Treatment options for hyperemesis gravidarum

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.

Keywords: Gastrointestinal disorders in pregnancy; Hyperemesis; Hyperemesis gravidarum; Mirtazapine; Nausea and vomiting in pregnancy.

Conflict of interest statement

Conflict of interest The Department of Psychiatry at Northwestern University received contractual fees for Dr. Wisner’s consultation to Quinn Emanuel Urquhart & Sullivan, LLP (New York City), who represent Pfizer Pharmaceutical Company, in 2015

Dr. Miller and Dr. Abramowitz declare that they have no conflict of interest.