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Drugs for vomiting in 1st trimester

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"Nausea and Vomiting of Pregnancy"[MeSH Terms] AND treatment

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ACOG nausea vomiting pregnancy first trimester vitamin B6 doxylamine medications

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For vomiting or nausea in the 1st trimester, the usual first medicine choice is:
  1. Vitamin B6 (pyridoxine): 10-25 mg by mouth every 6-8 hours.
  2. Add doxylamine if needed: 12.5 mg with the B6, often at night first because it causes sleepiness. A prescription delayed-release combination is also available in some countries.
ACOG considers B6 alone or combined with doxylamine safe in pregnancy and the preferred initial medication approach. ACOG guidance
If this does not control symptoms, an obstetric clinician may prescribe alternatives such as:
  • Metoclopramide
  • Promethazine or prochlorperazine
  • Ondansetron for persistent symptoms, after an individual risk-benefit discussion. Its fetal safety data are less settled, and it can affect heart rhythm in susceptible people.
Do not self-start prescription anti-vomiting drugs, and do not use a random “sleep aid” without checking its active ingredient. Doxylamine causes drowsiness, so avoid driving and alcohol.
Seek urgent assessment today if you cannot keep fluids down for 8-12 hours, have very dark/scant urine, dizziness/fainting, weight loss, blood in vomit, severe abdominal pain, fever, or vomiting is severe. This can be hyperemesis gravidarum and may require IV fluids, thiamine, and supervised treatment.
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