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Uptodate Reference Title
Management algorithm for treatment of nausea and vomiting of pregnancy (NVP)
Management algorithm for treatment of nausea and vomiting of pregnancy (NVP)
Women with mild symptoms may benefit from acupuncture, acupressure, or hypnosis. Women with heartburn/acid reflux may benefit from acid-reducing medications as adjunctive therapy anytime during the course of illness. Antacids containing aluminum or calcium are preferred. Cimetidine is the preferred H2 blocker. There is less experience using proton pump inhibitors (eg, lansoprazole or esomeprazole).
* Eat small amounts of food every one to two hours to avoid an empty or full stomach. It can be helpful to eliminate spicy, odorous, high-fat, acidic, and very sweet foods, and substitute protein-dominant, salty, low-fat, bland, and/or dry foods. Fluids should be consumed at least 30 minutes before or after solid food to minimize the effect of a full stomach. Fluids are better tolerated if cold, clear, and carbonated or sour. Avoid lying down after eating. ¶ Examples of some triggers include stuffy rooms, odors, heat, humidity, noise, visual or physical motion, and gastric irritants (eg, coffee, iron supplements). Δ Doxylamine succinate 10 mg and pyridoxine 10 mg may be given separately or as a combination pill. We begin with 20 mg of each drug at bedtime. If ineffective, we give an additional 10 mg of each drug in the morning and in the afternoon. ◊ We generally treat refractory cases with a short course of glucocorticoids but may begin with chlorpromazine in selected patients, such as those in whom the side effects of glucocorticoids may be more serious. § We usually begin with a diet consisting of bananas, rice, applesauce, and toast (BRAT diet) and then advance as tolerated to usual diet suggested for women with nausea and vomiting of pregnancy.
