title: The use of levomepromazine in Hyperemesis Gravidarum resistant to drug therapy--a case series.
abstract: Hyperemesis Gravidarum (HG) is a potentially serious complication of early pregnancy, which may rarely be severe enough to warrant termination of pregnancy. HG requires prompt treatment with intravenous fluids, thiamine supplementation and appropriate anti-emetic therapy. Anti-histamines such as promethazine are favoured as first-line agents, with prochlorperazine being used as a second-line drug. However, there is no clear data as to the most appropriate drug if these are ineffective. A case series of six women who presented with HG resistant to drug treatment is described. In these cases, levomepromazine 6.25mg tds was used to control HG. Five pregnancies progressed leading to live born infants with no evidence of congenital anomaly. One pregnancy resulted in an intra-uterine death with no external or ultrasound evidence of congenital anomaly. The role of phenothiazines in the pharmacological management of HG is discussed.
authors.affiliation: Maternal and Fetal Health Research Centre, Division of Human Development, University of Manchester, St. Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK. alex_heazell@talk21.com
authors.forename: Alexander E P
authors.initials: AE
authors.lastname: Heazell
authors.forename: Nigel
authors.initials: N
authors.lastname: Langford
authors.forename: Jatinder K
authors.initials: JK
authors.lastname: Judge
authors.forename: Martin A
authors.initials: MA
authors.lastname: Heazell
authors.forename: Gabrielle P
authors.initials: GP
authors.lastname: Downey
mesh_terms: D000293:Adolescent; D018492:Dopamine Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000188:drug therapy*; D008728:Methotrimeprazine / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care
chemical_list: D018492:Dopamine Antagonists; D008728:Methotrimeprazine