Pyridoxine Doxylamine: Effective Pregnancy Nausea Treatment

Summary of Key Points

Pyridoxine/doxylamine is a combination medication commonly prescribed to manage nausea and vomiting during pregnancy, including morning sickness and hyperemesis gravidarum. It may also be used for conditions such as insomnia and anxiety. While generally well-tolerated, side effects like drowsiness can occur. Always consult your healthcare provider before starting or adjusting your dose. You can schedule a telemedicine appointment with one of our providers for personalized care.

Names of Medication

US Brand Name: Diclegis (Pyridoxine/Doxylamine)

The generic name refers to the active ingredients in the medication, regardless of the brand under which it is sold.

Pharmacologic Category

Pyridoxine/doxylamine falls into several pharmacologic categories:

1. Antiemetic: Helps prevent nausea and vomiting, making it a common choice for treating pregnancy-related nausea.
2. Antihistamine: Blocks histamine to alleviate allergy symptoms.
3. Sleep Aid: Assists with sleep disorders, including insomnia.

Dosing Guidelines for Pyridoxine/Doxylamine

Nausea and Vomiting in Pregnancy (Morning Sickness): The typical starting dose is 2 tablets (each containing 10 mg of doxylamine and 10 mg of pyridoxine) taken at bedtime. If symptoms persist, 1 tablet may be added in the morning and another in the afternoon. Always consult your doctor before adjusting your dose.

Hyperemesis Gravidarum: This severe form of nausea and vomiting during pregnancy may require a higher dose or additional treatments. Consult your healthcare provider for personalized advice.

Insomnia and Sleep Disorders: The usual dose is 1-2 tablets (each containing 10 mg of doxylamine) taken 30 minutes before bedtime. Do not exceed the recommended dose. Speak with your doctor if symptoms persist.

Anxiety: Although not primarily used for anxiety, this medication may be prescribed off-label for its sedative effects. The typical dose is 1-2 tablets at bedtime. Always consult your healthcare provider before using this medication for anxiety.

Motion Sickness: Take 1-2 tablets 30 minutes before travel. If needed, an additional dose may be taken every 6-8 hours, but do not exceed 4 doses in 24 hours. Consult your doctor for personalized dosing.

Allergic Rhinitis and Cold Symptoms: Take 1 tablet every 6-8 hours as needed for symptom relief. Do not exceed 4 doses in 24 hours. Always consult your healthcare provider before using this medication for allergy or cold symptoms.

Dosage Forms and Strengths

Pyridoxine/doxylamine is available in the following forms:

1. Tablets: 10 mg pyridoxine / 10 mg doxylamine
2. Extended-release tablets: 20 mg pyridoxine / 20 mg doxylamine

Administration Instructions for Pyridoxine/Doxylamine

Take pyridoxine/doxylamine tablets with a full glass of water. It is best to take the medication on an empty stomach, about 30 minutes to an hour before meals or bedtime, depending on your condition. Do not crush, chew, or split the tablets. If you miss a dose, take it as soon as you remember, but do not double up on doses. Always follow your healthcare provider’s instructions and consult them if you have any questions.

Adverse Reactions and Side Effects

While pyridoxine/doxylamine is generally well-tolerated, some side effects may occur:

1. Drowsiness (Very Common): This medication may cause significant drowsiness. Avoid driving or operating heavy machinery while taking it.
2. Dry Mouth (Common): You may experience dry mouth. Staying hydrated and using sugar-free lozenges can help alleviate this symptom.
3. Dizziness (Common): Some patients report feeling lightheaded or dizzy. Be cautious when standing up quickly.
4. Headache (Less Common): Mild headaches may occur but are usually temporary.
5. Constipation (Less Common): This medication may slow digestion, leading to constipation. Increasing fiber intake can help manage this side effect.
6. Blurred Vision (Rare): Some individuals may experience temporary blurred vision. If this occurs, contact your healthcare provider.
7. Allergic Reaction (Rare): Seek immediate medical attention if you experience symptoms such as rash, itching, or difficulty breathing.

Contraindications for Pyridoxine/Doxylamine

A contraindication is a specific situation where a medication should not be used because it may cause harm. For pyridoxine/doxylamine, several contraindications exist. If any of these apply to you, discuss them with your healthcare provider before starting the medication.

1. Allergy to Pyridoxine or Doxylamine: If you have a known allergy to pyridoxine (vitamin B6) or doxylamine (an antihistamine), taking this medication could trigger a severe allergic reaction, including rash, itching, swelling, or difficulty breathing.
2. Use of Monoamine Oxidase Inhibitors (MAOIs): MAOIs, such as phenelzine (Nardil) or tranylcypromine (Parnate), can dangerously interact with doxylamine, leading to increased side effects like drowsiness, confusion, or even life-threatening conditions such as serotonin syndrome.
3. Asthma or Chronic Obstructive Pulmonary Disease (COPD): Doxylamine can cause respiratory depression (slowed breathing), which may worsen symptoms in people with asthma or COPD.
4. Glaucoma: Doxylamine may increase pressure in the eyes, worsening glaucoma and potentially leading to vision problems.
5. Stomach or Intestinal Blockage: Doxylamine can slow intestinal movement, exacerbating conditions like bowel obstruction or pyloric stenosis.
6. Urinary Retention: If you have difficulty urinating due to conditions like an enlarged prostate, doxylamine can worsen urinary retention.

If you have any of these conditions, it’s important to talk to one of our providers through telemedicine to discuss safer alternatives.

Drug to Drug Interactions

Pyridoxine/doxylamine can interact with other medications, potentially increasing side effects or reducing the effectiveness of your treatment. It’s important to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements. Below are some medications that may interact with Pyridoxine/doxylamine:

1. Alcohol: Consuming alcohol while taking Pyridoxine/doxylamine can intensify drowsiness and dizziness.
2. Other Antihistamines: Medications like diphenhydramine (Benadryl) or cetirizine (Zyrtec) can enhance the sedative effects of doxylamine, leading to excessive drowsiness or confusion.
3. Opioids: Drugs such as oxycodone (OxyContin) or hydrocodone (Vicodin) can increase the risk of severe drowsiness, respiratory depression, or confusion when combined with Pyridoxine/doxylamine.
4. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) or serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor) may interact with doxylamine, raising the risk of serotonin syndrome.
5. Anticholinergic Drugs: Medications such as atropine or scopolamine can increase side effects like dry mouth, constipation, and confusion when taken with doxylamine.

Always consult your healthcare provider before starting or stopping any medications. Our telemedicine providers are available to help you manage your medications safely.

Pyridoxine/doxylamine in Pregnancy

Is Pyridoxine/doxylamine Safe During Pregnancy?

Yes, Pyridoxine/doxylamine is considered safe during pregnancy, particularly for treating nausea and vomiting (commonly known as morning sickness). It is often the first-line treatment recommended by healthcare providers. The combination of vitamin B6 (pyridoxine) and doxylamine has been extensively studied and is generally well-tolerated by pregnant women. However, it’s essential to consult your healthcare provider before starting any new medication during pregnancy. If you’re experiencing morning sickness, one of our telemedicine providers can help determine if Pyridoxine/doxylamine is right for you.

Pyridoxine/doxylamine while Breastfeeding

Is Pyridoxine/doxylamine Safe While Breastfeeding?

While Pyridoxine is generally safe during breastfeeding, doxylamine may pass into breast milk and could cause drowsiness or irritability in a nursing infant. It’s important to weigh the benefits and risks with your healthcare provider. If you are breastfeeding and considering this medication, our telemedicine providers can help you make an informed decision based on your specific situation.

Estimated Cost of Pyridoxine/doxylamine

The estimated cost of a 30-day supply of Pyridoxine/doxylamine without insurance, using a GoodRX coupon, ranges from $20 to $50, depending on the pharmacy and location. Prices may vary, so it’s a good idea to check with your local pharmacy or use a discount service like GoodRX to find the best price.

Possible Alternatives to Pyridoxine/doxylamine

If Pyridoxine/doxylamine isn’t the right choice for you, there are alternative treatments and lifestyle changes that may help manage your symptoms. Always discuss these options with your healthcare provider before making changes to your treatment plan. Our telemedicine providers are available to help you explore these alternatives.

1. Nausea and Vomiting: Ginger supplements, acupressure wristbands, and dietary changes (such as eating smaller, more frequent meals) may help reduce nausea. Prescription medications like ondansetron (Zofran) or metoclopramide (Reglan) may also be considered.
2. Morning Sickness: In addition to Pyridoxine/doxylamine, lifestyle changes such as avoiding triggers (like strong smells) and staying hydrated can help. Ginger or vitamin B6 supplements may also be effective.
3. Hyperemesis Gravidarum: This severe form of morning sickness may require intravenous fluids, hospitalization, or other medications like ondansetron (Zofran) or corticosteroids. Consult a healthcare provider for personalized treatment options.
4. Insomnia: Cognitive-behavioral therapy for insomnia (CBT-I), melatonin supplements, and good sleep hygiene practices (such as maintaining a regular sleep schedule) are common alternatives.
5. Anxiety: Non-medication options such as mindfulness, cognitive-behavioral therapy (CBT), and relaxation techniques may help. Medications like selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines may also be considered.
6. Motion Sickness: Over-the-counter options like dimenhydrinate (Dramamine) or meclizine (Antivert) are common alternatives. Non-medication options include acupressure wristbands or focusing on the horizon while traveling.
7. Allergic Rhinitis: Antihistamines like loratadine (Claritin) or cetirizine (Zyrtec), nasal corticosteroids, and allergen avoidance are common alternatives.
8. Cold Symptoms: Over-the-counter cold medications, rest, hydration, and saline nasal sprays may help alleviate symptoms. Always consult a healthcare provider before using multiple medications to avoid interactions.
9. Sleep Disorders: In addition to medications, sleep disorders can often be managed with lifestyle changes like improving sleep hygiene, reducing caffeine intake, and practicing relaxation techniques before bed.

Recent Updates on Pyridoxine/doxylamine Research

Recent studies continue to support the safety and effectiveness of Pyridoxine/doxylamine in treating nausea and vomiting during pregnancy. A 2021 study published in the journal Obstetrics & Gynecology reaffirmed that this combination remains a first-line treatment for morning sickness, with minimal risk to the fetus. Additionally, ongoing research is exploring the potential use of Pyridoxine/doxylamine for other conditions, such as insomnia and anxiety, though more studies are needed to confirm its effectiveness in these areas.

As always, consult your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to discuss the latest research and help you make informed decisions about your health.

James Kingsley

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