“Breakthrough” In Rx Nausea & Vomiting in Pregnancy Dr Sharda Jain

1. “Breakthrough”
In Rx
Nausea & Vomiting
in Pregnancy
Presented on 16th August
at wood apple
on the occasion of
D.G.F. Independence Day function
Dr. Sharda Jain
…Caring hearts, healing hands

2. “Breakthrough” In Rx
Nausea & Vomiting Of pregnancy
the first dual release combination of doxylamine + pyridoxine
Gideon Keren MD
Internal Medical Review April 2018

3. NAUSEA
&
VOMITING
70-80%
50 + 25
N +V N
HYPEREMESIS GRAVIDARUM
0.8 – 1.6 %

4. CAUSES
PSYCHOLOGICAL
Hormonal (HCG) + OCP
H. Pylori
START
4-6 WEEKS
PEAK
8-10 WEEKS
60% DECREASE
12 weeks
99% DECREASE
20 weeks

5. RISKS
Multiple Pregnancy
Acid Reflex
Genetic
Multivitamins Not taken

6. *Stop or Decrease N & V
*Correct Complications
* MOTHER (Fluid, Hypokalemia & Metabolic Acidosis)
* FETUS

7. Rx
NON
PHARMA-
COLOGICAL
Life Style
PHARMA-
COLOGICAL
Home
remedies
Ginger
&
Accupressure

8. DRUGS
Multi
Vitamins
Pre-
Pregnancy
Doxylamine
Pyridoxine
DOPAMINE
ANTIAGONISTS
Metoclopromide
Promethozive
Fluid
+
Cortico steroid

9. Preconception (for women with a
history of hyperemesis Daily
Multivitamin

10. NAUSEA OR VOMITING INTERFERING WITH
DAILY ROUTINE
Oral Vitamin B6 10-30mg 2-4 times daily depending upon severity.
Add doxylamine 25 mg twice daily
Continued symptoms after 48 hours
Substitute doxyamine with other antiemetics
Promethazine 12.5 – 24 mg 4 hourly orally or rectally
Alternative therapies like acupuncture
Ginger tablets if available (not routinely available in India
250 mg 304 ti9mes cab be tried

11. PERSISTENT SYMPTOMS WITH OR WITHOUT
DEHYDRATION
Adequate intravenous fluids (up to 3 L in 24 hours)
Prochloperezine 25 mg 12 hourly. Intravenously or racially
or
metoclopramide 5-10 mg 8 hourly orally or intravenously

12. DEHYDRATION OR WEIGHT LOSS
Thiamine 100mg IV daily for 3 days
Continue IV thiamine with IV fluids daily
Ondansetron 8 mg 8-12 hourly intravenously or orally
Or
Methylprednisolone up to 15 mg thrice a day for three days
Taper over 2 weeks to lowest effective dose
Total duration of therapy 6 weeks

13. UNABLE TO MAINTAIN WEIGHT
consider Termination

14. 14
ejunal elease
Technology
NAVINA JR

15. Pharmacological treatment of NVP
 “Category ADrug In
Pregnancy”
Doxylamine & Pyridoxine – highly effective in
treatment of NVP
1st Line of treatment

16. Mode of action of Doxylamine & P5P
• Primary mechanism is direct inhibition of histamine at
the H1 receptor and anticholinergic effect
• Secondary mechanism is an indirect effect on the
vestibular system by decreasing stimulation of the
vomiting centre
16

17. PHARMACOKINETICS
Doxylamine - Active Metabolite
Pyridoxine – Pyridoxal 5 Phosphate
* Bypasses biological conversion
* Active metabolite of Vit B6

18. FEATURES OF JR TECHNOLOGY
Site specific
Ensures pH dependent
(6.0-7.0) drug release at jejunum
Gastro Resistant (coated polymer)
Prevents dissolution
of drug in gastric environment
Drug Bioavailability Enhancer
Enhances drug absorption, ensures
high bioavailability & higher peak
plasma concentration

19. Better efficacy & effective control of symptoms of NVP
19

20. 20
DOSE

21. EVIDENCE
• Safe & effective Rx of NVP
Ref Pediatr Drugs (2014) 16:199-211
DOI 10,1007/s40272-014-0065-5
• Randomized placebo Controlled trial
Rx of NVP
Ref Koren et al BMC pregnancy & childbirth (2015) 15:59
DOI 10,1186/s 12884-015-0488-1

22. Thank You!!!