Metoclopramide versus droperidol for extreme nausea, vomiting during pregnancy

May 6 2009

Nausea and vomiting are telltale indicators of pregnancy, affecting more than 80 percent of future mothers. For a few moms-to-be, symptoms can become so severe that hospitalization is required.

Yet a new medication protocol, introduced by the Sainte-Justine University Hospital Center, appears effective in improving symptoms more quickly and provides a safer option than those previously available. The findings, which are good news for moms and babies, are published in a recent edition of the European Journal of Obstetrics and Gynecology and Reproductive Biology.

"In 2002, we had to quickly change the medication protocol to treat hyperemisis gravidarum (HG), or severe nausea and vomiting of pregnancy, due to a FDA and Health Canada warnings," says senior researcher Anick Bérard, a professor at the Université de Montréal's Faculty of Pharmacy and director of the Research Unit on Medications and Pregnancy of the Sainte-Justine University Hospital Center.

"The warning found that a previously used anti-vomiting medication might cause adverse cardiovascular effects in mothers. We had to quickly choose another treatment, which was safer. The current study looks back at the data to evaluate the effectiveness of this treatment."

Metoclopramide versus droperidol

Dr. Bérard and her team, which included researchers from the Université de Bourgogne, evaluated 229 pregnant women who were admitted to hospital and treated for HG. The scientists compared use of the standard drug droperidol versus the administration of a newer medication called metoclopramide.

They found that metoclopramide worked faster to quell symptoms of nausea and vomiting than droperidol. Importantly, they found no evidence that either of these medications increased the birth defect rate compared to women who received no medication. As expected, metoclopramide was not associated with other serious side effects.

"This study validates our protocol," says Dr. Bérard. "Clinical trials are not conducted on pregnant women, so we had to rely on data from prospective and retrospective studies in this case. We anticipate that other institutions will now be comfortable adopting this new treatment regime.

About hyperemis gravidarum

Hyperemis gravidarum, or severe nausea and vomiting of pregnancy, affects about one percent of pregnant women. If left untreated, it can result in severe weight loss, dehydration, or death. Symptoms to look out for include severe vomiting and nausea; incapacity to keep food down for two to three days; lack of energy.

According to Dr. Bérard, women should not wait too long before seeking medical help. "The longer the symptoms continue, the longer the hospital stay," she says, adding most women with HG leave the hospital within three days and many are required to take medication throughout their pregnancy.

"Metoclopramide and diphenhydramine in the treatment of hyperemisis gravidarum: Effectiveness and predictors of rehospitalization," published in European Journal of Obstetrics and Gynecology and Reproductive Biology, was authored by Anais Lacasse, Ema Ferreira and Anick Bérard of the Université de Montréal and the Sainte-Justine University Hospital Centre and Amandine Lagoutte of the Université de Bourgogne.