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Antiemetic in pregnancy — GPhC CRA MCQ

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HardGastro-intestinal TherapeuticsAntiemetic in pregnancyGPhC CRA

A woman at 10 weeks’ gestation has persistent nausea and vomiting despite dietary measures but is hydrated, has no abdominal pain and has not lost weight. Which prescribed option is an appropriate first-line medicine in UK practice?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Offer prescribed cyclizine after checking contraindications and sedation risk

Offer prescribed cyclizine after checking contraindications and sedation risk: RCOG recognises H1 antihistamines such as cyclizine among first-line antiemetic options with established pregnancy safety data. Offer prescribed ondansetron before trying an established first-line antihistamine: Ondansetron can be useful but is generally considered after first-line agents and requires an individual risk-benefit discussion. Offer prescribed metoclopramide for regular use throughout the pregnancy: Metoclopramide is generally second-line and duration is limited because of extrapyramidal adverse effects. Offer prescribed dexamethasone before trying any conventional antiemetic treatment: Corticosteroids are reserved for refractory hyperemesis after standard therapies. Offer prescribed domperidone after checking cardiac and interaction risks: Domperidone has QT-related cardiac risk and is not selected on the false premise of cardiac safety.

Reference: RCOG Green-top Guideline 69: nausea and vomiting of pregnancy: https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-management-of-nausea-and-vomiting-of-pregnancy-and-hyperemesis-gravidarum-green-top-guideline-no-69/; BNF: cyclizine: https://bnf.nice.org.uk/drugs/cyclizine/