Coming off medication

Click here for our summary of the most common HG treatments prescribed in Ireland.

Firstly, there is no need to reduce medications “just because”. Sometimes we hear from patients that their doctors feel they should be off medication by a certain stage in pregnancy, but it is more important that your HG symptoms are under control and you are as well as possible. Some people find the side-effects of medications unpleasant and want to come off them for that reason, which is also fine - for some it’s a balance between HG symptoms and medication side-effects.

There is not a lot of detailed evidence on stopping medications individually, so the below is based on practical experience from patients, doctors and pharmacists. Always ask your GP or pharmacist for specific advice if you have questions. 

We do not advise you to stop any medications suddenly: this is because your symptoms may return quickly - within a day or two - and apart from being unpleasant for you, it may then take longer to get symptoms under control again. 

The Hyperemesis Research Foundation in the USA recommend the Rule of 2s: 

• Don’t attempt to reduce until the 2nd trimester (14+ weeks)
• Don’t attempt to reduce until your symptoms have been stable for at least 2 weeks
• Only wean medications over 2 or more weeks

So what might this look like?

Example for 4 Cariban per day: one in the morning, one in the afternoon, two before bedtime:: 

1. Assess when in the day you feel best, and drop the dosage at that time. So if you feel okay around midday, try taking your morning dosage a few hours later in the morning, skip the afternoon dose, and take the nighttime dose (3 pills in total). 
2. Monitor your response to this new dosage over 2-4 days: are your symptoms stable? If you get worse, return to the previous dose and wait for 1-2 weeks of stable symptoms before trying again. 
3. Only if you are stable on that dosage, try reducing the dosage again. This time you could try only taking one pill at nighttime and one during the day (2 pills in total) 
4. Then repeat steps 2-3 above, at each step making sure your symptoms are stable for at least 2-4 days before reducing the dosage again. 

We advise reducing medications one at a time - so if you are on both Cariban (doxylamine/pyridoxine) and Stemetil (prochlorperazine), for example, try just reducing one of those at a time and not both. It may take weeks or months to fully come off all medications - this is fine. 

It’s common to hear that HG worsens slightly towards the end of pregnancy even if it has disappeared or been stable during the previous months. If this happens, it is usually fine to go back on the medication that worked for you previously - check with your doctor or pharmacist if you have any questions or concerns.