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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Published studies include over 3,000 women who took prochlorperazine during pregnancy. In one large study, 877 infants exposed to prochlorperazine during the first trimester (Heinonen et al., 1977). No birth defects were observed among 50–99 infants whose mothers used prochlorperazine (Jick et al., 1981). In the Swedish Medical Birth Registry, the frequency of birth defects was not increased among 145 infants exposed during the first trimester (Asker et al., 2005. In 453 infants exposed during the first trimester to prochlorperazine, the frequency of birth defects was not increased (Milkovich and van den Berg, 1977). The frequency of congenital anomalies was not increased in the offspring of 704 women who took the drug in the first trimester (Briggs et al., 2021).
Nausea/Vomiting of Pregnancy and Hyperemesis Gravidarum
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Phenothiazines (prochlorperazine [Compazine], promethazine [Phenergan]) appear to be safe in pregnancy. A case-control study of promethazine showed no evidence of increase risk/rate of congenital anomalies in humans [95, 101]. Phenothiazines are often used in addition to or instead of antihistamines. The level 1 evidence for effectiveness is limited. As stated earlier, metoclopramide (with one IM shot of 50 mg of pyridoxine) is superior in decreasing vomiting and subjective improvement compared to monotherapy with either prochlorperazine or promethazine in NVP [86], it had similar efficacy with reduced side effects in HG [90]. Compared to ondansetron, there was no difference in severity of nausea in the setting of HG [100]. Two studies compared promethazine and corticosteroids in patients with HG. One study [102] found a decreased rate of hospital readmission with corticosteroids, the other study [103] found an increase in n/v at 48 hours but not after 17 days with prednisolone [2].
Common problems in pregnancy
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
The phenothiazine anti-emetic prochlorperazine is very widely used during pregnancy in the UK. The frequency of congenital malformations was no greater than expected among the children of 877 women exposed during the first trimester.9 Three other studies of exposure in early pregnancy found no evidence of an increased risk of malformation.13 The availability of a rectal preparation is an advantage.
Practical management of adverse events in patients with advanced systemic mastocytosis receiving midostaurin
Published in Expert Opinion on Biological Therapy, 2021
Jason Gotlib, Hanneke C. Kluin-Nelemans, Cem Akin, Karin Hartmann, Peter Valent, Andreas Reiter
As mentioned above, despite nausea and vomiting being the most common nonhematologic AEs with midostaurin therapy, several steps can be taken to manage these AEs. Following the first report of nausea and vomiting, the patient indicated that he had been taking his dose on an empty stomach. He was advised to instead take the medication with food and was prescribed ondansetron 8 mg to be taken 1 hour prior to midostaurin. Follow-up showed that while the nausea was not completely resolved, it had improved. Prochlorperazine 10 mg was added, to be taken after the morning dose of midostaurin on an as-needed basis for persistent nausea. He responded well, without the need for midostaurin dose reduction. Over time, he was able to discontinue the supplemental prochlorperazine and maintained full adherence to the midostaurin regimen. The patient responded to therapy with resolution of ascites and diarrhea plus a weight gain of 8 kg.
The pharmacological management of vertigo in Meniere disease
Published in Expert Opinion on Pharmacotherapy, 2020
Juan Manuel Espinosa-Sanchez, José A. Lopez-Escamez
Vestibular suppressants and antiemetic agents are the preferred drugs for the treatment of the acute phase in patients with MD [19]. Most medications share antivertiginous and antiemetic effects to a greater or lesser degree. Diphenhydramine and its derivative dimenhydrinate, meclizine, and cyclizine are H1-receptor antagonists that are useful for treating milder attacks orally. The association cinnarizine plus dimenhydrinate may be also beneficial [20]. Antidopaminergic drugs including metoclopramide, sulpiride, promethazine, and prochlorperazine are commonly used for severe nausea and vomiting. Setrons are serotonin 5-HT3 antagonists, they are mainly used when severe vomiting is a prominent symptom. A short course of steroids, commonly oral dexamethasone or methylprednisolone, is used to reduce vomiting and vestibular symptoms, especially when hearing loss is prominent [21]. Finally, benzodiazepines can be also used for acute crisis of MD because they act as vestibular suppressants enhancing the inhibitory action of GABA in the vestibular nuclei; nevertheless, long-term administration should be avoided, since they induce tolerance and drug addiction. They are also effective as antiemetics and to reduce the anxiety often associated with the episode of vertigo. The use of diuretics (mannitol, glycerol, acetazolamide, hydrochlorothiazide) in acute phase is a common practice in some countries [22].
A week-long outpatient induction onto XR-naltrexone in patients with opioid use disorder
Published in The American Journal of Drug and Alcohol Abuse, 2020
Mohammad Sibai, Kaitlyn Mishlen, Edward V. Nunes, Frances R. Levin, John J. Mariani, Adam Bisaga
On Day 1 (Monday), after an overnight abstinence from opioids, participants were assessed for withdrawal severity using the COWS (Clinical Opioid Withdrawal Scale) (10). COWS score of 6 or greater was required before the buprenorphine 2 mg was given, and participants waited in the clinic when necessary for withdrawal to reach that threshold. Additional two doses of buprenorphine 2 mg were given in the clinic at hourly intervals, for a total of 6 mg. An additional 2 mg dose was given to take in the evening at home if withdrawal symptoms persisted. Ancillary medications were given as needed for participants with persistent withdrawal in the clinic on Day 1, despite receiving buprenorphine. On Days 2 through 5, while in the clinic, participants were administered standing doses of clonidine and clonazepam to minimize withdrawal symptoms and anxiety and prochlorperazine to prevent nausea and received additional doses of ancillary medications as needed for persistent withdrawal. At the end of each clinic visit patients were sent home with additional doses of adjunctive medications to manage residual withdrawal and insomnia. Both trazodone and zolpidem were offered as some patients found it beneficial to combine them while others had a preference for one medication over the other.