title: Should doxylamine-pyridoxine be used for nausea and vomiting of pregnancy?
abstract: Doxylamine-pyridoxine is the first-line agent for the treatment of nausea and vomiting of pregnancy (NVP) according to Canadian guidelines, and this combination is commonly prescribed to pregnant women. There is limited evidence that doxylamine-pyridoxine is more effective than pyridoxine alone. There is stronger support for the safety of pyridoxine monotherapy than for the combination of doxylamine-pyridoxine during pregnancy, and some conflicting evidence links doxylamine-pyridoxine use to pyloric stenosis and childhood malignancies. The role of doxylamine-pyridoxine as the first-line pharmacological treatment for NVP in Canada should be reconsidered.
authors.affiliation: Department of Family and Community Medicine, St. Michael's Hospital, Toronto ON; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto ON; Department of Family and Community Medicine, University of Toronto, Toronto ON.
authors.forename: Navindra
authors.initials: N
authors.lastname: Persaud
authors.affiliation: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto ON.
authors.forename: Jessica
authors.initials: J
authors.lastname: Chin
authors.affiliation: Ottawa Hospital Research Institute, Ottawa ON; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.
authors.forename: Mark
authors.initials: M
authors.lastname: Walker
mesh_terms: D000014:Abnormalities, Drug-Induced; D000932:Antiemetics / Q000627:therapeutic use*; D004025:Dicyclomine / Q000627:therapeutic use*; D004319:Doxylamine / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D048968:Morning Sickness / Q000188:drug therapy*; D009369:Neoplasms / Q000139:chemically induced; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011707:Pyloric Stenosis / Q000139:chemically induced; D011736:Pyridoxine / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000932:Antiemetics; D004338:Drug Combinations; C004454:dicyclomine, doxylamine, pyridoxine drug combination; D004025:Dicyclomine; D004319:Doxylamine; D011736:Pyridoxine
keywords: clinical practice guidelines; evidence-based medicine; nausea and vomiting of pregnancy