Hyperemesis Gravidarum Patient Treatment Overview - Patient Reference for HER Treatment Algorithm

Sep 27, 2026

Hyperemesis gravidarum (HG) treatment focuses on addressing severe nausea and vomiting during pregnancy by using a staged medication approach. The plan aims to increase daily fluid and food intake and maintain daily functioning, while recognizing that medications may not relieve every symptom. The overview provides step-by-step guidance across preconception, onset, mild symptoms, and moderate to severe disease, including vitamin B1/B6 regimens, supplement preparation, and options for acid irritation and nausea control.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Treatment goals and approach

Treatment steps overview

Step 1: PREP (3-6 months before conception)

Core supplements

Optional supplements

Step 2: ONSET

Adjust supplements and start B1/B6

Acid reducer and B6/doxylamine options

Step 3: MILD symptoms

When to continue or switch

Antihistamine and additional medication options

Step 4: MODERATE TO SEVERE

Dose escalation and non-pill options

Acid blocker/PPI and nausea options

©2022 HER Foundat ion . All rights reserved . Hyperemesis Gravidarum Patient Treatment Overview Patient Reference for HER Treatment Algorithm HG symptoms are caused by multiple triggers, so multiple medications are usually needed. Goals of treatment are to increase fluid and food intake and daily functioning. Medications will not relieve all symptoms but should help you reach these goals. | Treatment steps build on each other. Start at Step1 or 2, then consider adding medications as needed.
HG is severe nausea and/or See HER Foundation tools for Take only one medication from vomiting in pregnancy. more info [hyperemesis.org/tools](hyperemesis.org/tools). each category at a time. | | | --- | --- | | DISCUSS THIS WITH YOUR HEALTHCARE PROVIDER BEFORE MAKING ANY CHANGES TO YOUR MEDICAL CARE.
This is not a substitute for a medical consultation. Medication use requires an assessment of risks and benefits. The medications in this Overview have low risk of fetal harm and benefits outweigh the risks in HG. Increasing medication dose is unlikely to increase risks but may increase side-effects. | | | STEP 1: PREP
3-6 months before conception.
Prepare with suggested supplements below.
Supplements
Consider taking all of the following:
1. B Complex twice daily (minimum 10 mg B1, 10 mg B6) or B-100 once daily
2. Prenatal multivitamin daily including minimum:› Folic acid/folate 600 mcg › Phosphatidylcholine 450
mg
› Iron 25 mg (ferrous bisglycinate often better tolerated) .
» Take additional supplements as needed to reach above doses.
Optional Supplements
1. Vitamin D with vitamin K daily (minimum 2000 IU of D)
2. Calcium with Magnesium Glycinate, approximately 200
mg each, twice daily Important Information Caution Medications in italics are prescription only.
| STEP 2: ONSET
Immediately upon onset of nausea and/or vomiting symptoms.
Take vitamin B1 ( Benfotiamine) 100 mg daily AND vitamin B6 100 mg daily, plus other supplements from Step 1 as tolerated.
Supplement Adjustments
If not tolerating supplements from Step 1, consider these daily:
1. Change to iron-free prenatal or take smaller amounts of prenatal multivitamin when manageable.
2. Add individual supplements to reach doses listed in Step 1: vitamin D drops or pills, phosphatidylcholine, iron, and folic acid.
Daily vitamin B1 ( Benfotiamine) is most important.
+ ADD
Acid reducer
Famotidine (Pepcid) 20-40 mg at bedtime if acid reflux symptoms
+ ADD
B6/Doxylamine
Consider ONE of these Vitamin B6 plus Doxylamine Combinations.
A. Vitamin B6 (Pyridoxine) 25 mg plus Doxylamine (Unisom) 12.5 mg every 6 hours OR
B. Diclegis/Diclectin Take three times daily (two pills before bed, one pill in morning, one pill in afternoon) OR
C. Bonjesta 20 mg twice daily (one pill in morning and one before bed)» Continue B6 supplement up to 100 mg daily if tolerated.
» Each option has different effects and side-effects.
If these are not available or tolerated, and/or symptoms do not improve, switch to one of the antihistamine options in Step 3.
Limit total amount of vitamin B6 to 150 mg per day.
| [hyperemesis.org](hyperemesis.org) [info@hyperemesis.org](info@hyperemesis.org) @HGmoms @HGmoms \#Advocate4HER [facebook.com/HERFoundation](facebook.com/HERFoundation) [linkedin.com/company/herfoundation](linkedin.com/company/herfoundation) ©2022 HER Foundat ion . All rights reserved . STEP 3: MILD If symptoms partly reduce food and fluid intake. Continue vitamin B1 ( Benfotiamine) 100 mg daily plus other supplements as tolerated. Option A: If symptoms are worsening rapidly and/or food or fluid intake is less than half of normal amount, continue B6/Doxylamine or switch to ONE antihistamine below and MOVE immediately to Step 4. Option B: If symptoms are mild and food/fluid intake is more than half of usual amount, but an alternate antihistamine is p

FAQs

What are the main goals of HG treatment in this overview?

Goals are to increase fluid and food intake and support daily functioning. Medications are intended to help reach these goals, even if they do not relieve all symptoms.

What should be done before conception (Step 1) to prepare for HG treatment?

Prepare 3–6 months before conception using suggested supplements, including B complex and prenatal multivitamin with minimum folic acid/folate and iron. Optional supplements such as vitamin D with vitamin K and calcium with magnesium glycinate may also be considered.

Which treatment changes are recommended when symptoms begin (Step 2)?

Immediately after nausea and/or vomiting starts, take vitamin B1 (Benfotiamine) and vitamin B6 daily and use tolerated supplements from Step 1. Add options such as an acid reducer (famotidine) and consider one B6 plus doxylamine combination; if not available or tolerated and symptoms don’t improve, move toward antihistamine options in the next step.

Sep 27, 2026

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