1st TRI MUST READ: Meds info - safety risks and PICC/NG info

[Natalie]

A message from Kimber:

Hi all.

I know medication safety is of great concern to most mothers, especially first time mothers with HG. A study was done recently on Zofran in children as young as 6 months and found to be effective and safe.

Anti-vomiting drug helps dehydrated kids
Macleans.ca - Thursday June 8, 2006
Ondansetron allows children with an upset stomach to keep fluids down in the emergency department A drug best known for treating chemotherapy-related nausea and vomiting also helps kids keep fluid down after ... http://www.macleans.ca/topstories/healt ... 22545_5612

When deciding about medications, look at our medication page in the treatment section and you will find links and info on safety and medication usage. Always remember that being sick with HG poses risks to your baby when you are dehydrated, malnourished and very stressed. Zofran and some of the other medications have yet to show any significant risks to the unborn child over the last 15 years of usage. That is not to say there is no risk, but you do have to compare the known risk of being very sick with the benefit of the medications you are given - most of which have no known risks.

We will be publishing results from our research survey which found that women not treated with medications often had more complications or issues with their children than those that were treated. This could support the theory that the risks of HG are greater than the risks of some medications.

Kimber

_________________
Kimber
kimber@HelpHER.org
kimber@hyperemesis.org
HER Foundation Founder
Director of Research & Ed
2 pg w/nine-months of HG each
Mom of two - Conner (1999), Kayleigh (2003)


A must read on Zofran / Unisom / B6

Welcome! This is a post containing information about Zofran/B6/Unisom and a bit more. If you are new to this site, and in the midst of HG, this post is for you.

ZOFRAN Zofran is prescribed in several different forms: Zofran is often prescribed as an oral tablet to be taken by mouth and swallowed in 4 or 8 mgs. Zofran is also available in an Oral Dissolveable Tablet (ODT) - which means it is sublingual, and dissolves in your mouth w/o the need of any liquid to swallow it. It is immediately absorbed into the blood stream, 4 and 8 mgs. Additionally, Zofran can be injected into your IV or PICC line, often in the hospital, but increasingly availably through home health care. Zofran is also available in a subcutaneous pump, which contains a small needle that is inserted barely into the skin, often on the thigh or stomach, and a connected pump ensuring a consistent administration of Zofran. The more direct the route between the medication and your blood stream, the more effective the drug tends to be. In order of effectiveness from least to greatest: Oral, ODT, pump, IV. The biggest adverse reaction to Zofran experienced by HGers here is constipation.

Personally, I took my Zofran around the clock every 6 hours. I was on 16 mgs per day, 4 mgs per dose. I set an alarm at night to wake up during the night, swallow my Zofran, go to the bathroom, eat some graham cracker so my tummy wasn't empty, and then would go back to sleep. Some gals just sleep through the night, and then take it when they get up. It depends on what works better for you, go with your gut feeling - it's usually right. Some women get permission to change their Zofran doses from large occassional doses to smaller more frequent doses. For example, if a woman was on 32 mgs per day, that is 4 different 8 mg doses, each 6 hours apart. Some women react better to 8 doses of 4 mgs each, every 3 hours. Same number of mgs per day, just taken in smaller doses more often. Again, the point is to figure out what works best for you, your HG symptoms, and your pregnancy. Everyone has a slightly different protocol, and regimen that they are ok with.

UNISOM The highest doseage of Unisom is 3 Unisom/day = 75 mgs. There are two types of Unisom on the market. One is the sleep tabs - containing Doxcilimine Succinate. This is the one you DO want. The other is a sleep gel, and contains a different ingredient Diphenhydramine which is also in Benadryl and can also be used for HG, but is not the one used in this protocol. Unisom is a sleep aid, so expect drowsiness, but when taking it at smaller doses, the drowsiness is not so noticeable. Indeed, after several weeks, many HGers report the drowsy effect wearing off, and not being noticeable at all. For comparison purposes, HGers who have taken both Unisom and Phenergan, generally find Unisom to make them much less drowsy.

The limit of 3 Unisom per day is information from Motherisk (a nausea and vomiting support call center in Canada. Phone support is available to the US - www.motherisk.org - look up morning sickness).

B6 Prolonged useage of B6 at high doses (I think the study was 1,000 mgs a day) can lead to nerve damage. Therefore, Motherisk recommends no more than 150 mgs per day. 200 mgs per day for a month or two is not considered prolonged useage, but they strongly prefer no more than 150 mgs, and recommend that anyone on more than 150 mgs reduce their B6 intake if at all possible. Please remember to include B6 in a B complex Vitamin, or Multi-Vitamin, or Prenatals if you are taking any of them. There are different ways B6 is available. First, it's available over the counter at any grocery or drug store in a tablet, usually 25, 50, or 100 mgs. To save $, buy the 100 mgs, and a pill splitter, as they can be hard to split by hand. B6 must be paired with an enzyme in order to be available for use within the body, and unpaired B6 is just wasted in the urine, so do not take more than 25-50 mgs at a time, and take your doses throughout the day so they are more effectively absorbed. B6 is also available in a sublingual form, which means that it dissolves in your mouth like the Zofran ODT, and is absorbed directly into your blood stream - no water needed. Sublingual is already paired with the neccessary enzyme. Sublingual B6 is available in 25 mgs which also gives you more flexibility in being able to take it as needed. I've heard that the peppermint flavor is preferrable over the orange, and it needs to be special ordered by a health foods store for you, or a vitamin store, or can be purchased on-line. I have tasted the sublingual while pregnant, and found it quite bitter. As long as I didn't move it around too much in my mouth and half-slept through taking it, I was ok. Women who have tasted it NOT pregnant reported no bitter taste. The 3rd form of B6 is referred to as Pyridoxine (B6) Injections. They sting, they hurt, they build scar tissue, but not having any clue about the sublingual B6 when I was pg, I had injections w/ both of mine, and it kept me out of the hospital, and were that last little thing that kept me from going over the edge (in addition to the Phenergan or Zofron/Unisom I was already on). I wonder if sublingual is as effective as the injected, or nearly so, but haven't had that one answered. I do know personally that 100mgs injected was more effective than 200 taken orally. B6 follows the same absorption rules as other meds. Oral least effective, sublingual MUCH MORE effective w/ B6, and injected IM (intramuscularly) is even better. B6/Unisom is more effective taken together, at the same time, but they are individually helpful as well. Some gals do not react well to one or the other, so use them with out the other.

Zofran, though, for most of us is a great vomit handler, unfortunately, it leaves nausea behind. The B6/Unisom for most helps w/ the nausea, and isn't enough for the vomiting - that's why combinations seem to work for so many, because they address different HG issues, even if it's a different combination than Zofran/B6/Unisom. For a few, the Zofran handles nausea, and the vomiting needs to be handled differently (like w/ Meclizine) so be aware that the same medication at the same dose is not equal for all HGers.

Andrea (Andy) - Ivydragon


From Susannah:

I pulled together some information about NJ tubes and PICCs from the threads here. I hope this helps...

Picc pictures thread
http://forums.helpher.org/viewtopic.php?t=7951

NG/NJ tube vs PICC
http://forums.helpher.org/viewtopic.php?t=962

Hydration poll
http://forums.helpher.org/viewtopic.php ... light=picc

PICC line advice from members
http://forums.helpher.org/viewtopic.php ... light=picc

"When to get a PICC" thread
http://forums.helpher.org/viewtopic.php ... light=picc

IV hydration thread
http://forums.helpher.org/viewtopic.php ... light=picc

PICC complication thread
http://forums.helpher.org/viewtopic.php ... viewresult

[abbyjinxy]

Hi!
I just got my BFP Friday. I am around 4 weeks along.
My OB said he would prescribe Zofran for me at the first sign of nausea or vomiting.
In the meantime, I am wondering if I should start the b6/unisom, or wait until the nausea kicks in.
I saw your rec above for the unisom/b6.

Can you please clarify?
I have a b complex that includes 100 mg of b6. I should take that with the unisom (containing Doxcilimine Succinate)? How many times a day?
Should I cut the b complex in 1/2 and take the 1/2 with a unisom in the morning, and then the other b complex 1/2 with a unisom at night?

[Kaline]

Thanks for the info. I'm glad to hear studies are showing that zofran appears to be safe. This is my second hyperemesis pregnancy. During the first, I was like any first time mom, worried about doing the right thing for my baby. I was afraid to take medications, so I didn't get on zofran until toward the end of the first trimester, when I was vomiting blood and vile several times an hour. I still worry about the medication, but got on it immediately with this pregnancy. I would have to agree that the benefits outweigh the possible risks.

I was wondering if there is any type of dissolving B6 tablet? The problem is that I can't swallow the pills when I am this sick. I've been taking the dissolving zofran, which has been helpful. I have a liquid B complex, but even that is so hard to get/keep down sometimes. For once, I can describe something like this and know that there are probably people here who relate. What a nice feeling (although I wish you all did not have to deal with this. I know it is miserable!)

[aaronsmommy]

Yes, there is sublingual B6 available at many health food stores.

[faithlove]

My first time around, I never even realized that the Zofran was just for vomiting! I was SO nauseas for so long... I guess if I can get some Unisom it would change my life! Thank you so much for that explanation at the bottom!

[AFmommy]

I am 6 weeks along with my 3rd HG pregnancy and never knew that Zofran only helped with vomitting altough thats all it has ever done for me. It has made it so im not throwing up non-stop but never really got rid of the nausea I felt my entire pregnancy. I have to thank you so much Kimber for posting that information or else I would have gone through my 3rd (and last!!) pregnany extremely nausea. The only problem now is that I am currently in Russia for the next 6 weeks. I brought all my Zofran with me so I think I will have my mother mail me the unisom. Please tell me that it is over the counter in Canada???

Thanks again for the information! By the way I am brand new to posting this so sorry if I did something wrong!

[Nezabudka]

Is any B6 has enzemes in it ? I just ordered some on line and I do not know if it is any good after ready this post. Or we need to prepare it ourselves? Please pm me if you can, thank you

this is the product i bought

http://www.puritan.com/b-6-vitamins-349 ... =1#product

[SnowFlower]

Thank you for this post this is a huge help. Right now I am a little over 10 weeks pregnant with #2 and was just admitted to the hospital. I have been going to the ER daily or every other day for fluids and Zofran as only IV form will work. I have one OB trying to get me approved for a Zofran Pump still waiting on insurance and went for a second opinion and got admitted but everyone is very against at home IV's PICC lines etc. They think I should just go to the ER daily for fluids and anti nausea meds which make it ok for me to eat and drink until they wear off. I have finally gotten a banana bag as my nutrients and vitamins are in the toliet and I already have an issue that was ongoing with that as I had a very malabsorptive weight loss surgery about a year ago. Due to that I dont digest or absorb things properly. No one seems to know what to do with me and I am just praying the second trimester will be nicer to me. It is so nice to know however I am not alone.

[liseprzy]

Why don't you ask them if they would be willing to let you get an NJ tube instead. My OB is very much against giving PICC lines, but he is fine with an NJ tube and it's worked great for me.

Since it carries less risk of infection etc., some doctors are more willing to look at the tube feeding option. Especially if you point it out to them. Once a feeding line is in, you can take liquid zofran through the tube as well as extra fluids. I have found that the liquid zofran directly into my interstine worked as well as the IV stuff. I am still nauseas, but I am not throwing up (on most days).

Insurance also tends to be easier to go for this as the cost is significan less...

[jessshakespeare]

Hello,
Very useful post thanks, I was wondering if that research survey had been published yet?

I'm on my third HG pregnancy and just had a letter from my doc quoting NICE (I'm UK) guidelines about how risks must out weigh benefits before treatment is offered. I would like something to show them on that basis if possible.
Thanks again!

[aaronsmommy]

I can't find a study that includes that information, not sure it got published.

Yes, with anything in pregnancy, the benefits have to outweigh the risks. It is pretty basic. Dehydration and malnutrition due to HG have well documented proven risks for mom and baby. Most of the medications for hg do not. If you have had HG before, you have a 50-80% chance of having it again. If you have had it twice, it is probably even higher.

Doxylamine is the best studied medication in pregnancy in terms of lack of risk to baby. Millions of women have taken it in early pregnancy and there were registries of over 100,000 women in the 70's that did not show any risk to the babies ( http://politicalbubbles.com/Bendectin_Tortogen_Litigen.pdf ). It is also the medication used first in the motherisk study on preemptive therapy, since that seems to be what you are looking for information on. Looks like doxylamine is available on amazon in the UK if you can't find it in your local pharmacy, and you can look at the medication page for dosing instructions.

[jessshakespeare]

Thanks, yes I am interested in pre-emptive, its a difficult choice but last time I was in hospital at 5+4 so not a lot of time!
I'm also interested in challenging a few things here with doctors and the guidelines, I find it all very frustrating how little doctors know how much they sit on the fence. The US seems further ahead. Thanks again for your help.

[rainiermec]

My daughter has had this going on three weeks now. She has been in the hospital twice. They gave her Prednisone and that helpled her immensly but her OB stopped it. She has all of the regular drugs, Zofran, Promethazane and the other two I cannot think of right now. It is at the point where she is bouncing back and forth on terminating the pregnancy as she cannot even get out of bed and her health is getting much worse daily. The OB basically says just deal with it. Well, she cannot, she is really kind of losing it.

We are in a city between Seattle and Tacoma WA if anyone knows of a good doc who understands this better.

I am a very concerned Grandpa and am trying very hard to support her but without a physician that is more helpful I do not know what to do.

I have set up an e-mail to contact me if you can give me any ideas for her.

grandpaher@gmail.com

[DebbieS]

Prednisone is good. I was on prednisolone weeks 9-36 and it did help immensely. It is something that is usually managed by a Dr specialising in maternal medicine or high risk pregnancies, so maybe that's who she could see next (they may be known as a perinatologist, a maternal fetal medicine specialist or an obstetric physician (which is different from an OB)). If you do an advanced search for Seattle by the author MamaLily (post is called "Washington state" in the "help with finding a Dr" folder) it gives some info on Drs that might be useful. Keep advocating for her. When you are in the midst of HG it can be hard to focus on anything except making it through the day.

[PrincessLala]

Hi,
I'm new here, 12 weeks pregnant. Been on Zofran since 7 weeks when I couldn't keep anything down except Sprite and lost about 6 lbs in 5 days. Finally went in to Urgent Care and the Zofran helped immediately. I was weak but much better and then I got the flu. Since then I've been nauseated again and it seems to be getting worse. I'm not able to eat much and mostly I'm drinking ginger beer and a little water. So my question is about the Unisom/B6 because I think I need to try something else. I can't afford the little Zofran I'm taking so would like to start somewhere else. I've found the Source Naturals Coenzymated sublingual B-6, that seems to be the only sublingual option, but I'm not sure which Unisom to get. I'd like the quickmelts because I don't want to swallow a pill, but it appears they aren't the right kind? They are the Diphenhydramine and not the Doxylimine Succinate. Will it help to take that or why is the DS one preferred? Does it come in a melt or disintegrating tablet of sorts? Please help. I've lost ten lbs so far and want to start gaining back, but I'm afraid I'm just losing more. Thanks in advance.

[DebbieS]

Diphenhydramine is Benadryl. It is an antihistamine like doxylamine succinate (the unisom sleeping tablets), but a different chemical compound/med. Either can be used in treating HG, although the B6/doxylamine succinate combo is the more studied med for nausea and vomiting in pregnancy in terms of it's safety (it's class A, Benadryl is class B). Doxylamine tablets are usually very small & don't have much taste, so I found them easier to take than some sublingual meds that had a stronger taste, though this is personal. Both can make you drowsy, so it can be a good idea to start with a smaller night dose, then increasing it and adding small day doses as you get used to it. Pill splitters can be handy - my day doses were typically 1/4-1/2 a tablet. Some on this site have used Benadryl as an alternative to unisom, or have chosen their night dose to be Benadryl instead of unisom.