Sickness - Cyclizine and prochlorperazine together?

[LouJ85]

Hi I'm currently 5 weeks pregnant and beyond miserable with sickness. I haven't eaten a thing today and just stayed in bed sipping water. Anything I try to eat just wants to come back up. I rang doctors and they have given me 2 meds to try, but advised separately. However I've googled it and some people took these in combination. Has anyone taken both these drugs together for sickness and did it help? I'm desperate. Thank you

I took both of them together, but later in the pregnancy - e.g. started with cyclizine, then added another which didn't work, then added another, then added prochlorperazine. Finally, the combination of all three did the trick (mostly). I assume it's to see if one works or not the other - if you take both straight away and have a bad reaction to one (or one doesn't work for you), you won't know which it is. And then as your pregnancy develops they can try other things too. However I was so completely desperate I would have been tempted too if they'd given me both together!

Thanks for your reply.
Yes that's a good point about not knowing which one helps or not if I take together. Cyclizine had been working well up until today, for some reason it's just not. The GP did say there's a third option if neither of these helps enough, which is the last resort one (Ondansetron). I can't spend the next however many weeks/months housebound like this so I need something to work.
So very fed up.

They’re fine together. Sometimes it helps to stagger the dosing a little bit just so you always have something working at its most active, if that makes sense.
FWIW there are more than three options - you can take a whole cocktail of different things to get on top of it if you need to. Good luck!

Yes I took them together with another anti sickness.

Sometimes it's better to alternate the tablets rather than take all together Try to eat something sweet regularly even if just a haribo or sweet popcorn whatever you can tolerate and sip as much water as you can through the day. This was the advice from my consultant when I was pregnant with hyperemesis.

You can take them together - be aware that both will make you extremely drowsy.

Give it a few days, but don't be afraid to ask for ondansetron. Pregnancy sickness support are a great charity and can give you a lot of advice.

Thank you all that's really helpful. So if I stagger the doses it doesn't matter about time between them? E.g. I could take cyclizine at 7am and prochlorperazine at say 9-10am, and alternative like this through the day so long as I don't go over max dose of each? (Hope that makes sense).
I've woken this morning after taking 2 x prochlorperazine before I slept- one at 7.30pm and again at 1.30am when I woke feeling queasy. Seems to have helped quite a bit this morning with how I feel.

Also - is Ondansatron the best and most effective? I am willing to give this combination a good go but if it gets to the point of the last resort drug I need to know that it will give me some relief and quality of life!

Yes so as one is wearing off the other is taking effect so they don't all wear off at once. Hope they work for you and you start to feel better. Pregnancy sickness support is a great source of information and support if you need it.

I had ondansetron aswell it was the one that worked best for me but had to have it prescribed by the hospital as my doctors were a bit funny about it.

My GP would only prescribe ondanestron after 12 weeks - I have no idea whether this is for sound medical reasons or just her personal preference! It seems every GP has their own ideas about what is right. But staggered is totally fine and normal. I used to take the cyclizine first, wait for 30mins and then try and eat something, then take the proch. 30mins after that. Then ondanestron at whatever the interval for that was... I took all 3 doses of cyclizine a day - I started out trying to wait and see if I needed it, but by the time I realised I did, it was too late...

So those who took a combination- please tell me this was enough to see you through until it subsided at 12 weeks? I know it's not guaranteed to subside at that point for all women, but I just need some hope that it can be controlled with the right meds so I can eat and leave the house.

@SJC270 - the GP didn't say I needed to be 12 weeks before I could have it, he said he would prescribe it as a last resort if these don't help. So like you say it might be personal preference for different GPs.

@Quackajack
Thanks for the heads up re pregnancy support site, I'll have a look x

I've been on ondansetron since the day after my positive test but it is my 2nd HG pregnancy and I have a supportive GP. Not the case first time round sadly.

You can definitely take them together. I take an omeprazole the minute I wake up, then an ondansatron, I then alternate O and promethazine throughout the day so I am always not too far away from the next one.

Being brutally honest I was bed bound from week 7 until week 18ish when I began to be able to function slightly better. I have only had 1 hospitalisation so far. I am 26 weeks now and still have the odd days where I am bed bound but on the whole the meds do make a big difference.

It is hellish and you have my sympathy.

I was prescribed not just cyclizine and prochlorperazine but also metaclopramide. I think the doctor at the hospital went a bit overboard because they didn't want me back for another visit!

I have primarily taken cyclizine twice a day, and use prochlorperazine and metaclopramide as 'top-ups' if the nausea creeps in again.

My schedule is normally something like this:

6-8am: Take cyclizine as soon as I wake up

12pm: Take metaclopramide if still feeling sick before lunch.

4pm: Take cyclizine again (if needed)

6pm: Take prochlorperazine if still feeling sick at dinner time

It's just my little schedule that I've found works for me, and usually keeps the sickness away (only vomited once since I started these meds 8 weeks ago).

Each medication has different side effects but I generally find that prochlorperazine is the worst for drowsiness - hence why I take it in the evening and not in the middle of the day. Cyclizine causes drowsiness too however I seem to have got used to it now and don't zone out as much as I used to. Metaclopramide doesn't make you drowsy but does make you need the loo as it works by keeping your stomach emptier.

One thing I will say is don't put pressure on yourself to cut them down if you reach the 12 week mark and you are still nauseous or vomiting. I am at 18 weeks now and still nauseous - although nowhere near as much as I was at 10 weeks. These medicines are safe to use in pregnancy and if they give you a better quality of life then they are worth taking.

Sorry quite a long reply but I hope it answers some questions!

@FilthyforFirth @LouJ85 that’s really good & useful to hear about the ondanestron- if I ever decide to go for no.2, I’ll push to be put on it straight away! The lack of transparency around what is available is so frustrating - the first GP I went to (a man) told me they wouldn’t want to stop the nausea and vomiting because it’s “healthy and normal” - at that point it was 10+ times a day. I pushed for a second opinion and got prescribed the drugs - and got diagnosed with HG and only narrowly avoided hospitalisation.

Now - at 29 weeks - I only take cyclizine in the morning. Up to 18 weeks I took everything.

@SJC270
Healthy and normal??! Christ I'd have knocked him out. What an ignorant and completely factually incorrect statement!!

@SJC270 that unfortunately sounds like the GP in my first HG pregnancy. When I complained of being sick 10+ times a day and dry heaving 30+ times a say he actually said to me 'well you're pregnant, what did you expect?'. I had another GP from the same hateful practice talk to me about the virtues of ginger whilst I was throwing up in her sink IN THE THIRD TRIMESTER. The only 'good' GP in that place refused to prescribe me ondansatron and I was forced to go to my hospital every 2 weeks for a new prescription there. As hospitals can only prescribe 2 weeks at a time and my GP said her CCG wouldnt allow her to prescribe it as it is expensive.

I am so so lucky it is different this time. Whilst the nausea has been worse, off the charts horrific cant move for days at a time, the physical being sick is massively reduced and I have never sustained the throwing up 10/15 times a day I was in my first pregnancy.

If you go for a 2nd my best advice is to get a nice GP on board before you are pregnant. I had no messing around with first and second line responses and went straight to ondansatron.

Ondansetron is looked at as a “last resort” by some pretty much because it’s a newer medication with less evidence behind it in pregnancy (cyclizine, metoclopramide, prochlorperazine having been around for decades). People always worry that newer medications might have some unknown effects and so are more cautious. There was a report that maybe ondansetron caused increased risk of heart problems in babies but since then that has been disproved in other studies. If there is any increased risk at all it’s absolutely tiny. So on balance the approach is avoid it and use other meds as first line if possible - but if ondansetron is needed it’s fine to use. The 12 week thing is about first trimester being the time baby’s organs form - but actually heart is formed by about 6-7 weeks anyway so 12 weeks is a bit silly.
Ondansetron can be a life saver for some - a word of warning though, it often causes constipation!
Other things to consider are omeprazole (a PP mentioned), promethazine, pyridoxine. Most hospitals should have a hyperemesis guideline and you may find your local one by googling as well.