Mirtazapin bei Hyperemesis gravidarum

Lieb, Martin; Palm, U.; Jacoby, David B.; Baghai, Thomas C.; Severus, Emanuel

doi:10.1007/s00115-011-3297-4

Cited by 8 publications

(7 citation statements)

References 14 publications

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“…Most guidelines recommend ondansetron for severe cases of hyperemesis gravidarum and thus, we have discussed whether this should be the treatment offered to participants after the intervention. However, in several case reports, mirtazapine has been effective when ondansetron has not 14 18 22. Thus, in the event that a participant has experienced significant symptom relief during the intervention and therefore wishes to continue the trial medication, we find it unethical not to offer this.…”

Section: Methods and Analysismentioning

confidence: 98%

“…Most of the case reports on mirtazapine and hyperemesis gravidarum describe dosages of up to 15 mg daily to be effective. However, in some case reports the initial dosage was mirtazapine 30 mg daily 16 17 22. Thus, to not disregard a possible effect due to inadequate dosage and better reflect the usage outside a clinical study, this trial allows for an optional dosage increase to 30 mg mirtazapine daily.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The pharmacological profile resembles that of a long-acting 5-HT 3 antagonist combined with a sedating antihistamine 13. Mirtazapine is described in 23 case reports as an effective treatment for hyperemesis gravidarum,14–22 and the antiemetic effect is confirmed in a systematic review and meta-analysis on mirtazapine for postoperative nausea and vomiting 23. However, there are no controlled trials with mirtazapine in pregnant women with hyperemesis gravidarum.…”

Section: Introductionmentioning

confidence: 99%

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Validating the effect of Ondansetron and Mirtazapine In Treating hyperemesis gravidarum (VOMIT): protocol for a randomised placebo-controlled trial

Ostenfeld¹,

Petersen

Futtrup

et al. 2020

BMJ Open

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IntroductionCurrent pharmacological treatment options for hyperemesis gravidarum have been introduced based on scarce evidence and are often not sufficiently effective. Several case reports suggest that mirtazapine, an antidepressant, may be an effective treatment for hyperemesis gravidarum, but so far there are no controlled trials investigating the potential effect of mirtazapine on hyperemesis gravidarum. The antiemetic ondansetron is currently widely used to treat hyperemesis gravidarum despite sparse evidence of effect in pregnant women. This study aims to investigate the effect of mirtazapine on hyperemesis gravidarum while also providing data on the effect of ondansetron.Methods and analysisThis randomised double-blind placebo-controlled multicentre trial will be conducted in eight Danish hospitals. One hundred and eighty pregnant women referred to secondary care for hyperemesis gravidarum will be randomly allocated to 14-day treatment with either mirtazapine, ondansetron or placebo. Main inclusion criterion will be Pregnancy Unique Quantification of Emesis (PUQE-24) score ≥13 or PUQE-24 score ≥7 if accompanied by weight loss >5% of pre-pregnancy weight or hospitalisation. Participants are eligible regardless of whether other antiemetics, including ondansetron, have been tried. The coprimary outcomes are effects of mirtazapine and ondansetron, respectively, on PUQE-24 score tested hierarchically on day 2 and day 14. Secondary outcomes include, but are not limited to, differences between the three groups in number of daily vomiting episodes, dropout due to treatment failure, use of rescue medication, weight change and side effects.Ethics and disseminationThe trial has been approved by the Regional Committees on Health Research Ethics in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. Results will be published in peer-reviewed journals and submitted to relevant conferences.Trial registration numberNCT03785691

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Section: Methods and Analysismentioning

confidence: 98%

Section: Methods and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Validating the effect of Ondansetron and Mirtazapine In Treating hyperemesis gravidarum (VOMIT): protocol for a randomised placebo-controlled trial

Ostenfeld¹,

Petersen

Futtrup

et al. 2020

BMJ Open

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“…Mirtazapine, an antidepressant which blocks 5-HT3 receptors, may be an alternative when other antiemetics fail to treat hyperemesis. Two small case series 14,15 and three case reports [16][17][18] describe significant improvement in symptoms of hyperemesis gravidarum which are resistant to other medicines.…”

Section: Mirtazapinementioning

confidence: 99%

Treatment of nausea and vomiting in pregnancy

Taylor¹

2014

Aust Prescr

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Most pregnant women will experience some degree of nausea or vomiting during pregnancy.Dietary and lifestyle interventions, along with appropriate drug treatment, can enable women to continue their everyday life and work with minimal disruption.Clinical guidelines for therapy are available, and early treatment has been shown to reduce the severity of symptoms.Pregnant women should be reassured that nausea and vomiting do not usually harm the fetus. Also, medicines used to treat this condition are not associated with an increased risk of birth defects, miscarriage, prematurity or other adverse outcomes in pregnancy.An evidence-based treatment algorithm developed by the Motherisk teratology information service in Canada 8 has been adapted for use in Australia

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“…Typical serotonergic side effects such as gastrointestinal complaints and sexual dysfunction are registered rarely [113] due to the 5HT 2 -and 5HT 3 -blockade. The latter may be responsible for additional antiemetic effects [114]. Also beneficial effects in the treatment of neuropathic pain were reported [115].…”

Section: Noradrenergic and Specific Serotonergic Antidepressant / α-Rmentioning

confidence: 99%

Individualized Pharmacological Treatment of Depressive Disorders State of the Art and Recent Developments

Zirngibl¹

2014

J Depress Anxiety

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moderate and severe disability independent of socio demographic factors with increasing importance in the projection to the year 2030 [1]. The multifactorial genesis of depressive disorders requires a multimodal and individualized treatment. Typical symptoms of depression are summarized in Table 1. The severity of symptoms, diagnostic subtypes and presence of specific symptoms, as well as age and psychiatric or somatic comorbidity play a role influencing the course of illness and choice of treatment. The treatment which provides the best tolerability together with the highest likelihood of response should be preferred in treatment plans and algorithms. Treatment of depressive disorders mostly consists of a combination therapy, determined by the current clinical features. The main constituents of a multimodal antidepressant therapy are pharmacotherapy, psychotherapy using established therapeutic techniques, and social support. Less severe forms of depression

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Mirtazapin bei Hyperemesis gravidarum

Cited by 8 publications

References 14 publications

Validating the effect of Ondansetron and Mirtazapine In Treating hyperemesis gravidarum (VOMIT): protocol for a randomised placebo-controlled trial

Validating the effect of Ondansetron and Mirtazapine In Treating hyperemesis gravidarum (VOMIT): protocol for a randomised placebo-controlled trial

Treatment of nausea and vomiting in pregnancy

Individualized Pharmacological Treatment of Depressive Disorders State of the Art and Recent Developments

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