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February 10, 2022

Levels of Medication for Hyperemesis Gravidarum (HG)

Individual response to Hyperemesis Gravidarum (HG) medication varies due to many factors including genetics and hydration. If a patient is vomiting constantly, oral dosing of medications will likely be ineffective and alternates such as sublingual, transdermal (patch/cream), subcutaneous (subQ), intravenous (IV), or other routes should be considered along with hydration. The medication levels for HG are explained below.

Medication Levels for HG

1st Level Medications for HG

  1. Antihistamine
  2. Acid reducers
  3. Vitamins B1 and B6
  4. Meds successful in previous pg

2nd Level Medications for HG

  1. Prokinetics: Reglan* (oral, low dose 5 mg)
  2. Acid blockers/PPIs (e.g. Protonix, Prevacid)
  3. Serotonin antagonists (e.g. ondansetron/Zofran, granisetron/Kytril)
  4. Phenothiazines (e.g. Stemetil, Promethazine)
  5. Corticosteroids (after 8 weeks)
  6. IV fluid/Nutritional therapy

*prophylax with antihistamine

3rd Level or Experimental Medications for HG

  1. Benzodiazepine (e.g. Diazepam)
  2. Neuroleptic (e.g. Inapsine)
  3. Remeron (Mirtazipine)
  4. Anticonvulsants (e.g. Neurontin/Gabapentin)
  5. THC/marijuana (or dronabinol Rx)
  6. Clonidine (transdermal)

Weaning Medications for HG

Stopping medication quickly can make a patient sicker, so weaning slowly is recommended. Also, adding one medication at a time can show which one is helping symptoms.

Medication Information
Medication Strategies
Treatment Algorithm
Patient Treatment Brochure
HER Support Groups
Complications Secondary to Hyperemesis Gravidarum (HG)

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Posted in HG Management, What is HG
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