"Morning Sickness"

In order to avoid becoming dehydrated, just sip liquids: carry around a sports bottle and try sipping small amounts through a straw every so often. Try to keep you stomach coated with instant mashed potatoes, saltine crackers, slices of baked potatoes, etc.

Sea- bands® (or copper bracelets), even acupuncture or hypnosis, may be tried but most patients have not reported significant symptom improvement.

Usually when your stomach is completely empty your nausea ensues. Until 1999 the most commonly prescribed medication for nausea was Bendectin. ® Bendectin® contained doxylamine and Vitamin B6.This medication was voluntarily withdrawn from the market because of the cost of on-going costly medical liability. In recent large clinical trials this medication was found to be safe and efficacious in ameliorating nausea and vomiting during early pregnancy. Isolated instances of any cause-effect on the unborn baby were completely unsubstantiated. Because of the safety profile of this drug combination, the medication was approved by the FDA Panel re-released as Diglegis. ®

On April 9, 2013 the U.S. Food and Drug Administration approved new drug, Diclegis for use in women with morning sickness. It is the only FDA-approved drug to treat specifically pregnancy-related symptoms of nausea and vomiting.

Diclegis® costs about $5 per pill. However, you can find OTC (over-the-counter) Vitamin B6 and doxylamine at your local (or chain store) pharmacy or grocery store.

Generic Doxylamine 25 mg and Vitamin B6 100 mg every 6 hours can ease your nausea.

At your pharmacy you can find that the combination of generic OTC (over-the-counter) Vitamin B6 (Pyridoxine) 50 mg and Doxylamine.

There are also name brands such as Unisom SleepTabs® that contain doxylamine. If one were take 50 mgs of Vitamin B6 plus one half (1/2) tablet of the sleep aid Unisom© , you would recreate the same formulation that exists today in Diglegis. It would be very similar to the decades used medication Bendectin. The dose of the medication is 25 mg of doxylamine® and 50 mg of Vitamin B6 as needed every 6 hours. Most patients can testify that this combination works well and is very effective in counteracting nausea. Unisom® contains 25 mg of doxylamine.

Author money tip: Using generic or brand name doxylamine and Vitamin B6 OTC could be 10 times less expensive than prescription Diglegis® (when you compare costs of generic versus brand name). There are two forms of Unisom© sold in stores: so you have to be careful to read the ingredient labels.

Unisom SleepTabs®: containing 25 mg of doxylamine (also sold as Bentyl®)

Unisom Gel caps®: containing 25 mg of diphenhydramine (also known as OTC Benadryl®)

The Unisom pills may make you sleepier than the gel caps. However, if you also have insomnia, the traditional Unisom pills will help your nausea but also help you get a better night’s sleep!

If these measures are not helpful, then the medications listed below may be necessary and can be prescribed to you:

Phenergan 25 mg either orally, by cream application or rectally every 6 hours

Compazine 10 mg and 25 mg (oral and rectal suppositories every 6 hours as needed)

Zofran 4 mg either orally or sublingual (under the tongue) every 4 hours

Zofran is classified as a Category B drug in pregnancy. There are reports of its use in early pregnancy with an increase association of certain malformations such as cleft palate or lip defects as well as septal defects in the heart. However, after all other therapy fails to alleviate symptoms, most OBs will prescribe Zofran because of its effectiveness compared to the rare possibility of associated birth defect.

Morning Sickness usually improves after the first trimester of pregnancy. However, in a few patients it can last throughout the entire pregnancy. Occasionally it can come back just for a few weeks in the last trimester: the point is that these symptoms vary with each patient and with each pregnancy that you may have.

Another point: Prescription prenatal vitamins can make the nausea worse in many patients. In such cases, I recommend that patients hold off taking their Prenatal Vitamins and try using chewable Prenatal or Children’s Vitamins until their morning sickness subside after the 1st trimester (although nausea at any time of day can last throughout the pregnancy is some patients). If possible, try to continue taking OTC folic acid 0.8 milligrams (mg) and Iron OTC per day until you are feeling better.

Author’s Note: Severe “morning sickness,” also known as Hyperemesis Gravidarum, affects less than 5% of pregnancies. Occasionally patients must be hospitalized for intravenous fluids and medications to prevent dehydration and metabolic disturbances. To give patient’s some reassurance, a UCLA Medical Center study found that morning sickness was correlated positively with having healthier babies!

The chief objection to prenatal vitamins by patients is the size of the pills. Some pharmaceutical companies have tried to make them smaller, chewable and even divided them in half (making you take one twice a day. If you are eating a healthy well balanced diet, particularly fresh vegetables, fruits, dairy products, etc. you will be taking a sufficient amount of vitamins to sustain your growing baby.

Bottom-line, OTC folic acid (.8 mg twice daily) and Iron supplementation (325 mg twice daily) along with a healthy diet can replace your need for a prenatal vitamins.