Ondansetron - any advice please?

[MimPimMim]

I would really appreciate any advice please - I’m pregnant with my second (6+5, based on my last period) and had hyperemesis during my last pregnancy with my DD. It was horrendous and I really struggled to cope, off work for months and it lasted my entire pregnancy. GP and community midwife were pretty useless and I wasn’t really taken seriously. After much begging, I was eventually prescribed cyclizine at 16 weeks, which didn’t work, and then prochlorperazine, which took the edge off but still didn’t allow me to really function. This time round (knowing the horrors of last time!), I was proactive about getting a prescription early and have been prescribed ondansetron by the hospital (GP still unwilling to prescribe anything...), 4mg three times a day and advised to start taking it immediately. I’ve been on it a couple of days now and it doesn’t really seem to be doing anything... does anyone have any experience of whether that dosage sounds right and/or if it just needs to build up in my system? Have a two year old now so can’t go through the same thing again, both for her sake and mine!

Thanks very much for any advice

Hi OP, sorry to hear you have HG again, I'm in the third trimester of my second HG pregnancy so can really sympathise!!

In the end, a combination of ondansetron and cyclizine worked for me - either one on its own didn't have a huge impact. I was on 4mg 3x a day too so the same dosage as you, I cant remember the cyclizine dosage but it was 3x daily. Perhaps you could ask for cyclizine too?

I had HG in both pregnancies too. During my second, I was on ondansetron 8mg 3 times a day. I think that’s the highest dose they give. So your doctor can definitely increase your dose if necessary.

The dose can be increased for in desert on to 8mg I think

I took cyclising and ondesetron, something every 4 hours

I was still in hospital a lot but it was better for me then just one or the other

Xx

I should also add that I was still extremely sick on that dose and couldn’t work or mind my toddler throughout the pregnancy, but the medication stopped the vomiting and helped my appetite.

I find it very odd they prescribed you Ondenestron given the risks of deformities and not cyclizine as taking cyclizine early enough may have been all you needed. Try the hypermesis support thread and the website xxxx

MHRA/CHM advice: Ondansetron: small increased risk of oral clefts following use in the first 12 weeks of pregnancy (January 2020)
Epidemiological studies have identified a small increased risk of cleft lip and/or cleft palate in babies born to women who used oral ondansetron during the first trimester of pregnancy. Healthcare professionals are advised that if there is a clinical need for ondansetron in pregnancy, patients should be counselled on the potential benefits and risks, and the final decision made jointly.

Are you aware of this

The risk of odansetron causing cleft lip and palate is 0.03% based on current research. (Systematic review). The background risk is between 2-4%. I wouldn't worry about it. I had HG in both pregnancies, took ondanstetron and also used to work in fixing cleft lip and palate. And still had to argue with the doctor about it. Outdated research and preconceptions have alot to answer for.

As previous posters have said:
Ondansetron
Cyclizine
Docusate (laxative to counter ondansetron)
Omeprazole

That should help.
Get signed off if you need to. ( With HG it's normal to be off for 20 weeks so please don't worry about it)
Try pregnancy sickness support website and the HG thread on here.
Sending love and hugs. This too shall pass.

Just to add to other PPs, even on both cyclizine and ondansetron I couldn't sit up without being sick, it just kept me out of hospital. I was off work until 19 weeks and even now I am barely managing although it has improved enough for me to be able.to WFH.

Thanks everyone, I really appreciate it. I am aware of the increased risk of ondansetron causing cleft lip and palate but, as Frazzle says (thank you!), I think that on balance the benefits of taking it outweigh the risk. I can’t overstate how unwell I was last time and I need to do what I can to mitigate that (appreciating that it is unlikely that it will do anything more than stave off the worst!). I’m booked in for a conversation with the hyperemesis specialist at the hospital next week so will mention all the recommendations above, thank you. I can already feel it creeping in and am feeling really down about the prospect of enduring this again, especially now I have my wonderful DD. It was much much quicker to conceive this time than my last pregnancy (first cycle rather than over a year) so I think I thought I had a little more time before facing this again. And, of course, I was hoping that I would be in the small minority that didn’t get it again! I had forgotten how mentally draining it is too, I was not in a great place last time. And this time I can add feeling guilty for being a rubbish Mum as I’m struggling already

Babyboyblue I’m sorry to hear that you are going through it at the moment Wishing you all the very best of luck with the rest of your pregnancy and hopefully some improvement over the coming weeks.

@MimPimMim thank you and the same to you too!!

My sister has hg too and has found cyclizine and metaclopromide is the combination that works for her 🙂 I don't think she could get ondansetron from our pharmacies as it was out of stock so couldn't give it a go. Keep pushing the doctors to find what works for you!

Thanks Funauntie, I’ll mention that to the hospital when I’m talking through options with them next week. Good luck to your sister - and to you too if your username means that you are also having a baby!

Also pyridoxine 25mg three times a day reduces NV of pregnancy and is first one advice.
Doxylamine at night.

I use ondansetron a lot too. 4-8mg three times a day is fine. Agree on the laxative advice - i use macrogol.

Thank you, although I suffered with very bad nausea in the first trimester and major food aversions that are now getting better (from about 18wks) I count myself very lucky to have escaped hg as my sister that is currently also pregnant has suffered in both her pregnancies and my other sister has suffered in her pregnancy also!

Good luck and I hope you find a combination that works for you 🤞🙂

There's a website www.pregnancysicknesssupport.org.uk which has a Facebook group which was very supportive for me

Im not in the UK but in Aus we use Promethazine 10mg as a first line medication for HG. It can make you a bit drowsy so maybe good for night time if you are ill at that point? Maybe speak to someone about that option? We recommend it before cyclizine and metaclopromide here.

Thanks everyone, really appreciate all the support and advice. I’ll mention all these things to the hospital tomorrow. It’s been a pretty awful weekend Going to call pregnancy sickness support tomorrow too, as it would be good to talk to someone. Starting to feel pretty desperate and not sure how I do this again, so need to get a plan in place. Really appreciate all the advice, thank you.