Metoclopramide and nausea

[PeanutBean]

Prochlorperazine seems to be safe in the 1st and 2nd trimester so good luck.
:

Not 3rd?

 

[Holly21]

There has been some concern about using prochlorperazine in the 3rd trimester as extrapyramidal side effects in newborn babies have been reported. Extrapyramidal side effects include involuntary movements, tremors, restlessness and rigidity. I hadn't noticed how far on you are (keep thinking I'm in the 1st trimester forum) - poor you, that's awful having nausea so far on.

 

[PeanutBean]

There has been some concern about using prochlorperazine in the 3rd trimester as extrapyramidal side effects in newborn babies have been reported. Extrapyramidal side effects include involuntary movements, tremors, restlessness and rigidity. I hadn't noticed how far on you are (keep thinking I'm in the 1st trimester forum) - poor you, that's awful having nausea so far on.

Do you have any links I can follow to look up on this? I'm going to be anxious taking it now... It's not even helping much anyway!

 

[Holly21]

I get my information on drugs in pregnancy from the British National Formulary, which is the most reliable drug information source and 1 that every UK doctor uses. It comes in the form of a book (you can usually buy them off Ebay, but note that they're updated regularly - a couple of times a year I think) or you can access it online www.bnf.org

You have to register - nurses, pharmacists etc use the BNF so I would imagine members of the public can register to access it too.

This is what the page says (I've edited the irrelevant bits about other drugs):

"Home > British National Formulary > Appendix 4 Pregnancy > Table of drugs to be avoided or used with caution in pregnancy > Antipsychotics > Phenothiazines
Prochlorperazine
Third trimester: Extrapyramidal effects in neonate occasionally reported"


When we use a drug for one purpose, we often find that it has uses in other conditions too e.g. prochlorperazine is actually an antipsychotic drug but has a good antisickness effect, cyclizine is an anti-itch medicine but is also good for certain types of nausea (hence why you see antipsychotic up there). Prochlorperazine is a member of a class of drugs known as the phenothiazines, like cyclizine is a member of a class of drugs known as antihistamines.


This site is a bit more worrying https://drugsafetysite.com/prochlorperazine

You can find any amount of info if you google it - in general, reputable sites are those from a respected company e.g. a national family planning association, a medical site etc.

All medical students have it drummed into them not to prescribe anything to pregnant women unless absolutely necessary - we all know how very vulnerable babies are to drugs so it would have to be a very brave (or very stupid) doctor who prescribed anything without thoroughly checking it over. Aside from the obvious duty of care to you and your baby and the need to make sure you're both as protected as possible, doctors get sued very easily these days, especially in the field of Obstetrics, and this makes doctors think very carefully before prescribing anything for pregnant women.

No-one is going to run a drug trial comparing how drugs affect babies in utero - the risk would be too big so all we really know about drug safety in pregnancy is gained from seeing side-effects in babies whose mothers took drugs during pregnancy and feeding this back to the drug companies, BNF, other doctors etc.

As I said, I don't often come across pregant women these days but if I did any someone needed anti emetics, I would go for cyclizine over prochlorperazine. However, your doctor knows you, not me and I'd hope he/she has checked out hat is best for you. Go back and see them again if you're not satisfied and hope the nausea settles (I threw up in the shower today. Not nice. Glad I am on annual leave for a week!).

 

[PeanutBean]

Thanks for all the info Holly. I'm a scientist so well aware of the implications in assessing drug (or anything) safety in pregnant women. I have access to various scientific journals but only those subscribed to by the uni I am affiliated with. I was getting info on the drugs I've been prescribed from an NHS site (https://cks.library.nhs.uk/home) but it didn't say anything about contraindications in 3rd tri though obviously it can take time for such things to filter down.

Unfortunately despite constantly asking for my GP, who has always been very good, I've been receiving treatment from another doctor at the practice (who I've always thought was rubbish). He's not even seen me. I managed to get him to phone me and we talked for about two minutes so he doesn't really know my background or anything about me except what is in my notes. I think I mentioned further back in the thread somewhere that when I asked if the promethazine he originally prescribed (that is unavailable) was similar to cyclizine he said no, it's an antihistamine. When I asked for something other than the metoclopramide as it made my stomach wreck I specifically mentioned cyclizine and that I've had it before with success. I listened while the receptionist typed it all up and she read it back to me. But he just did the new prescription for the prochlorperazine and nothing was said about cyclizine. I don't know what to think about it all now!

 

[Holly21]

Hmm, perhaps time to start seeing your old GP or a new one - there's a time and a place for phone advice but unless a doctor really knows the patient well or it's a simple problem, or is advising another doctor about a patient, face to face is always best. I've not used the above site before but as an NHS site it should have accurate information on it.