A place to discuss all things treatment-related. Medications, IVs, midlines, PICC lines, NG tubes, sub-q pumps, home health care, etc. Also includes alternative and homeopathic remedies including NAET, vitamins, liver detoxing, and more for active HG and TTC preparation.

Moderators: JennyK, mammaclare, nomore


Postby Ivydragon » Jun 01, 2004 5:40 pm

Welcome! This is a post containing information about Zofran/B6/Unisom and a bit more. If you are new to this site, and in the midst of HG, this post is for you, although everyone should be familiar w/ it to know it's here. It was originally written to a new HGer a while back, and revised it a bit after suggestions that it be used here. It's written from my perspective directly to you.

Zofran is available taken by mouth and swallowed as an oral tablet in 4 or 8 mgs. Zofran is available ODT - which means it is sublingual, and dissolves in your mouth w/o the need of any liquid to swallow it. It is immediately absorbed into the blood stream, 4 and 8 mgs. Zofran can be injected into your IV or PICC line - wish I would have asked for this one in the hospital! Zofran I think is also available in a subcutaneous pump. The more direct the route between med and your blood stream, the more effective the drug tends to be. In order of effectiveness from least to greatest: Oral, ODT, pump, IV. The biggest adverse reaction to Zofran here is constipation, and several highly suspect it added to their weakness, although the weakness could have been recovery from repeat HG pgs..

I took my Zofran around the clock every 6 hours, so when I was on 16 mgs a day, I was setting an alarm at night to wake up, swallow it, go to the bathroom, eat a cracker so my tummy wasn't empty (graham cracker) and then would go back to sleep. Some gals just sleep through the night, and then take it when they get up. I was too afraid to try that, and so I took it every 6 hours - like clockwork. It depends on what works better for you, go w/ your gut feeling - it's usually right - even if it's against what we think is best (that's a generality that's important to remember - we have lots of opinions, but it's just to help you know what your options are, and we will support your decisions).

The highest doseage of Unisom is 3 Unisom/day = 75 mgs. There are two types of Unisom on the market. One is the sleep tabs - containing Doxcilimine Succinate. This is the one you DO want. The other is a sleep gel, and contains a different ingredient for sleep aid, and we don't use it. Now, it is a sleep aid, and some are made drowsy with it, but not nearly so much as the Phenergan as a comparison. I haven't heard it compared to the Tigan, so am no help there. I do know, however, that if you break it up into smaller pieces (even quarters) that the sleepy effect is greatly reduced. I was on the B6/Unisom combination for both my pgs, and after a little while, I can remember being disappointed that it didn't help me sleep better! I have never been on more than 2/day, and the 3/day is info from 2002 from Motherisk (a nausea and vomiting support call center in Canada, and is available to the US - www.motherisk.org <http> look up morning sickness).

Ok, B6. Prolonged useage of B6 at high doses (I think the study was 1,000 mgs a day) can lead to nerve damage. Motherisk recommends 150 mgs per day. 200 at the height of HG for a month or two is not considered prolonged useage, and is safe, and I would do it if 200 worked better for me than 150. I'd feel pretty uncomfortable ever going over 200 mgs/day. There are different ways B6 is available. Firstly, it's available over the counter at any grocery or drug store in a tablet (yes, another pill to swallow!). I try to remember to take B6 to lessen my PMS symptoms, and mine are 100 mgs, and I know that you can get them smaller mgs than that. For the $, higher mgs is a much better deal, but don't take the full 100 at a time. B6 must be paired with an enzyme in order to be available for use within the body, and unpaired B6 is just wasted in the urine, so do not take more than 25-50 mgs at a time, and stretch them out so they are more effectively absorbed. The oral tablets can be hard to split, and a pill splitter is worth it's weight in gold. B6 is also available in a sublingual form, which means that it dissolves in your mouth w/o having to swallow it, and is absorbed into your blood stream - no water needed. Sublingual is already paired with the enzyme. Sublingual B6 is available in 25 mgs which also gives you more flexibility in being able to take it as needed. I've heard that the peppermint flavor is preferrable over the orange, and it needs to be special ordered by a health foods store for you, or a vitamin store, or can be purchased on-line, and if you need help finding it on-line, I know where, just ask, and I'll dig up. I also know that Motherisk is doing a study about the comparison of the efficacy of sublingual vs. the pill B6 form. Ok, the 3rd form of B6 is referred to as Pyridoxine (B6) Injections. They sting, they hurt, they build scar tissue, but not having any clue about the sublingual B6 when I was pg, I had injections w/ both of mine, and it kept me out of the hospital, and were that last little thing that kept me from going over the edge (in addition to the Phenergan or Zofron/Unisom I was already on). I wonder if sublingual is as effective as the injected, or nearly so, but haven't had that one answered. I do know personally that 100mgs injected was more effective than 200 taken orally. B6 follows the same absorption rules as other meds. Oral least effective, sublingual MUCH MORE effective w/ B6, and injected IM (intramuscularly) is even better. B6/Unisom is more effective taken together, at the same time, but they are individually helpful as well. Some gals do not react well to one or the other, so use them w/o the other.

It seems that for one or two, Zofran did lose it's effectiveness, but we're really unsure if the HG is getting too bad for the Zofran to handle, or if it stops working, or what. Zofran, though, for most of us is a great vomit handler, unfortunately, it leaves nausea behind. The B6/Unisom for most helps w/ the nausea, and isn't enough for the vomiting - that's why combinations seem to work for so many, because they address different HG issues, even if it's a different combination than Zofran/B6/Unisom. For a few, the Zofran handles nausea, and the vomiting needs to be handled differently (like w/ Meclizine) so be aware that the same stuff at the same dose is not equal for all HGers.

A PICC is not your only option. If none of the combinations we suggested work better, than you can certainly try steroids or an NG tube. Steroids are more easily prescribed by a perinatologist, in case you're interested and your Dr. balks. They have been used for other types of pg issues, outside of HG, so we know from research that they are fairly safe. They have been used very successfully in some cases of HG that are not responding to other treatments, and may be a viable option. You can also do an advanced search, and search for steroids here at HER, and all sorts of info will come up, if that isn't enough, let us know, we'll find you more, feel free to ask questions, and to ask for more info.

Now, a PICC for some HGers isn't such a bad thing at all. For me, it's pretty terrifying, but when faced w/ many and repeated pokes for IVs, it looks much more appealing! If you do get into a position of needing constant hydration, it's an option to consider.

NG tubes are something I know more about receantly. Mamalily, one of our moderators had an NG tube that worked quite successfully. If it looks like you're headed towards needing consistent nutrition I'd recommend an NG tube over a PICC line w/ TPN. There are many pros and cons: nearly no risk of infection, keeps your intestines functioning, and doesn't stress out your liver. All pills can be crushed and mixed with water, and the NG tube can end in your small intestine, so you're not vomiting up what goes down. I'll work with Mamalily to get the regimen for placement posted on here at HER.

You know, all Drs. are not all equal when it comes to HG knowledge. Some know more than others, and they have different opinions about treatments, and amounts, etc. The information we offer you is from the patient side of things - the HG sufferer side of things - the things we've learned from sitting down and comparing what worked for one, and didn't for another, and what different Drs. tried, etc. I think most HGers hit a point where they just have to become more proactive about their care, either you'll need to ask more questions, or suggest treatment options, etc. Some Drs. are threatened by this, and some welcome it, and there's only one way to find out, and that's to ask for better treatment, or specific options they haven't suggested. We have had HGers ask for help in locating a new Dr. because of the ignorance of the one they have, or the lack of deceant treatment. We have some gals who are fantastic at helping with this. Hopefully, if you really like your Dr. they will be willing to try some other suggestions. Combinations really are more effective for most it seems, and it just takes some experimentation to figure out if they might work well for you. I wish we could just give you a regimen that works guaranteed for everyone, but we haven't found one yet!

Here at this website, we are surrounded by the best HG info that is available. Kimber is the co-founder of the official HER foundation and this website and has spent years researching HG and gathering the information we now have at our fingertips. Research and read here.

Homeopathy has been used successfully by an HGer in the UK - find her story at www.hyperemesis.org.uk. Kerry had a surprise pg that she was able to successfully manage better than her previous HG experience by using a knowledgeable homeo/naturopath. There is more important homeopath information in our Alternative Treatment forum, or there will be by Aug. 2004.

Feel free to ask for help. There is a lot of information here, and we know you are not feeling even close to your best, or normal. We're here for you, so don't feel like you have to sort through everything to find all the answers - we really will do that for you!

Sending you hugs, and maybe you've found some relief knowing you're not the only one as many others have. We've been there, or we are there now, we know how you feel, and you're not alone anymore.

Andrea (Andy) - Ivydragon
Last edited by Ivydragon on Jun 05, 2004 12:57 pm, edited 1 time in total.
Mom to Aaron 14 (HG), Anna 11 (HG), Adam 8 (adopted), Andrew 8 (adopted), fostering a newborn . . .
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Postby annie1005 » Jun 02, 2004 11:43 am

Thanks for the great info., Andy! Very helpful!
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The link...?

Postby Cecca » Jan 02, 2005 10:03 am

Wow! Fantastic to have all that information in one place for handy reading. Thanks so much. I am particularly interested in the naturopathic approach, and tried to access the link to the UK woman's story that was mentioned. The link takes me to a page called "The Bottom Line" and I couldn't figure out what to do after that. Any suggestions? It didn't make any mention of health, pregnancy or what the subject of the page actually is. Any further info. about homeopathic/naturopathic approach or where to get the info. would be much appreciated. I haven't found too much in the Alternative forum, though I wish folks would post more often there :D

Thanks a bunch,
HG pg #1: DS Reilly b. 5/1/2000
HG pg #2: DD Sonia b. 12/30/2002
HG pg #3: lost angel 6/3/2004
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New to HER

Postby Adriana » May 31, 2005 8:33 pm

I have discovered this GREAT HG website long before I finally said YES to another pregnancy. With my first pg, I knew very little about HG and even less about possible treatments. My previous Dr. has never mentioned any meds or that I could even have HG. I suffered through 5 months of constant vomiting and nausea, and then finally ended having to go for an IV treatment. After this my HG slowly tapered off, I was in my 5th month by then. With this 2nd pg, I knew I had options way before I decided I wanted to go through with it. It was a matter of finding a new Dr. who would be willing and experienced anough to help me. I found one, and he's a good one. I was on Zofran (8mg), but only took it when I felt I couldn't do without it, which was about 5 times a week (with about 1 vomiting epsiode a day, after Zofran and Unisom kicked in). I am still on Unisom and every time I try to wean off it, I get another vomiting episode. How safe is it in the second and third trimesters? I take only one at night, but I'm 19 weeks and wondering whether I should be still taking it.

Any suggestions?


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Postby hudsoncs » Feb 12, 2007 1:50 pm

Thank you SO much! These meds are the perfect combo for me. The onlything I change is that If I'm really bad, I take the unisom (up to 50 mg) at night (2 doses) and then during the day (to not be so tired) I've taken Meclizine & Zofran. Vit b6- any time.
Thanks for all you ladies do!
This site has been such a help and encouragement!
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A PICC line was the answer for me!

Postby RockinMama » Feb 23, 2007 3:21 pm

Your info above is great! Here is my experience with all that...
I have been hospitalized three times now during my 17 weeks of pregnancy. The last hospitalization combined with the loss of 35 lbs. cemented the idea that "we need to do something drastic here". So, they placed a double-port PICC line in and started total IV nutrition. This continued for a few days to help get my strength up, then we moved on to constant hydration and IV zofran every 6 hours. This was a small miracle! I can now eat one smaller meal a day and can be at home. My OB helped set me up with in-home IV care and a nurse. I have been doing this for 3 weeks now and have successfully gained 3 lbs! I feel ok and can function on a basic level now. I highly recommend a double-port PICC line. I get my meds through one and they can draw blood from the other! NO MORE IV POKES AND PRODES!
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Postby MommEE » May 29, 2007 8:49 am

I just want to thank you so much for this post! During my second (and last) HG pregnancy, I found this site and this information is what got me through! I cannot tell you how thankful I am.
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