Nausea and Vomiting in Pregnancy

[firsttimepapa]

Hi Mummies and Daddies,

Chance upon this forum thus would like to share, discuss and seek your assistance on this issue. I have posted it in other forums but no reply as yet.

My wife is currently in her first Trimester and having bad nausea and vomiting symptom.
The doctor prescribed both diphenhydramine and Zofran(ondansetron)to my wife, later to be taken if the symptom persist after consuming the 1st drug.

However, as a Kiasu Dad in an internet savvy society, i went to google more on NVP and I thought probably i should share this with fellow Mummies and Daddies.

An extract

Guidelines published online August 19 by the American College of Obstetricians and Gynecologists (ACOG) and in the September issue of Obstetrics & Gynecology review the evidence on diagnosing and managing nausea and vomiting during pregnancy.

Among the new guidelines, replacing those from 2004, are updates on widely known treatments. The combination of doxylamine and vitamin B6, which was taken off the market in 1983, is back and has been proven safe and effective. ACOG says the combination should be considered first-line pharmacotherapy.

For ondansetron, the review includes a list of medications that patients taking the drug should avoid. Although some studies have shown an increased risk for birth defects with early ondansetron use, other studies have not, and the absolute risk to any fetus is low, according to the review. As with all medications, the risks and benefits should be weighed in each case.

http://www.medscape.com/viewarticle/849872

I went to google further and found out The Canadian has being using a drug recommended which is safe for pregnancy since the 80s, called Diclectin and in U.S. it is called Diclegis (same company, same drug, different trade name)

I tried to google it in Singapore but i could not find any information. Any Mummies or Daddies know any Obstetrics that prescribed this product?
Thank you in advance!

Cheers

 

[firsttimepapa]

So i tried to do some research and found an interesting study.
Thought probably i should share it.

https://www.dovepress.com/doxylamin...r-the-man-peer-reviewed-fulltext-article-IJWH

Anyway i am still in the midst of finding an Obstetrics who prescribed this drug.
It's better for my wife to have a proper diet and better quality of life during 1st trimester with the availability of safe recommended drug.
Moreover I read a mild morning sickness can become severe if ignored resulting in adverse effect such as hyperemesis. Will it also affect the womb?

Do kindly advice if anyone had been prescribed with Diclectin/Diclegis.
Thank you.

 

[Ironmaiden]

Hi firstimepapa,

I did not have severe vomitting and nausea like your wife during my pregnancy.

However, have you tried to discuss the above with her gynae? I feel he/she may be in a better position to advice.

 

[Skiasia]

Hi
I hv very bad morning sickness last time when i was expecting.I almost got into depression because of this.Whatever food went in will come out the next moment .the feeling was dammed terrible.
You will need to go to hospital for drip if got severe according to my gynae.
So throughout my first trimster,my gynae prescribe a med called pulin to stop the vomiting .it helps ..maybe u can ask ur wife gynae abt this med.
But again u must trust ur gynae in prescribing the med.did ur wife feel worsen after taking ? Otherwise googling too much will make u think negative...

 

[firsttimepapa]

Hi firstimepapa,

I did not have severe vomitting and nausea like your wife during my pregnancy.

However, have you tried to discuss the above with her gynae? I feel he/she may be in a better position to advice.

Yes, my wife OB provided diphenhydramine and Zofran(ondansetron). However as mentioned in my 1st post, the only drug that is approved for NVP and is safe is called Diclectin/Diclegis.
As my wife is in her first trimester, i am still searching for an Ob that prescribe Diclectin/Diclegis.

 

[firsttimepapa]

Hi
I hv very bad morning sickness last time when i was expecting.I almost got into depression because of this.Whatever food went in will come out the next moment .the feeling was dammed terrible.
You will need to go to hospital for drip if got severe according to my gynae.
So throughout my first trimster,my gynae prescribe a med called pulin to stop the vomiting .it helps ..maybe u can ask ur wife gynae abt this med.
But again u must trust ur gynae in prescribing the med.did ur wife feel worsen after taking ? Otherwise googling too much will make u think negative...

Hi Skiasia, thank you for sharing your experience.
As mentioned earlier to Ironmadien, I am still searching for an Ob that prescribe that safe and only approve drug for NVP.

I'm not trying to be negative, but if you do a google on diphenhydramine and ondansetron, one is an antihistamine for allergic or common cold. Ondansetron on the another hand is used for cancer patient to battle nausea and vomiting after cancer chemotherapy, radiation therapy, or surgery. They are not indicated for Nausea and vomiting in Pregnancy but used off label. And Ondansetronare is not recommended for NVP due to it's safety profile ( chances of cleft lips for newborns )
Ran a quick check on Pulin in Singapore, and it is indicated for
"Used in the treatment of functional gastrointestinal disorders."
Was it useful? It is FDA category B unlike the drug i was mentioning which is rated Category A.

Category A = Studies in pregnant women have shown that the medicine does not present an increased risk to the baby.
Catgory B = No risk in other studies: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Source: https://en.wikipedia.org/wiki/Pregnancy_category

 

[firsttimepapa]

In case you guys were wondering what drug i am referring to,
https://en.wikipedia.org/wiki/Pyridoxine/doxylamine

In Canada, the only approved antiemetic drug for use in pregnancy is Diclectin, which is a combination of 10 mg of doxylamine and 10 mg of vitamin B6 in a delayed-release formulation.
https://www.duchesnay.com/en/diclectin/patients
( I am considering writing in to this company to seek my queries )


In U.S., the same drug is branded as Diclegis.
https://www.diclegis.com/en/what-is-diclegis/how-safe-is-diclegis


Any Mummy or Daddy who knows any OB who prescribed this, kindly drop me a message or reply this thread. In my humble opinion, it is good to read up a bit to know what is given and understand what is available in the market that is safe for pregnant ladies. I am going to ask my wife's OB on this drug when we visit him next week and share his feedback. I had also written to both NUH and KKH regarding the availability of this safest drug and will update accordingly.

Have a great night! My wife calling me in

 

[trinity4ever]

Thanks for sharing, firstimepapa.

From what i understand, certain drugs maybe banned overseas but allow in Spore. The qn is whether to trust the gynae or to trust the reports found. My take on this is trust yourself. If you are uncomfortable, then don't take. In doubt, ask your gynae but i reckon most gynaes will tell you those drugs which are banned overseas are not medically proven to be harmful to bb so it is not wrong for them to prescribe. That's why i feel end of the day, is your comfort level. Btw, KKH does prescribe ondansetron to pregnant ladies.

Personally, my approach is more KS type. If i'm doubtful of the drug, i won't take it. No matter how uncomfortable i feel or how sick i am. I'm not willing to take that gamble.

 

[firsttimepapa]

Thank you Trinity for sharing your valuable opinion.
My wife took dimenhydrinate but didn't take the Ondansetron when the vomiting worsen.

KKH has to see this if they are still prescribing Ondansetron.
"In 2011, data from the National Birth Defects Prevention Study (a multisite, population-based, case-control study in the US) suggested an increased risk for cleft palate (adjusted odds ratio 2.37, 95% CI 1.18–4.76) among women treated with ondansetron for NVP in the first trimester."
"another group of investigators presented data in August 2013 based on the same Danish registries, but with 1,248 women who filled a prescription for ondansetron during the first trimester between 1997 and 2010. Their data indicate a mildly increased risk for congenital malformations (3.5% and 4.7%, adjusted odds ratio 1.3), mostly due to a twofold increase in congenital heart defects associated with ondansetron use during the first trimester of pregnancy."

I'm not taking the risk with Ondansetron and this should be taken seriously to all ladies who are pregnant and prescribed with Ondansetron.
I wonder if Singapore have such data like U.S.?
I worry there are such cases but many ladies do not know it is due to the drug, such as Ondansetron which is not indicated nor approved for Nausea and vomiting for pregnancy, prescribed to them. If these cases surfaced in U.S., the Obstetric will be sued for providing a drug not indicated nor safe for nausea and vomiting in pregnancy.

 

[firsttimepapa]

Just an update as promised,
I asked our OB about it along with the articles I mentioned above. She was initially shocked and slightly apprehensive, however upon reading the articles, she agreed there is no drug approve for nausea and vomiting except for the stated drug. However she mentioned there is no distribution of Diclectin/Diclegis in Singapore thus she has no access to it.
She say she will check if she can the drug and get back to us.

NUH needed more time to get back to me.

Healthexchange(KKH/SGH) did not reply my email.

Anyway, a friend's friend told me there might be a doctor in Thomson hospital who dispense the stated drug indicated for nausea and vomiting in pregnancy. I going drop the clinic a call on Monday to find out more.
Will update along the way.

Have a great weekend

 

[Cerina]

Hi

I am taking dhaperazine for your info. Initially it does helps but now i m in 9 wks and my morning sickness worsen. It quite terrible but i have no choice but to bear with it.

If you gals have any remedy to reduce it let me know.

 

[firsttimepapa]

Hi

I am taking dhaperazine for your info. Initially it does helps but now i m in 9 wks and my morning sickness worsen. It quite terrible but i have no choice but to bear with it.

If you gals have any remedy to reduce it let me know.

My dear Cerina,

Please stop using Dhaperazine ( Prochlorperazine )! I am not trying to frighten you, however, do confront your Obstetrics and asked why he or she is providing a drug that is unsafe for both you and your baby!!
Kindly view attach on the Fda Category for this drug. This extract is taken from MIMS.COM
http://www.mims.com/Singapore/drug/info/Dhaperazine/

 

[firsttimepapa]

Anyway, I called one of the clinic in Thomson Hospital, and was told the doctor had ordered Diclectin and is waiting for the delivery of this drug to his clinic, however it might take 2 weeks to a month for the drug to arrive as it will be given on named patient basis. (i suppose it meant on selected patients?). However our schedule clashes with his available slot but the nurse will try to slot us in if there is an opening. Otherwise our visitation will be on the 2nd week of April.

I do not know if it is appropriate to share the clinic name? Do pm me at this moment if you want more information.
I will try to C.S.I further on clinics who might carry this drug.

It is good to do a quick research on the safety profile of the drug prescribed to us during pregnancy. Trusting the Obstetrics is important, however doing our own due diligence is equally or even more important.
My sound advice - Ask you hubby to do it.

P.S. thank goodness my wife is in her early 1st trimester. Still have chance to explore different Obstetrics.

Good night and will provide updates when i gathered more information along the way!

 

[firsttimepapa]

Just an update,

I have called a few hospital pharmacy and clinics and these are the clinics who will have Diclectin by April
1) Tlc Gynaecology Practice Clinic & Surgery For Women, Dr Paul Tseng located at Thomson Medical
2) Michele Lee Women & Fertility Clinic, Dr Michele Lee located at Mount Alvernia
3) K K Ho Clinic for Women, Dr Ho located at Mount Elizabeth Medical Center
4) Astra Women's Specialist, Dr Henry Cheng located at Mount Elizabeth Novena Specialist Centre. I googled and he have another clinic located at Bishan, The Women's specialist centre Bishan.

Anyone has feedback on these 4 doctors above.

Anyway I am pretty shock NUH did not update further after our last correspond email and KKH did not even attempt to reply my queries.
Is this how the government hospital works?

 

[MommyMiie]

Sorry to bump up this post. Just wanna share my recent experience. (Pardon me for any spelling error as I'm still a little drowsy from my medicine)

I'm currently pregnant in my first trimester and suffered from hyperemesis previously.

The whole vomiting nightmare began when I was week 6. Initially it wasn't that bad but gradually it got worse to the point that I basically visited GP every alternate day for MC.

GP prescribed me with Dimenate 50MG (orange pill) for 90% of my trip to clinic but it doesn't work on me. But do note, it's a drowsy med and unfortunately for me, a moment after I consumed this medicine (say within 30 mins), I'd ended up puking non-stop like nobody's business and my acid influx came with it. It was truly extremely horrible.

The last GP visit I went (mid-April 2016), I told the GP that the Dimenate wasn't working for me and asked if there's any other medication other than this - I was then prescribed with Metaclopromide 10MG. And of course, it didn't work - in fact, this medicine was worst than Dimenate - I puked in lump and I could feel my throat burnt up from the acid.

*Note: the last GP advised me to visit KKH O&G should the medicine not works.

So I decided to pay a visit to O&G clinic and the doctor merely prescribed me with 3 medicines or should I say supplements - (1) Folic Acid 5MG, (2) Pyridoxine HCI 50MG [Vitamin B6] & lastly, Ranktidine 150MG. Initially it worked - I puked lesser, but again, it gotten worse.

Throughout the entire period, I've not seen my OB yet as I wasn't "time" to visit an OB so when I finally gotten to see my OB, he mentioned that I was actually suffering from hyperemesis as I wasn't able to take in any fluid / water / food etc and gotten me admitted for drip.

Let me tell you this - being on drip was the most wonderful thing ever - I finally felt alive! OB mentioned that due to long period of no food or drink, I was suffering from electrolyte-loss as well. So take note.

Fast forward a little, I got better and got discharged. Guess what my OB prescribed me with? (1) Metaclopromide 10MG, (2) Diazepam 2MG

But upon reaching home, I started my puking "ritual" again and ended up hospitalized - this time round blood test was done on me, turned out it's due to Thyroid-related issue. OB again prescribed me with the above 2 medicines, but changed my 10pm dosage to Diazepam 10MG instead of 2MG - so basically 97% of my time = spent on bed sleeping and eventually my puking calms down *phew*.

I went for my check-up today, oh, I've yet to mention my OB's name - he's Dr Henry Cheng from Astra Women's Specialist (point 4 from previous post by firsttimepapa) and he prescribed me with a new medicine - Diclectin (to be taken 2 at night) - lets hope I do get better from this medicine.

So to all mommies out there, good luck & stay positive!

 

[firsttimepapa]

Sorry to bump up this post. Just wanna share my recent experience. (Pardon me for any spelling error as I'm still a little drowsy from my medicine)

I'm currently pregnant in my first trimester and suffered from hyperemesis previously.

The whole vomiting nightmare began when I was week 6. Initially it wasn't that bad but gradually it got worse to the point that I basically visited GP every alternate day for MC.

GP prescribed me with Dimenate 50MG (orange pill) for 90% of my trip to clinic but it doesn't work on me. But do note, it's a drowsy med and unfortunately for me, a moment after I consumed this medicine (say within 30 mins), I'd ended up puking non-stop like nobody's business and my acid influx came with it. It was truly extremely horrible.

The last GP visit I went (mid-April 2016), I told the GP that the Dimenate wasn't working for me and asked if there's any other medication other than this - I was then prescribed with Metaclopromide 10MG. And of course, it didn't work - in fact, this medicine was worst than Dimenate - I puked in lump and I could feel my throat burnt up from the acid.

*Note: the last GP advised me to visit KKH O&G should the medicine not works.

So I decided to pay a visit to O&G clinic and the doctor merely prescribed me with 3 medicines or should I say supplements - (1) Folic Acid 5MG, (2) Pyridoxine HCI 50MG [Vitamin B6] & lastly, Ranktidine 150MG. Initially it worked - I puked lesser, but again, it gotten worse.

Throughout the entire period, I've not seen my OB yet as I wasn't "time" to visit an OB so when I finally gotten to see my OB, he mentioned that I was actually suffering from hyperemesis as I wasn't able to take in any fluid / water / food etc and gotten me admitted for drip.

Let me tell you this - being on drip was the most wonderful thing ever - I finally felt alive! OB mentioned that due to long period of no food or drink, I was suffering from electrolyte-loss as well. So take note.

Fast forward a little, I got better and got discharged. Guess what my OB prescribed me with? (1) Metaclopromide 10MG, (2) Diazepam 2MG

But upon reaching home, I started my puking "ritual" again and ended up hospitalized - this time round blood test was done on me, turned out it's due to Thyroid-related issue. OB again prescribed me with the above 2 medicines, but changed my 10pm dosage to Diazepam 10MG instead of 2MG - so basically 97% of my time = spent on bed sleeping and eventually my puking calms down *phew*.

I went for my check-up today, oh, I've yet to mention my OB's name - he's Dr Henry Cheng from Astra Women's Specialist (point 4 from previous post by firsttimepapa) and he prescribed me with a new medicine - Diclectin (to be taken 2 at night) - lets hope I do get better from this medicine.

So to all mommies out there, good luck & stay positive!

Thank you for sharing! My wife is also currently on Diclectin. It seems to help my wife cope on her morning sickness. As she also tend to vomit at night, she had to take an additional tablet around noon time apart from the usual 2 tablet before bedtime. How have you been coping? I hope it helps you too.

 

[MommyMiie]

Thank you for sharing! My wife is also currently on Diclectin. It seems to help my wife cope on her morning sickness. As she also tend to vomit at night, she had to take an additional tablet around noon time apart from the usual 2 tablet before bedtime. How have you been coping? I hope it helps you too.

Mine is getting better except for my wee hours puke. Haha.

Initially I was told to take 2 pills at night but after I realised I get puky during the day, I now switch to 1 when I wake , another when I going to bed. And also, i won't feel so sleepy.

Does your wife feel sleepy if she take 2 at night?

 

[jiejie85]

Hi mummies!! do you know where I can get diclectin? my clinic is charging me $3/pill and it costs me $90 a month if i take 1 pill every night. Looking for alternative on where I can get the pill. TIA!

 

[Minimalist58]

Nuh is selling at $1.50/pill but needs to be prescribed by doctor!