Want to know what are the most common medications prescribed for Hyperemesis Gravidarum? Get the guide now at https://hgpharmacist.com/top10
The following blog is for information only and not to be taken as medical advice. Please consult your provider before making any changes during pregnancy.
Five Types of Patches for Nausea and Vomiting During Pregnancy
What happens when you lose the ability to eat? This answer is obvious! There’s a limited time of life left. The irony of Hyperemesis Gravidarum (HG) is that women have had a fundamental part of life taken away at a time they are growing another life inside of them.
Through my own experiences and by counseling thousands of women with nausea and vomiting during pregnancy, I see many doctors, at least those who understand that women cannot swallow pills, prescribe dissolvable pills, suppositories and intravenous (IV) medications while ignoring a comfortable medication route: topical patches. I’d bet the reasons why these doctors choose to ignore patches as an alternative is due to the following reasons: they believe the patches are either not proven to be safe, not effective or too expensive. I long for the day that there is an inexpensive patch which has been proven to be both safe and effective to ease vomiting during pregnancy. For now, here are my thoughts on patches that are often used by HG sufferers during pregnancy in the hopes to have the ability to eat again.
***One word of caution: Be careful to dispose of all patches safely as they can be fatal to pets and children!
1. granisetron (Sancuso)
Sancuso is a prescription patch with the active ingredient granisetron. It is FDA approved for postoperative nausea and vomiting and radiation-induced nausea and vomiting for cancer patients. The manufacturer states that although it is not FDA approved for use in pregnancy, it has been proven not to cause fetal harm in animal studies and is rated pregnancy category B.
How it works:
Granisetron is a serotonin (5-HT3) antagonist , which is the same medication class as ondansetron (Zofran), palonosetron (Aloxi) and dolasetron (Anzamet). These medications are called serotonin (5-HT3) receptor antagonists because they block serotonin in both the brain and gastrointestinal tract. Specifically, they “block serotonin both peripherally on vagal nerve terminals in the gastrointestinal (GI) system and centrally in the chemoreceptor trigger zone in the area postrema of the fourth ventricle, resulting in powerful antiemetic effects.”
I believe there are a couple reasons that Sancuso is NOT commonly prescribed, as it is an effective antiemetic medication:
- It is off-label. This means that because it is not being used for FDA approved use, the manufacturer’s sales reps are not allowed to discuss it with prescribing practitioners. This leaves me wondering how many obstetricians and midwives have no idea that this patch exists. Know that in the United States, practitioners can not only ask about it but can also get free samples. Have your provider contact the manufacturer to request a sample for you.
- It is non-formulary on most insurances. The cash price of one patch is around $650, resulting in a one month supply costing around $2600. Since insurances usually choose one medication from each class to have on their formulary, and with ondansetron now available as a cheap generic medication, ondansetron will always be the preferred medication which means it has the lowest copay. It is possible to get Sancuso covered by some insurances with a “prior-authorization.” In other words, your doctor will have to complete extra paperwork stating that you failed the cheaper medication option in order for the pharmacy to be able to dispense this to you. If you want to try Sancuso and cannot afford it, click here for manufacture assistance options: https://www.patientrxsolutions.com/patients.php or https://sancusopriceguarantee.com/patient/#. With many insurances, this option costs about $20 per patch.
Summary:
- Instructions: Place one patch on the outer arm for up to seven days.
- Effectiveness: Clinically proven effective. As there are genetic variations on how the body responds to most medications, I urge everyone to ask for a pharmacogenetic test to see which HT3 antagonist will be effective in your body.
- Most common possible adverse effects (the same as ondansetron): headache, constipation.
- Caution: low kidney function, cardiac disorders, using in direct heat or sunlight.
***Click here for more information on the safety and availability of Sancuso.***
⇒ Overall rating:
- Cost: Expensive (but only $20 through the manufacturer’s assistance program through non-government insurances)
- Effectiveness: highly effective for most
- Safety: Many potential side effects but benefits often outweigh risks
2. Scopolamine (Trans-Scop)
Scopolamine (Trans-scop) is a prescription patch well known by cruise ship passengers trying to avoid motion sickness. It is FDA approved for general nausea and vomiting, motion sickness and nauseas and vomiting due to anesthesia.
How it works:
Scopolamine works to prevent motion-induced nausea and vomiting through multiple pathways in the brain, specifically blocking impulses from the brainstem to the central nervous system. The specific pathways are from “vestibular nuclei to higher CNS centers and from our reticular formation to our vomiting center.” (Medscape). Additionally, it is an anticholinergic belladonna alkaloid. Belladonna is actually a plant that has been used for medicinal reasons for thousands of years, but it is poisonous to humans. Its anticholinergic properties are so powerful that it is now used in a variety of medications.
Ptyalism Benefit
Scopolamine patches block acetylcholine, which is a hormone that controls nerve-muscle impulses. This is great to stop vomiting and excess saliva, known as ptyalism or sialorrhea. In fact, dry mouth is the most common side effect, but this drying in the body can be extremely dangerous for women with HG because it exacerbates dangerous symptoms to include dehydration and slowing down the digestive system increasing the risk of severe constipation.
Scopolamine may be effective in women whose nausea and vomiting is caused by motion. However, many HG women find the adverse effects outweigh the benefits so much that the HER Foundation does not list it on their medication treatment algorithm. If you try it, do so cautiously and take off the patch as soon as you start experiencing adverse effects.
Summary:
- Instructions: Place one patch behind the ear for up to three days.
- Effectiveness: Clinically proven effective.
- Most common possible adverse effects: dry mouth, dizziness, blurred vision.
- Caution: Avoid use in severe preeclampsia, glaucoma.
⇒ Overall rating:
- Cost: Affordable (use a drug discount card if your insurance will not cover it)
- Effectiveness: variable
- Safety: Many potential adverse effects. While adverse effects often outweigh benefits, some women say this worked wonders.
3. Clonidine
Clonidine (Catapres-TTS) is predominantly an antihypertensive, meaning it lowers high blood pressure, or for Attention Deficit Disorder (ADD), so it would never have occurred to me to use it Hyperemesis Gravidarum until I came across this clinical study: Transdermal clonidine in the treatment of severe hyperemesis. A pilot randomised control trial.
This was a well-designed but very small clinical trial. All of the twelve women in the study did not find improvement from standard treatments. Half of the women were given just IV fluids and thiamin and the other half were given IV fluids, thiamin and a clonidine patch, which they wore for “two consecutive periods of five days.” (The dosing does not make sense as the study said they used a 5mg patch but patches are available in the US as 0.1-0.3 mg/day.) There was then a wash-out period, meaning the medication was cleared from the system, and they tried the same treatment on the opposite set of women. The women were also allowed other antiemetics, either scheduled or as needed. The trial measured how they rated their PUQE score, visual analog scale, how much protein was in the urine each morning, how many doses of other antiemetics they took and the number of days not needing IV therapy. This resulted in a “significant reduction of symptoms and reducing the need for other supportive measures and medications.”
Just like scopolamine, dry mouth is the most common side effect. I wish they had monitored ptyalism (sialorrhea) in the clinical study!
Caution: the patch may have aluminum in it. Check the inactive ingredients if this is a concern.
Summary:
- Instructions: Place one patch to clean, hairless skin on upper arm or chest. One patch can stay for up to seven days. Rotate site weekly.
- Effectiveness: Clinically proven effective by one small trial.
- Most common possible adverse effects: Hypotension, dizziness, drowsiness, headache
- Caution: Avoid use in severe preeclampsia, glaucoma.
⇒ Overall rating:
- Cost: $33-$75 depending on strength (use a drug discount card if your insurance will not cover it)
- Effectiveness: More clinical testing needed
- Safety: Relatively safe
4. Vitamin patches
Malnutrition is a major cause of increased risks in pregnancy due to Hyperemesis Gravidarum, including mortality, so the idea of using a vitamin patch to get vitamins during HG sounds perfect. Vitamin patches are commonly sold to people who spent the night drinking too much alcohol but none are marketed to pregnant women. Some of the vitamins that HG women need to supplement because they are quickly depleted include all the B vitamins (B1/Thiamin, B3/riboflavin, B6/pyridoxine, B9/folate, B12/cobalamin), Vitamin C, Vitamin D and Vitamin K. Minerals needed to supplement include potassium and magnesium.
The challenges with vitamin patches:
- Vitamins are classified as supplements, so they do not require FDA approval for safety and efficacy.
- Just like prescription medications for vomiting, none have been clinically tested in pregnant women.
- None of the companies I contacted have studies proving how much of the active ingredient actually gets into the body and onto the site of action.
In other words, we just do not know if any of the vitamins in the patch are actually making it to where it needs to be in the body to have an effect.
If you would like to see if you benefit from a vitamin patch, here are two companies that have been recommended to me from HG survivors:
Patch MD*
- PatchMD offers dozens of vitamins and minerals and in many combinations. Please check every ingredient before ordering any because some of their patches have herbs or other supplements NOT safe during pregnancy.
AKALO
- This company offers two patches: 50mg Vitamin B1 (thiamin) and 50 mg Vitamin D3 (cholecalciferol). Both of these vitamins are known to help ease symptoms of HG as well as prevent complications.
⇒ Overall rating:
- Cost: Affordable
- Effectiveness: Variable
- Safety: Most likely safe. ***Again, do NOT use without approval from your doctor
5. Anti-nausea patches
Anti-nausea patches are sold online without a prescription. The challenge with these brands is that they each of their own proprietary combination of herbs without any information other than the names of the ingredients. Before trying an herbal patch, research each ingredient to see if it is safe during pregnancy and clear is with your medical provider.
⇒ Overall rating:
- Cost: Very cheap
- Effectiveness: Unknown
- Safety: Unknown
If you found a patch that is safe, affordable and efficacious, please let us know! info@HGPharmacist.com
Dr. Danielle Plummer, PharmD
Hyperemesis Gravidarum (HG) Consultant, Educator and Patient Advocate
Join our support group today! https://www.facebook.com/groups/hgsolutions
*I may get a commission for purchases through this link
