Parenteral antiemetics for nausea and vomiting during pregnancy

If nausea and vomiting during pregnancy are sufficiently severe to preclude oral therapy, or oral therapy is not tolerated, use:

1metoclopramide 10 mg intramuscularly or intravenously, 8-hourly if required (TGA category A)¹ metoclopramide metoclopramide metoclopramide

1ondansetron 4 to 8 mg intravenously, 8- to 12-hourly if required (usual maximum 16 mg daily) (TGA category B1)² ³ ondansetron ondansetron ondansetron

1prochlorperazine 12.5 mg intramuscularly or by slow intravenous injection, 8-hourly if required (TGA category C)⁴. prochlorperazine prochlorperazine prochlorperazine

If a parenteral antiemetic is ineffective at the maximal dose, discontinue the drug. Consider using an alternative drug from the list above, in combination with pyridoxine and doxylamine. Mirtazapine may also be considered as an adjunct to therapy for nausea and vomiting.

For severe persistent vomiting that does not respond to the treatments above, seek obstetric advice about possible alternative treatments and hospital admission for rehydration or nutrition.

¹ For precautions related to the use of metoclopramide, see Common antiemetic drugs for management of nausea and vomiting in adults.Return

² Safety data in humans about ondansetron in pregnancy are conflicting; a small increase in cardiovascular malformations and orofacial clefts have been reported.Return

³ Ondansetron should be given by intravenous injection over at least 30 seconds or by intravenous infusion in compatible fluid.Return

⁴ For intravenous administration, inject over 2 minutes.Return