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Morning Sickness/Nausea of Pregnancy/Hyperemesis Gravidarum
Published in Charles Theisler, Adjuvant Medical Care, 2023
Medications can be given to treat nausea and vomiting during pregnancy: Vitamin B6 (pyridoxine) is effective in relieving the severity of nausea in early pregnancy.7 The American Congress of Obstetrics and Gynecology (AGOG) recommends monotherapy with 10–25 mg of vitamin B6 three or four times a day to treat nausea and vomiting in pregnancy.8Doxylamine (25 mg aka Unisom tid), an over-the-counter sleep medication, is safe to take at night if vitamin B6 alone does not relieve symptoms.5 A prescription drug that combines vitamin B6 and doxylamine (Diclectin) is also available. Both drugs, taken alone or together, have been found to be safe to take during pregnancy and have no harmful effects on the baby.9Thiamine: Severe nausea and vomiting of pregnancy (hyperemesis gravidarum) can lead to vitamin BI (thiamine) deficiency and Wernicke's encephalopathy in women. Vitamin B1 replacement is needed for all women with vomiting that lasts for more than three weeks. Prophylaxis with multivitamins and therapy with B6, with or without doxylamine, are safe and effective therapies for nausea and vomiting of pregnancy.4
Nausea/Vomiting of Pregnancy and Hyperemesis Gravidarum
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Doxylamine is an antihistamine that has been studied in combination with vitamin B6. This combination (formerly known as Bendectin and now available as Diclegis in the United States, Diclectin in Canada, Debendox in the United Kingdom) is safe, with no evidence of teratogenicity (proven with over 200,000 exposures, by far the most for any other drug in pregnancy), and effective (>70% decrease in n/v) [3, 4]. The published evidence on the efficacy of doxylamine and pyridoxine is limited [1]. The “Benedectin Antinausent 8-way” study is a 1970s unpublished study that has been referred to in support of the use in combination of doxylamine and pyridoxin. It was subsequently analyzed and was found to have questionable data integrity and other methodological concerns. The claims of the efficacy of this combination based on this trial need to be revisited [69]. ACOG suggests the use of Doxylamine in combination to vitamin B6, as it is effective and to use it as first-line therapy [4]. Doxylamine and vitamin B6 are associated with decrease in both n/v when used together compared to no therapy or placebo [70–73]. A double-blind RCT showed Diclectin (an available doxylamine-pyridoxine delayed-release preparation) to significantly improve n/v and quality of life compared to placebo [73].
Drugs in pregnancy and lactation
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Starting in the late 1950s, Bendectin® was the major agent to treat NVP worldwide. This controlled-release combination of doxylamine and pyridoxine (originally also with dicyclomine) was used by 40% of pregnant American women in the late 1970s.
Increased rates of diphenhydramine overdose, abuse, and misuse in the United States, 2005–2016
Published in Clinical Toxicology, 2021
Antonia Nemanich, Erica Liebelt, Amber K. Sabbatini
We also note concerning trends in both the number and severity of exposures involving DPH among older adults. While relative rates of DPH exposures due to suicide attempts among older adults increased dramatically over the past decade, the actual number of reported exposures remains small. In contrast, DPH misuse increased progressively with age and was a more common cause of exposure among adults over 55. Although DPH and other OTC antihistamines are not recommended for older adults due to increased risk for anticholinergic effects, they remain FDA approved to treat insomnia, and are familiar and generally perceived as safe [23]. More than half (59%) of older adults taking nonprescription medications to improve sleep are taking products that contain either DPH or doxylamine, yet many are unaware of the potential side effects of these medications or dangers when taken in excess [24]. DPH misuse can be associated with serious consequences as older adults already have higher rates of polypharmacy, and are often on multiple medications that can affect the central nervous and cardiovascular systems.
Selecting a pharmacotherapy regimen for patients with chronic insomnia
Published in Expert Opinion on Pharmacotherapy, 2020
Amanda B. Hassinger, Nikolas Bletnisky, Rizwan Dudekula, Ali A. El-Solh
With limited access to sleep medicine experts and pervasive consumer advertisements, patients with chronic insomnia often use over-the-counter sleep aids that are readily available without a prescription. Despite the availability of FDA-approved hypnotics and their proven efficacy, approximately half of all physicians are still prescribing off-label antidepressants for insomnia. Anti-histamines like diphenhydramine and doxylamine have predictable sleep promotion but are linked to many side effects (confusion, dry mouth, delirium, constipation, urinary retention). These drugs have long elimination half-lives and often cause next-morning drowsiness [104]. Elderly people are the most vulnerable to these side effects and while there is no systematic evidence for their efficacy, there are significant concerns about their safety [13]. As recommended by the American Academy of Sleep Medicine (AASM) [105], off-label hypnotics may be considered in at least two situations: When FDA-approved drugs are not efficacious for a particular patient and when insomnia coexists with a co-morbid condition that may actually benefit from this off-label drug which is FDA approved for the co-morbid condition.
Cannabis Expectancies for Sleep
Published in Journal of Psychoactive Drugs, 2019
Brianna R. Altman, M.N. Mian, M. Slavin, M. Earleywine
Despite the established efficacy of these treatments, individuals may opt to self-medicate with substances, perhaps to attain immediate relief from the distress of sleep-related disturbances. For instance, some individuals use alcohol to promote more restful sleep at night. However, alcohol at high doses may lead to greater sleep disturbances or individuals may develop a tolerance to alcohol’s sedative effects (Roehrs and Roth 2001). Likewise, prolonged alcohol use for sedative purposes increases daytime sleepiness, potentially exacerbating other problems (Johnson et al. 1998). Similarly, individuals might self-administer over-the-counter (OTC) drugs to improve their sleep quality. However, they may misuse these drugs by selecting inappropriate products, administering them for longer than suggested, and doing so without consulting medical professionals (Abraham et al. 2017). Moreover, some OTC drugs contain chemicals such as diphenhydramine or doxylamine, that can induce or worsen other symptoms or interact with other medications producing unintended negative effects (Johnson et al. 1998). Although individuals might find short-term relief with alcohol or OTC medications, the consequences associated with these drugs call for alternatives for those who would rather self-medicate than see a medical professional or psychologist.