Tigan (Category C), likewise, has been around for a long time and has likewise been used with a comfort level. Also, Tigan is a good replacement for Compazine and Phenergan if there's a phenothiazine allergic reaction.
I've saved the best for last. Zofran (ondansetron), although newer, seems to cause no harm. In fact, in spite of its recent introduction it's a Category B drug. Home health agencies have even used it in a pump-delivery system to great effect, saving a lot of hospital time. HMOs, forever worried about the current fiscal quarter instead of the long term, generally decline to pay for a Zofran pump at home. Capitalism - actually, fiscal quarter capitalism - prevails.
Zofran is also available in pills. As mentioned, it's very pricey. Once I was on a plane and a man next to me had a bad case of airsickness, along with all of the sound effects that make that diagnosis a no-brainer. I happened to have a Zofran pill on me - my own stash of very expensive Zofran - and rose to the challenge of altruism by offering it to him. Even though I explained to him that I was a doctor, I was a stranger to him. He accepted it politely and then discretely, or so he thought, threw it away. Even we doctors can have unprofessional thoughts at times, like the one in which I wanted to ring his retching neck for throwing out my $35 pill.
Zofran represents a major leap in controlling nausea, and I say that based on my own clinical experience with it - it's awesome. And get this - no one really knows how it works.
Reglan (FDA Category B) helps with nausea by helping to empty the stomach the right way - down instead of up.
Other Causes of Nausea
Before slapping down that drug card, though, you need to know that hyperemesis, although common, is abnormal. Your doctor needs to rule out other causes of extreme nausea and vomiting in pregnancy. Other causes:
- Hyperthyroidism - either the real thing or a hyperthyroid-like condition because of too much hCG (pregnancy hormone), as in hydatidiform moles (see Chapter Six: Miscarriage) and multiple gestations (see Chapter Seventeen: Multiple Gestations).
- Gall bladder disease - The gall bladder, like the intestines, is sluggish in its own job of eliminating bile, leading to distention, inflammation (cholecystitis) and even stones (cholelithiasis). Nausea is a common feature of gall bladder problems.
- HELLP syndrome - an end-stage condition of Pregnancy-induced Hypertension (PIH), there is liver toxicity from the pregnancy. But this is a condition well out of the first trimester. (Any nausea and vomiting after 16 weeks or so is probably no ordinary morning sickness gone awry.)
- Appendicitis - almost always associated with nausea, the actual point of the pain may not be in the classical right lower quadrant, because the increasing size of the uterus will push the position of the appendix up during the pregnancy.
- Other gastrointestinal problems, like Irritable Bowel Disease (Crohn's Disease or Ulcerative Colitis), ulcers, hepatitis, pancreatitis, obstruction of the intestinal tract from adhesions, etc.
Of course, being nauseated and pregnant provokes a prejudicial inclination to suspect pregnancy-related nausea. After all, if it looks like a duck and walks like a duck...(acceptable metaphor until the third trimester).
Your doctor may want to use other ways to address hyperemesis before jumping to prescriptions:
Change of diet - low fat, low sugar diet, with a lot of vegetables and fruits. Many homeopathic clinicians feel the liver is getting the brunt of the pregnancy, causing the nausea, so a diet that doesn't stress the liver is seen as an answer to decreasing the nausea.
Avoid caffeine and of course nicotine.
Raise Bendectin from the dead! Even though Bendectin is no longer commercially available, many obstetricians and gastroenterologists consulted by them are making their own. It is simply a combination of pyridoxine (Vitamin B-6) + 1/2 of a Unisom (consult your physician about proper dosage). Or, you can jump the border and get some Diclectin from our friends to the north.