NVP Counselor
Date: 2004-08-03

Question:
Do you know the maximum dose of oral Zofran that is currently being used for HG? I have seen up to 8mg tid in some websites but normally it seems to be 4mg bid-tid. I am a physician and my wife has suffered through HG for 4 straight pregnancies. She is currently on home IVF and Zofran po 4mg tid.(the maximum dose used by our OB's though they would probably increase if more is given elsewhere). We are also trying Hypnotherapy x 1 session thus far. There is a paper (website http.//www.easysurgery.com/hyperemesis.pdf ) describing its possible efficacy. It makes sense if you can decrease some of the triggers it may give some relief. We will probably try accupuncture next. One physician friend of mine stated accupuncture at the same site used by seabands is much more effective than seabands. We have of course tried all other Rx and OTC products with only relief with Phenergan up to now but unfortunately this does not seem to be working well for this pregnancy. In So.Cal. we have some doctors who will be aggressive and others passive but luckily since I am a Family Practitioner I can get what we need. I definitely agree patients need to switch doctors when they are not recieving the care they deserve with this disease. Thank you for having this forum.

Answer:
The Motherisk NVP treatment algorithm posted on this site indicates as a guideline 8 mg BID for Zofran. Evidence-based data on Zofran is still scarce with 15 cases followed up. A recent Motherisk study (in press) of 176 women includes 3 spontaneous abortions, 2 therapeutic abortions, 6 birth defects (3 hypospadias, 1 double urinary collecting system in kidney, 1 mild pulmonary stenosis, and 1 duodenal atresia). Most women were on 12 or 16 mg per day and some up to 24 mg. This number of birth defects does not represent an increase over the 1 percent to 3 percent baseline risk of birth defect that is present in every pregnancy.

Based on the calls we receive to our Motherisk NVP Helpline, Zofran seems to be commonly used in the US. For women with severe symptoms that do not respond even to Zofran, we stress the need to check all other possible causes. H Pylori has occasionally arisen as an undiagnosed condition.