMEDIX Healthcare Series. Drugdex Drug Evaluations. (2021, January). Prochlorperazine. Retrieved January 13, 2021 from MICROMEDEX Healthcare Series.
  4. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2021, January). Chlorpromazine Hydrochloride. Retrieved January 13, 2021. From MICROMEDEX Healthcare Series.
  5. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2021, January). Trimethobenzamide. Retrieved January 13, 2021. From MICROMEDEX Healthcare Series.
  6. Smith JA, et. al. Nausea and vomiting of pregnancy: Treatment and outcome. In: UpToDate, Waltham, MA. (Last Updated October 21, 2020. Accessed on January 14, 2021).

Badell ML, Ramin SM, Smith JA. Treatment options for nausea and vomiting during pregnancy. Pharmacotherapy 2006; 26:1273-1287.

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. 

MICROMEDIX Healthcare Series. Drugdex Drug Evaluations. (2017, January). Prochlorperazine. Retrieved January 13, 2017 from MICROMEDEX Healthcare Series. 

MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2018, February). Chlorpromazine Hydrochloride. Retrieved February 20, 2018. From 

MICROMEDEX Healthcare Series. MICROMEDEX Healthcare Series. Drugdex Drug Evaluations. (2015, November). Trimethobenzamide. Retrieved January 25, 2016. From MICROMEDEX Healthcare Series.


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