NVP Counselor
Date: 2005-12-11

Question:
My doctor (in London) has prescribed Metoclopramide for nausea. I haven't taken it because I've seen on the web (NHS Direct) and in Professor Koren's book that it is only "probably safe". Should I go back to my doctor and ask for doxylamine succinate and vitamin B6 separately?

(By the way, I couldn't get the treatment algorithm link to work properly but it did work if I clicked on it and then deleted the duplication of the motherisk website at the beginning of the link. This may just be my computer.)

All the best,

Answer:

If available to you in the UK, doxylamine and vitamin B6 would be more or less equivalent to Diclectin. They are usually taken 25 mg. vitamin B6 and 12.5 mg doxylamine, 3 times a day. Regarding safety, these 2 substances have been used for nearly 40 years, widely studied and constitute the first line treatment for NVP.

Regarding metoclopramide, 3 studies between 1983 and 1998, as well as a pharmaco-epidemiological prescription database (published in British Journal of Clinical Pharmacology 2000; 49(3):264-8) all concluded there was no increased risk of birth defects, therefore metoclopramide appears to be "probably safe" in pregnancy. As defined in Everyday Risks in Pregnancy and Lactation, "probably safe means that there is no evidence that the drug is dangerous to the fetus and that the information showing it to be safe is rather large. Here, the benefit/risk assessment will be weighted, in most cases, in favor of using the medication."