Now, we learned in the main post, "Learning about Hyperemesis Gravidarum" that morning sickness remedies, as a whole, do not work on HG patients. If remedies such as ginger, crackers, bland foods, little sips, small meals, sea bands, etc completely control your HG, it is quite likely that you do not in fact have it. I won't say absolutes here because I'm not a doctor, and everyone is different. But I would say the odds as shown below, pretty much speak for themselves. Out of 134 women, none could control HG with diet alone. Again, it is possible to have horrible morning sickness, and to not have it qualify as HG.




With most HG patients, we find that as we try new things, especially by listening to our cravings, we find what our body will tolerate. Most HG patients seem drawn to sweet and/or salty foods, some women survive on almost nothing but french fries, ice cream, certain drinks, etc because that's what works for them! Do not be deceived by those that will try and get you to eat something more nutritious. I will echo my doctor when I say that it's better to get something to stay down than nothing at all. The foods that work for us we affectionately call our "safe food," because more often than not it brings us relief by either staying down, or by hurting to a minimal measure coming back up. Sometimes, yes, we find some respite in some remedies. I asked 175 women that ranged from mild to severe HG (the entire spectrum), what things they found helped them.

Getting Dehydrated

Receiving fluids is sometimes just what mothers need, patients with mild-moderate-severe Hyperemesis Gravidarum. For mild cases, getting the fluids can help jumpstart your system, instead losing in a game of catchup. It could be the break you need to get your body to a point where you can manage fluid intake on your own. You may need it more often than that too. Moderate to severe cases will likely need fluids much more often and on a schedule. How do you know if you're dehydrated? Signs could be cracked and bleeding lips, dark yellow/brown urine, dry skin, dry eyes, headaches, and lack of saliva/bad breath. I'll go more in depth on this treatment here.You can also check for decreased skin turgor. This tests the elasticity of the skin. Pinch the skin as shown, very firmly for several seconds and release. If it does not immediately or quickly return as it was before, you are dehydrated. An example of this is shown below.



Medications
I've used this chart once already before, but I'm putting it here again as I go more in depth on different drugs to try.


Zofran/Ondansetron

Obviously this drug has proved to be the most effective, if not at least most popular, in treating Hyperemesis Gravidarum. There are different forms of the drug to try. It is likely your doctor will first offer a swallow-able pill form. If that works, great! If it doesn't, ask to try the dissolving pill form; they tend to do the trick. If these still don't work and you go in for IV Fluids, ask them to insert the drug into your bag. This helped me, as I stopped vomiting for a few hours. They usually give 4-8 mg, though in my experience they'd rather stick with the smaller dosage. If it doesn't work as well as you'd hoped, request the 8 and explain your feelings.

In cases of severe HG, you may want to talk to your doctor about using a Zofran pump. It gives you a bolus of the medicine intravenously at intervals set by your doctor. This will be discussed in greater detail later on.

There have been some concerns about the safety for the unborn baby, news circulating that Zofran could cause birth defects. As a consequence, some doctors refuse to prescribe it. Whether to sate your own concerns or a unwilling doctor, go to this page for more information.
Oh yes, and there is the delightful side effect of constipation. That compounded with the fact that it's common for pregnant women to get constipated makes for a great party. :)

Phenergan/Promethazine

This drug is another favorite of HG patients. The most common side effect is drowsiness. They are available in pills, but can also be administered via suppository. Thought you may evade the constipation with this one? Guess again!

Diclegus/Pyridoxine/Doxylamine

Diclegus also works well, but the major deterrent is that it can be very expensive. Here is a coupon that potentially could lower your copay. If your insurance will not accept it, you can contact their patient assistance program for help. If that still doesn't work, ask your doctor to send a prescription to a mail order pharmacy, a month's worth will cost $100.

Reglan/Metoclopramide

About half of the women who have tried this drug like it, but the other experience adverse effects. The primary side effect could be anxiety and restlessness. It is available in pill and can be given via IV. I tried it once this way when I was in the infusion clinic getting fluids....never, never, never again. Yep, I had the "adverse effects." It took all of my willpower to stay still in my chair, I felt like I was going to explode. But don't let that scare you away from trying it, just recognize it for what it is if you experience this yourself.

Unisom and B6 Regime

Some doctors favor this treatment. The way one of my doctors explained it to me was that many years ago, Diclegis was withdrawn from the market but now has been in use again. In that gap of time and since, doctors used these two drugs because it mimics Diclegis when they are combined. It's definitely a cheaper route since both are medications available in almost any grocery store. Unisom is a sleep aid, so if you're sensitive as I am, it will make you drowsy. When I explained this to my doctor, he just said to drink caffeine to make the difference. I didn't like the sound of that, it just gave me a bad feeling, but I acquiesced and tried it for a few days to see if it made a difference. It didn't for me. When I talked to my aunt, a nurse, she was shocked that he made the recommendation concerning caffeine, as that there has been proof in the amount he was suggesting, it can damage the baby's heart. We weren't surprised, we weren't impressed with this doctor in the least. So if you don't get sleepy, yeah! If you do, and are in a situation where you can't take naps, my suggestion is you try something else.

Scopolamine/Hyoscine Hydrobromide

This drug can be given orally, a shot, eye drops, via IV, but most commonly is administered through a patch behind the ear. (This was also the way I tried it.)

Compazine/Prochlorperazine

I don't know much about this one, I only tried it once while I was in the hospital. But according to a cursory google search, it can be given at least by suppository or pill form.

Kytril/Granisetron/Sancuso

Again, google search here. I've never heard of this one! Your doctor may not have heard of this medication, so you'll need to bring it up if you'd like to try it. It's available at least in patch or liquid form.

Steroids

This is one of the more extreme measures that doctors can take. I'll discuss it in greater detail later on.

Cyclizine

This is most commonly used to treat motion sickness, but it may work for you! $5 at Wal-Mart.

Acid Pump Inhibitors

Taking an acid pump inhibitor medication can be very beneficial in addition to an anti-emetic drug(s). Try different ones until you see what works best for you, but what most women use are in this order: Zantac/Ranitidine, Omeprazole, Protonix, Pepcid AC, Nexium, and Prevacid. 

What if these don't work?

Like I said before, it's going to take work to find the right care plan for you. And you know what?....It's possible that you won't find complete, if any, relief in medications. I never found a drug that helped me for more than a few hours. The first time I finally felt human was when I got my feeding tube. So you may need more extreme treatment, you may have an uncomfortable pregnancy that is manageable with medications. If you want to learn about more treatment options (including IVs, which is a treatment given to women in the whole spectrum of HG) go to my "Treatments for Severe HG" here.