Friday, May 23, 2008

Research: Prescription Drugs for Hyperemesis Gravidarum

Hello, everyone! It's been a busy week! We are slowly cranking our way through a month replete with weddings and graduation parties - I'd say we're about two-thirds done, and the rest should be fun and stress-less. But what a busy month! Hopefully things should slow down in June for a couple of months.

Today I thought I'd do a quick research post about prescription drugs for hyperemesis gravidarum. However, rather than being a collection of knowledge, this is primarily an admission of ignorance - I really don't have much to post.

When I went through my own bout of hyperemesis gravidarum, I had two things working against me - (1) no maternity insurance, and (2) ignorance. The first part of that duo still makes me mad. What exactly do they think they are doing by denying maternity care to their clients? (almost all private insurance refuses maternity care) And what are we supposed to do when we have our babies? Have them unassisted on the side of the road? Sheesh. (Side note: And when we finally did get maternity care through Joe's work, the minimum payment was so high that it was cheaper to pay our midwife in cash. Insurance. You gotta love 'em.)

The second part of that, ignorance, was the result of something that I'd read in a book, and which turned out to be patently false - a statement saying that after the thalidomide nightmare, drug companies had stopped putting out anti-nausea meds for pregnant mums because one could never be sure what it would do to the baby. Well, that is quite false! There are a myriad of options out there. When we met with our midwife for our first prenatal, at 13 weeks, and she said, "You know, you can go to an OB and get a prescription for anti-nausea meds," we just stared at her. And, of course, at that point it was an exercise in futility, because we had no maternity insurance at that point. They would have "paid for maternity-care-related emergencies," but considering that a lot of HG-mums have been hospitalized repeatedly for HG with their insurances still refusing to pay, we knew we didn't have a chance of getting them to pay for anti-nausea meds.

Short story long. Anyhow, moving on.... There are a ton of anti-nausea drugs on the market. Most of them have not been proven to be safe for both babies and mums, but they seem to be safe and are thus used. And, after all, when HG is life-threatening, it's better to use the drugs than to watch the mum and baby both die. If I get HG again, I will have no problem with using drugs. I want to try naturopathic remedies first (acupuncture, homeopathy, chiropractic care, etc.), but if those don't work, I will not balk at using prescription drugs.

In terms of "drugs," there is first of all the Vitamin K/C combo mentioned in another blog entry. Check it out. I'm going to ask our consulting OB about that one. Another one is Vitamin B complex supplements. Those didn't do a thing for me, but I think that they were just too little, too late (when you're too sick to keep a pill down, pills don't do you much good). However, there are Vitamin B injections. Vitamin B is also packaged with other supplements specifically for morning sickness (called, I think, Unisom - someone correct me if I'm wrong). Good place to start.

In Ashli McCall's book, "Beyond Morning Sickness," there is a really good appendix of anti-emetic drugs, which I highly recommend. You'll get names, categories, methods of administration, risks, benefits, side effects, etc. Highly recommended.

This website also has a ton of info on drugs for HG:

http://www.emedicine.com/med/topic1075.htm

One of the problems with drugs for severe HG is that the drugs do a better job of stopping the vomiting than they do the nausea. The vomiting may be what's dangerous to your body, but the nausea is what's dangerous to your mind. Most of us would prefer to sit around all day throwing up rather than deal with the nausea which can drive one to utter and complete despair (Amen, ladies?).

The most popular drug on the market right now is Zofran, and it seems to be a great thing (although it doesn't work for everyone). It is class C, meaning that it hasn't been proven safe (or unsafe), but lots of moms have used it and love it. The biggest problem with Zofran is that it is incredibly expensive to manufacture (it's about $50/pill without insurance), and insurance companies HATE paying for it. A lot of them refuse point-blank to pay for it, even when the mum is hospitalized due to lack of it (I hate insurance!!). So keep it in mind - having a supportive OB willing to fight for you is essential.

One of the main problems in getting proper medication for HG is simply trying to find a supportive OB. If you have one who brushes you off, tells you it's "all in your head," tells you that this is normal, or sends you home with Vitamin B or dramamine (when those have proven insufficient), that will be your biggest problems. There ARE treatments and drugs available - but you will need a knowledgeable and compassionate OB to work with.

When HG-mums come in and are super-dehydrated, one of the first steps taken is usually replacement of fluids by IV. This will usually provide some relief; however, that relief generally fades after the treatment. IV treatment alone is not generally enough.

If a mum is truly unable to keep anything down, including meds, there are a variety of long-term IV treatments (PICC lines with TPN nutrition, etc.) that can be used. These are usually not a lot of fun but are workable and will get you through.

Remember, if your OB is not going to fight for you, find one who will! Treatments do exist for all levels of HG.

Well, I'd better go do something productive!! Love to all!!

4 comments:

Jen said...

I love learning about HG, though for my own sake I hope I never have to know!

Any news on house #4?

Anonymous said...

Hi-
I had moderate HG with my 1st pregnancy. My husband and I just spent the last 4 months researching, praying, meeting with doctor's, etc- all contemplating whether or not to have another child. We have decided to go for it- but won't start trying until late this year/early next year when my daughter will be 2 years old +. I would love to chat sometime if you are interested! You can convo me through my Etsy website- www.katherineskloset.etsy.com! I would love to discuss. Also, www.hyperemesis.org has been AMAZING!
~Lisa

JenX67 said...

I have written a long-overdue post about my experience with HG. As a working mom I can say for certain more needs to be done on behalf of pregnant working women to raise awareness about this debilitating illness.

Anonymous said...

According to the Davis' Drug Guide for Nurses, Seventh Edition, Zofran is actually Pregnancy Category B, not C. I just wanted to let you know, because it's safer than compazine, a commonly prescribed antiemetic.