Home Subcutaneous Metoclopramide Therapy for Hyperemesis Gravidarum

Abstract

OBJECTIVE:To describe the use of subcutaneous (s.c.) metoclopramide in the outpatient treatment of hyperemesis gravidarum. STUDY DESIGN:In a retrospective design, women who received continuous s.c. metoclopramide for treatment of hyperemesis gravidarum were identified from a national database. Data analysis included weight at start and stop of treatment, frequency of resolution of symptoms, and side effects of medication. In addition, data were collected on adjuvant therapies. RESULTS:Between January and December of 1997, there were 646 women with hyperemesis gravidarum who received continuous s.c. metoclopramide on an outpatient basis. A total of 413 patients (63.9%) had complete resolution of symptoms. Seventy-five percent of patients had received one or more antiemetic medications before initiation of s.c. metoclopramide. A total of 192 patients (30.5%) reported at least one side effect related to treatment. The majority of reported side effects were considered mild and did not require discontinuation of s.c. metoclopramide. CONCLUSION:S.c. metoclopramide appears to be a safe, effective treatment for hyperemesis gravidarum. Outpatient treatment may result in decreased costs compared with inpatient hospitalization. Journal of Perinatology 2000; 20:359-362.Hyperemesis gravidarum is characterized by intractable nausea and vomiting during pregnancy with concurrent disturbances of nutrition and fluid balances. While nausea and vomiting afflicts 60% to 70% of pregnant women, hyperemesis gravidarum is relatively uncommon, occurring in ϳ5 per 1000 pregnancies.1 Ultimately, hyperemesis gravidarum accounts for ϳ4% to 7% of all antenatal hospital admissions and 30% of admissions before 20 weeks' gestation. 2When patients experience hyperemesis gravidarum, there is significant disruption in their lives, and there is a high cost to society. In a review of hyperemesis gravidarum by Cowan, 3 women reported curtailing social contacts. They also reported that relationships with spouses and families were altered. Vellacott et al. 4 reported that 183 of 243 pregnant women experienced nausea and vomiting in pregnancy, and 47% of these women felt that their job efficiency was reduced. Gadsby et al.1 have estimated that in England, some 8.6 million hours of paid employment and 5.8 million hours of housework are being lost through nausea and vomiting in pregnancy of all severities each year.Traditionally, this condition has resulted in costly management and loss of productivity due to prolonged and/or recurrent hospital admissions, as well as physical and emotional sequela. According to the Healthcare Cost and Utilization Project (HCUP), the average charge for patients treated for ICD-9-CM 643.13 (Hyperemesis with Metabolic Disturbances-Antepartum) in the hospital is $1291.33 per day.5 Studies looking at patients with hyperemesis gravidarum have reported frequent hospital admissions. 2,6,7 In one such study, 28% (39 of 140) of patients with hyperemesis gravidarum were admitted to the hospital 2.9 times on average (range 2 to 6 time...

Use of metoclopramide in the first trimester and risk of major congenital malformations: A systematic review and meta-analysis

“…It is also deserved to arouse attention to the adverse drug reactions (ADR) of metoclopramide using during pregnancy, especially the Extrapyramidal Symptoms (EPS), which are common ADR among patients received the treatment with dopamine-receptor blocking agents. Buttino et al performed a retrospective study containing 646 pregnant women who were diagnosed as HG and received subcutaneous (s.c.) metoclopramide therapy to explore the ADR of metoclopramide [ 31 ]. As a result, 29.7% patients experienced side effects symptoms (lethargy, site irritation, agitation) and 4.6% reported EPS.…”

Treatment of Severe Nausea and Vomiting of Pregnancy with Subcutaneous Medications

“…In 2000, Buttino et al described the use of continuous subcutaneous metoclopramide within a comprehensive outpatient program for the treatment of women with hyperemesis gravidarum. 11 Continuous subcutaneous metoclopramide was prescribed to 646 women after other first-line treatments failed, though PUQE scores at initiation of treatment were not reported. Along with continuous subcutaneous administration of medication, patients enrolled in the outpatient program received individualized dietary instruction, daily and as-needed telephone assessment and support by a perinatal nurse, and home nursing visits as needed.…”

Evidence‐Based Approaches to Managing Nausea and Vomiting in Early Pregnancy

“…Metoclopramide does not cause sedation, and many clinicians now prescribe metoclopramide orally for outpatient treatment without a previous trial of phenothiazines. In addition, metoclopramide is frequently used as a first‐line treatment given intravenously or subcutaneously when women are admitted to an inpatient setting for treatment of HG, and has been shown to reduce the need for hospital visits and IV hydration 89,90 …”

“…In addition, metoclopramide is frequently used as a firstline treatment given intravenously or subcutaneously when women are admitted to an inpatient setting for treatment of HG, and has been shown to reduce the need for hospital visits and IV hydration. 89,90 Prochlorperazine, Promethazine, and Metoclopramide: Which Works Best?…”