PREGNANCY-BIRTH Messages for August, 1999: Re: Zofran and Pregnancy

Re: Zofran and Pregnancy

From: anonymous@obgyn.net
Mon, 2 Aug 1999 12:54:46 -0500 (CDT)

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In reply to: Eric: "Zofran and Pregnancy"

At Mon, 2 Aug 1999, Eric wrote: >
>My wife is 14 weeks pregnant. She has been hospitalised twice for
>ketosis (dehydration) and has lost 15lbs. in the last two weeks due her
>inability to keep anything down. She was using phenegran with mixed
>results, but her doctor has now prescribed zofran. It is my
>understanding that zofran has only been available for a little over a
>year. Is there ANY information concerning potential adverse affects to
>the baby? What about information concerning the constituant parts of
>zofran?

Zofran (ondansetron) is a very potent, very expensive antiemetic that works very well in early pregnancy. While it is a relatively new drug, it has been around a lot longer than a year. It seems I can remember it being used by anesthesiologists when I was a resident in the early 1990's for postoperative nausea.

The limiting factor for its use in pregnancy has been the very great expense, particularly in comparison to Phenergan for example. Nevertheless, I know of at least one small study and a couple of case reports regarding use in pregnancy with excellent results. Zofran is Category B, which means that either animal studies did not reveal any reproductive risk and there are no human studies, or that there was a problem noted in animal studies that was NOT confirmed in human studies. For practical purposes, this is the best that you can hope for with drugs in pregnancy, as Category A means that human studies are clear of risk, and nobody but nobody does drug studies on pregnant women. Tylenol for example is also a B.

I have this giant book about drugs in pregnancy and lactation, and quickly flipping through it revealed that only a few of the vitamins, such as C, are labeled as Category A, and not even all of them. I hope your wife gets to feeling better.

--
William D. McIntosh, MD

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