Treatment protocol

1. 1

   Step 1

   Lifestyle & nutrition
   • Vitamin B6 (pyridoxine) 10–25 mg every 6–8h
   • Ginger 250 mg 4×/day
   • Small frequent bland meals, electrolyte fluids
2. 2

   Step 2

   First-line antiemetics
   • B6 + Doxylamine 10/10 mg up to 4×/day (Diclegis / Bonjesta)
   • Add Dimenhydrinate 50–100 mg every 4–6h if needed
3. 3

   Step 3

   Add dopamine antagonist
   • Metoclopramide 5–10 mg every 8h
   • or Promethazine 12.5–25 mg every 4–6h
   • or Prochlorperazine 5–10 mg every 6–8h
4. 4

   Step 4

   5-HT3 antagonist
   • Ondansetron 4–8 mg every 6–8h (after 10 weeks gestation when possible)
5. 5

   Step 5

   Dehydration / weight loss
   • IV fluids with thiamine (B1) BEFORE dextrose
   • Correct electrolytes (K+, Mg)
   • Repeat IV fluids as needed
6. 6

   Step 6

   Refractory HG
   • Methylprednisolone 16 mg every 8h × 3 days, taper (after 10 weeks)
   • Consider NJ/NG enteral feeds or TPN if weight loss persists

Reference only. Dosing decisions belong to your provider. Always discuss medication choices in pregnancy with your OB or maternal-fetal medicine specialist.