Pharmacologic Therapy

1. Prescribed medication is the next step if dietary modifications and vitamin B6 therapy with doxylamine are ineffective. The phenothiazines are safe and effective, and promethazine (Phenergan) often is tried first. One of the disadvantages of the phenothiazines is their potential for dystonic effects.

2. Metoclopramide (Reglan) is the antiemetic drug of choice in pregnancy in several European countries. There was no increased risk of birth defects.

3. Ondansetron (Zofran) has been compared with promethazine (Phenergan), and the two drugs are equally effective, but ondansetron is much more expensive. No data have been published on first trimester teratogenic risk with ondansetron.

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