Table 3.

Medications recommended for treatment of hyperemesis gravidarum by major authoritative bodies

	RCOG	ACOG	EASL
First line	Antihistamines: Promethazine Cyclizine Phenothiazines: Prochlorperazine Chlorpromazine	Pyridoxine (vitamin B6) alone or in combination with doxylamine	Pyridoxine (vitamin B6) alone or in combination with doxylamine
Second line	Metoclopramide Domperidone Ondansetron	Dimenhydrinate Diphenhydramine Prochlorperazine Promethazine	Dopamine antagonists Metoclopramide Phenothiazines Chlorpromazine Prochlorperazine Anticholinergics Dicycloverine Antihistamine Cyclizine
Third line	Corticosteroids: Initially hydrocortisone intravenously Prednisolone orally with clinical improvement Taper dose gradually until at lowest maintenance dose that controls symptoms	Metoclopramide Ondansetron Trimethobenzamide (only recommended if dehydration not present)	Ondansetron Glucocorticoids
Fourth line		Chlorpromazine Methylprednisolone orally or intravenously for 3 days. Taper over 2 weeks to lowest effective dose. If beneficial, limit total duration of use to 6 weeks.

ACOG, American College of Obstetricians and Gynecologists; EASL, European Association for the Study of the Liver; RCOG, Royal College of Obstetricians and Gynaecologists.