Diclegis: A New “Vintage” Treatment for Morning Sickness

As a resident physician during my OB/GYN training I remember many instances treating difficult cases of morning sickness, when my seasoned attending would wax nostalgic about the medication Benedictin. “It worked so well, I hate that its not available,” they would commonly lament. In The Pregnancy Companion, I talk about using the individual ingredients as the first line treatment of nausea during pregnancy: doxylamine {Unisom} and pyridoxine, which are currently available over the counter. While sometimes effective, many found the doxylamine too sedating for daytime use and the pyridoxine difficult to locate in the correct dose of 25 mg. Recently however Benedictin has been re-released in the US under the name “Diclegis.”  This comes in an extended release form intended to be taken as 2 pills nightly. If this is ineffective an additional pill can be taken in the morning and another at lunch. So far I have had several patient with significant improvement in their symptoms with minimal side effects.

Safety

Diclegis is the only medication for nausea in pregnancy with a category “A” safety rating, meaning is doesn’t case harm or birth defects to the baby. The label recommends to not take while breastfeeding, but the reason for this is that a small amount passes through the breast milk and may have a sedating affect on your nursing child {i.e. like giving them Benedryl}. It would likely depend on how old the nursing child is, as to how concerning this side effect would be.

Drug Interactions

Diclegis is in the antihistamine class so do not take with other antihistamines such as Benedryl, Claritin, Zyrtec, etc. Do not take with other sleep aids or alcohol {which you shouldn’t be taking when pregnant anyway.}

Price

Since it is “new”, Diclegis is not covered well on most insurance programs. It can cost a couple hundred dollars if you have no insurance, but the company does provide coupon cards that you can get from your provider.

I was a little reluctant to try this medication, not really convinced that the extended release would be better than the over the counter individual ingredients, but I have had several patients with significant relief from this medicine. Nausea and vomiting in pregnancy can be truly debilitating for some women, so I’m always excited to have another option to help my patients feel better.

For additional morning sickness remedies read my previous post here.

Did you struggle with morning sickness in pregnancy? What medications or remedies worked best for you?

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