Which first-line treatments are recommended for managing hyperemesis gravidarum in primary care?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

The recommended first-line treatments for managing hyperemesis gravidarum in primary care include oral cyclizine or promethazine (antihistamines), prochlorperazine or chlorpromazine (phenothiazines), or the combination drug doxylamine/pyridoxine (Xonvea®) .

Consider the use of doxylamine/pyridoxine depending on local prescribing guidelines, as it is the only licensed drug treatment for this indication .

Reassess the woman after 24-72 hours to evaluate response, and if symptoms respond, continue treatment and review weekly .

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