Episode Transcript
Dr. Miller: You're pregnant. You feel sick. You feel miserable. What can you do about it? We're going to talk about that next on Scope Radio.
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Dr. Miller: I'm here with Howard Sharp. He's a professor of Obstetrics and Gynecology at the Ï㽶ÊÓƵ of Utah. Howard, you see a lot of nausea and stomach upset in pregnant women. What can they do about it?
Dr. Sharp: Yeah, that first trimester is rough, and there are some women that it just continues even to the second and third.
Dr. Miller: I heard that it was less common in the subsequent pregnancies, but not always true.
Dr. Sharp: Right, and I really feel badly for those that just don't get a break. There have been times we've had to bring patients in for IV fluids, a number of things, for something called hyperemesis gravidarum, which is basically throwing up all the time.
Dr. Miller: Is they throw up all the time.
Dr. Sharp: Exactly.
Dr. Miller: And we have to have a special medical name for that.
Dr. Sharp: It makes us sound smart.
Dr. Miller: It does.
Dr. Sharp: We need that.
Dr. Miller: But at any rate, are there new treatments out that can help women with this?
Dr. Sharp: Yes. There are new treatments.
Dr. Miller: Back in the day it seemed like you just had to suffer through it. Poor women. I know my wife was very sick with her first and second child.
Dr. Sharp: It's interesting. The new treatment is the old treatment. There's a new drug and it's called Diclegis, and it is a trade name but I'll have to use it because it's the only one available that is FDA-approved. A long time ago there was a drug called Bendectin which was basically vitamin B6 and half a Unisom tablet or doxylamine. The patients were given that. They did pretty well and then someone said, "Hey, we're seeing more birth defects with this." And so there was a big lawsuit over this and it was taken off the market.
Dr. Miller: For the Bendectin?
Dr. Sharp: Bendectin. And then when it was re-looked at, they found that there actually were not more birth defects with it. So now it has come back as Diclegis. And it is . . .
Dr. Miller: New and fortified.
Dr. Sharp: Yes, it is. You can get it at the pharmacy, and it is FDA-approved.
Dr. Miller: You need the physician to prescribe, of course?
Dr. Sharp: Yes. It is. And it's a little different than just picking up those two medications over the counter, because it's compounded in a way that it is more of a sustained release than just the shorter-acting or the counter vitamin B6.
Dr. Miller: So when do you decide to give this antiemetic?
Dr. Sharp: If a patient is really uncomfortable, or uncomfortable at all, I'll go ahead and give it to them. Nausea is miserable, so if they're not able to hold down liquids or if they're just feeling poorly all the time, I think it's totally reasonable.
Dr. Miller: When did this come on market? Is it recently?
Dr. Sharp: Just in the last year or so. It's fairly recent. Now there are other meds we've used. We've used Phenergan. We've used Compazine.
Dr. Miller: The standards, but they have awful side effects.
Dr. Sharp: They do. They just totally wipe you out. You're just so sleepy.
Dr. Miller: Some people say that they're still nauseated, but they're so sleepy they don't care.
Dr. Sharp: Exactly. And so that brought another medication on board called Zofran.
Dr. Miller: That's been around for a little while now.
Dr. Sharp: It has, and the nice thing about it is it doesn't make you so sleepy, and so that got a lot of traction for a while. The only thing is it does really slow down the bowels so it makes people very constipated.
Dr. Miller: And they're already constipated.
Dr. Sharp: Yeah. So that's the issue. And then a little over a year ago the FDA put out a warning on that. There was a slightly higher incidence of cleft lip and palate.
Dr. Miller: So you no longer use that?
Dr. Sharp: We do use it, but we counsel that there is a small risk of this birth defect. But now that we do have an FDA-approved medication, I prefer to go with that.
Dr. Miller: What are your patients telling you after they take the new antiemetic?
Dr. Sharp: Well, it doesn't always work. It's one of those things that not everything works for everybody. You just never know. Some people do well taking ginger. Some people do this acupressure or they'll use bands on their wrists, and if that works, great. It's like that skeleton key. You've got to find the right one to unlock that door.
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