Are medications working?
What are your expectations of medications? Here are some frequent concerns we hear and what we know about effective medication management. Many women expect relief of nausea and vomiting immediately from medications, but medications don't target nausea. Additionally, other symptoms like acid reflux and gastroparesis may not be improved by common antiemetic medications.
Nausea’s pathway is poorly understood, thus few medications actually reduce nausea significantly. Medications like Kytril (granisetron) and Zofran (ondansetron) are very commonly used for HG because they are the most effective at reducing vomiting. They affect the serotonin receptors in the GI system and prevent triggering of the vomit center in the brain along one pathway. They are not formulated to reduce nausea. If your medication is reducing the frequency and severity of vomiting and retching, it’s probably doing it’s job.
Did you know that more than one prescription medication is typically required to adequately manage HG and minimize weight loss? Combining medications is common. Don’t expect to feel suddenly free of all nausea and vomiting by taking one medication. Your symptoms may also increase throughout the first trimester and vary for months longer. Just because you have an increase in symptoms, it doesn’t mean your medication stopped working. You may just be having a bad day or need additional medication or fluids and vitamins.
Remember: Stopping medication quickly can make you sicker, so ask about weaning slowly. Also, try to start one medication at a time, so you can see which one is helping your symptoms.
Without adequate hydration, electrolytes, and key vitamins (thiamin, B6, K, Mg, Na), medications may not work properly. Vitamin deficiencies worsen nausea and vomiting. Do you need rehydration?
Tablets don’t always stay down. Medications come in multiple forms, and every person responds differently to the different forms and routes. Some use orally dissolving tablets (ODT) that can be taken by mouth or vaginally as directed. Still others need a continuous infusion by a subcutaneous pump or IV. There are also transdermal patches, suppositories, and some medications can even be compounded into a cream or suppository.
Not everything works the same for everyone and every pregnancy. Some medications are more effective in general, so be sure you have optimized dosing and scheduling before making a change to a new medication. Sometimes taking a different medication in the same category may have more benefit, like switching from ondansetron to granisetron.
Further, most medications are more effective in higher amounts (e.g. taking 8 mg of Zofran/ondansetron instead of 4 mg) and if taken on a consistent schedule, not as needed (prn). OR if taking a single 4 mg tablet every 6 hours doesn’t seem to be enough, ask to take 4 mg every 3 hours (the same as 8 mg every 6 hours). Ask also about different ways to take your medication to improve absorption.
Taking medications during pregnancy can be very upsetting for women as the general belief is that they will hurt their baby(ies). However, the risks of chronic dehydration, malnutrition, metabolic and emotional stress, as well as reduced mobility are significant. These issues have been demonstrated to increase the risk of complications in mothers and possibly even in their child(ren). Conversely, most studies of medications commonly used for HG have not been found to significantly increase the risk of malformations in the baby.
Women with HG want to be heard and believed, so they can receive the treatment they need to protect themselves and their babies. We developed this document to help women talk with their doctors.
More medication management tips:
- Scheduling your medication can increase effectiveness.
- Treat side effects. A daily stool softener is usually necessary to control the constipation that is a side effect of serotonin medications.
- Some moms do better with a specific brand of medication since inert ingredients or flavors may trigger reactions.
- Many women need medications throughout most if not all of pregnancy.
- Tell your doctor if you have existing health conditions, especially heart arrhythmias, as some medications can increase the risk of complications.
- Always discuss all medications with your doctor to avoid interactions, and discuss all medication changes with your health care team.
Do not combine more than one medication in the same category (eg. Kytril and Zofran are both serotonin meds and should not be taken together). Taking an antidepressant with Zofran could put you at risk of serotonin syndrome.