Treatment options for hyperemesis gravidarum

Amy Abramowitz*, Emily S. Miller, Katherine L. Wisner

*Corresponding author for this work

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

Hyperemesis gravidarum (HG) is a severe and prolonged form of nausea and/or vomiting during pregnancy. HG affects 0.3–2% of pregnancies and is defined by dehydration, ketonuria, and more than 5% body weight loss. Initial pharmacologic treatment for HG includes a combination of doxylamine and pyridoxine. Additional interventions include ondansetron or dopamine antagonists such as metoclopramide or promethazine. The options are limited for women who are not adequately treated with these medications. We suggest that mirtazapine is a useful drug in this context and its efficacy has been described in case studies. Mirtazapine acts on noradrenergic, serotonergic, histaminergic, and muscarinic receptors to produce antidepressant, anxiolytic, antiemetic, sedative, and appetite-stimulating effects. Mirtazapine is not associated with an independent increased risk of birth defects. Further investigation of mirtazapine as a treatment for HG holds promise to expand treatment options for women suffering from HG.

Original languageEnglish (US)
Pages (from-to)363-372
Number of pages10
JournalArchives of Women's Mental Health
Volume20
Issue number3
DOIs
StatePublished - Jun 1 2017

Keywords

  • Gastrointestinal disorders in pregnancy
  • Hyperemesis
  • Hyperemesis gravidarum
  • Mirtazapine
  • Nausea and vomiting in pregnancy

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health

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