title: Treatment options for hyperemesis gravidarum.
abstract: Hyperemesis gravidarum (HG) is a severe and prolonged form of nausea and/or vomiting during pregnancy. HG affects 0.3-2% of pregnancies and is defined by dehydration, ketonuria, and more than 5% body weight loss. Initial pharmacologic treatment for HG includes a combination of doxylamine and pyridoxine. Additional interventions include ondansetron or dopamine antagonists such as metoclopramide or promethazine. The options are limited for women who are not adequately treated with these medications. We suggest that mirtazapine is a useful drug in this context and its efficacy has been described in case studies. Mirtazapine acts on noradrenergic, serotonergic, histaminergic, and muscarinic receptors to produce antidepressant, anxiolytic, antiemetic, sedative, and appetite-stimulating effects. Mirtazapine is not associated with an independent increased risk of birth defects. Further investigation of mirtazapine as a treatment for HG holds promise to expand treatment options for women suffering from HG.
authors.affiliation: UIC Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, Chicago, IL, 60612, USA. abramowitza@gmail.com.
authors.forename: Amy
authors.initials: A
authors.lastname: Abramowitz
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Chicago, IL, 60611, USA.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 303 E. Chicago Ave, Chicago, IL, 60611, USA.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000175:diagnosis* / Q000188:drug therapy*; D008803:Mianserin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000078785:Mirtazapine; D011247:Pregnancy
chemical_list: D000317:Adrenergic alpha-Antagonists; D000932:Antiemetics; D018491:Dopamine Agonists; D008803:Mianserin; D000078785:Mirtazapine
keywords: Gastrointestinal disorders in pregnancy; Hyperemesis; Hyperemesis gravidarum; Mirtazapine; Nausea and vomiting in pregnancy