Treatment for Nausea and Vomiting in Pregnancy
Date First Published:
July 30, 2017
Last Updated:
September 20, 2017
Report by:
Kevin Nowak, MD, Senior Emergency Medicine Resident (Spectrum Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Eric VanDePol, MD, Spectrum Health/Michigan State University Emergency Medicine Residency Program
Three-Part Question:
In [pregnant women who present to the emergency department with nausea and vomiting] is [ondansetron] compared to [metoclopramide] associated with [improved symptoms]?
Clinical Scenario:
A pregnant female presents to the emergency department with repeated episodes of vomiting. She has not used any medications at home for relief. She has been unable to tolerate fluids. While a nurse prepares to place a peripheral IV, you begin to wonder if ondansetron or metoclopramide would be more beneficial for a pregnant woman with vomiting.
Search Strategy:
Medline 1966-08/17 using OVID interface, Cochrane Library (2017), and Embase
Search Details:
[(exp metoclopramide AND exp ondansetron)] AND [(exp pregnancy OR hyperemesis)]
Outcome:
33 studies were identified; two randomized trials addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Ondansetrone or metoclopromide? Which is more effective in severe nausea and vomiting of pregnancy? A randomized trial double-blind study. Kashifard M, Basirat Z, Kashifard M, Golsorkhtabar-Amiri M, Moghaddamnia A. 2013 Iran | 83 pregnant women with hyperemesis gravidarum in 2011-2012 83 pregnant women with HG were enrolled in 2011-2012 |
Double blinded RCT | Severity of nausea and vomiting | No significant difference in nausea score, but significant decrease in vomiting with ondansetron compared to metoclopramide | Small sample size, relied on subjective nausea scores. |
| Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial. Abas MN, Tan PC, Azmi N, Omar SZ. 2014 Malaysia | 160 women with hyperemesis gravidarum in 2011-2012 | Double blind RCT | Well-being score and vomiting episodes | No significant difference between nausea or vomiting, but better side effect profile with ondansetron | Likely underpowered for less common side effects; the primary outcomes were over the course of a 24-hour time scale only. |
Author Commentary:
Two randomized controlled trials showed that ondansetron and metoclopramide are both effective in controlling nausea and vomiting in pregnant patients. The studies also showed that there were more side effects with metoclopramide. Both drugs are economical, have a long history of widespread use, have an excellent fetal safety record, and are reasonable first-line short-term antiemetics of choice in hyperemesis gravidarum.
Bottom Line:
Pregnant patients with hyperemesis gravidarum can be effectively treated by ondansetron or metoclopramide, but there are more side effects with metoclopramide.
References:
- Kashifard M, Basirat Z, Kashifard M, Golsorkhtabar-Amiri M, Moghaddamnia A.. Ondansetrone or metoclopromide? Which is more effective in severe nausea and vomiting of pregnancy? A randomized trial double-blind study.
- Abas MN, Tan PC, Azmi N, Omar SZ.. Ondansetron compared with metoclopramide for hyperemesis gravidarum: a randomized controlled trial.