Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: neonatal withdrawal symptoms after successful antiemetic therapy with mirtazapine

Schwarzer, Verena; Heep, Axel; Gembruch, Ulrich; Rohde, Anke

doi:10.1007/s00404-007-0406-5

Cited by 25 publications

(15 citation statements)

References 17 publications

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“…Mirtazapine is a new antidepressant that selectively blocks postsynaptic 5-HT 2 and 5-HT 3 receptors [7]. As it blocks receptors associated with nausea and vomiting, mirtazapine had been shown to treat severe vomiting during pregnancy [8] and to treat cancer patients with pain, nausea and a variety of distressing symptoms [9,10]. Its anti-emetic effect has also been reported after laparoscopy surgery [11] and gastric bypass [12].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Chang

Sheen

2010

Anaesthesia

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SummaryNausea and vomiting are frequent complications of intrathecal morphine. In this randomised, double-blind trial, we tested the efficacy of mirtazapine, an antidepressant that blocks receptors associated with vomiting, on the incidence of nausea and vomiting after intrathecal morphine. One hundred patients receiving spinal anaesthesia for lower limb surgery were assigned equally to take either an orally disintegrating form of 30 mg mirtazapine or matching placebo 1 h before surgery. Spinal anaesthesia was performed by injection of 15 mg isobaric bupivacaine 0.5% along with 0.2 mg preservative-free morphine. Nausea and vomiting were evaluated 3, 6, 12, 18 and 24 h after intrathecal morphine administration. The incidence of nausea and vomiting was significantly lower in patients receiving mirtazapine compared with placebo (26.5% vs 56.3%, respectively; p = 0.005). The mean (SD) onset time of postoperative nausea and vomiting was significantly delayed in mirtazapine patients: 9.4 (2.5) vs 5.2 (1.8) h, respectively; p < 0.0001. The severity of nausea and vomiting was also decreased after mirtazapine at the 3-6 h and 6-12 h periods. Our data indicate that pre-operative mirtazapine decreases the incidence, delays the onset and reduces the severity of nausea and vomiting induced by intrathecal morphine in patients undergoing spinal anaesthesia. A single dose of intrathecal morphine is often administered to patients undergoing major orthopaedic procedures to provide sustained postoperative analgesia. Postoperative nausea and vomiting (PONV) occurs frequently, with a reported incidence of up to 74% and lasting up to 24 h [1]. Serotonin (5-HT 3 ) receptor antagonists have been used as anti-emetics to prevent or to treat nausea and vomiting induced by intrathecal morphine [2][3][4][5][6]. Mirtazapine is a new antidepressant that selectively blocks postsynaptic 5-HT 2 and 5-HT 3 receptors [7]. As it blocks receptors associated with nausea and vomiting, mirtazapine had been shown to treat severe vomiting during pregnancy [8] and to treat cancer patients with pain, nausea and a variety of distressing symptoms [9,10]. Its anti-emetic effect has also been reported after laparoscopy surgery [11] and gastric bypass [12]. Its effect on the prevention of intrathecal morphine-induced PONV has not yet undergone evaluation. We therefore hypothesised that prophylactic mirtazapine would reduce the incidence and delay the onset of intrathecal morphine-induced PONV in patients undergoing orthopaedic surgery. MethodsThe protocol was approved by the Clinical Research Ethics

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Section: Discussionmentioning

confidence: 99%

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Chang

Sheen

2010

Anaesthesia

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“…Another risk factor that must be taken into consideration is the possibility of fetal side effects [2,66]. Antidepressants such as mirtazapine have also been used with some success in ameliorating the symptoms of HG [67]. …”

Section: Treatment Strategiesmentioning

confidence: 99%

Managing hyperemesis gravidarum: a multimodal challenge

Jueckstock

Kaestner

Mylonas

2010

BMC Med

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Up to 90% of pregnant women experience nausea and vomiting. When prolonged or severe, this is known as hyperemesis gravidarum (HG), which can, in individual cases, be life threatening. In this article the aetiology, diagnosis and treatment strategies will be presented based on a selective literature review. Treatment strategies range from outpatient dietary advice and antiemetic drugs to hospitalization and intravenous (IV) fluid replacement in persistent or severe cases. Alternative methods, such as acupuncture, are not yet evidence based but sometimes have a therapeutic effect.In most cases, the condition is self limiting and subsides by around 20 weeks gestation. More severe forms require medical intervention once other organic causes of nausea and vomiting have been excluded. In addition, a psychosomatic approach is often helpful.In view of its potential complexity, general practitioners and obstetricians should be well informed about HG and therapy should be multimodal.

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“…15 Nevertheless, a warning for PNAS is stated by the UK Teratology Information Service (uktis.org), with the suggestion to monitor exposed neonates postpartum for 2 days to detect possible adverse effects. These data showed no evidence of increased risk for congenital malformation.…”

mentioning

confidence: 99%

Mirtazapine in Pregnancy and Lactation

Smit

Wennink²,

Heres³

et al. 2015

Journal of Clinical Psychopharmacology

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Depression is a common disorder in pregnancy and associated with adverse effects for both mother and neonate. Pharmacological treatment and prevention options include mirtazapine. In a series of 56 cases, we investigated neonatal outcome after intrauterine exposure to mirtazapine and exposure through lactation in the first days postpartum.No increase in any neonatal complication was observed. None of the infants exposed to mirtazapine in the first trimester were born with a major malformation. Of the 54 infants exposed to mirtazapine in the third trimester, 14 were diagnosed with poor neonatal adaptation syndrome (PNAS). This incidence (25.9%) is similar to the incidence of PNAS after intrauterine exposure to other antidepressants. The incidence of PNAS after exposure to mirtazapine was significantly diminished in children who were partially or fully breastfed (18.6% versus 54.5%, P = 0.024).

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Treatment resistant hyperemesis gravidarum in a patient with type 1 diabetes mellitus: neonatal withdrawal symptoms after successful antiemetic therapy with mirtazapine

Cited by 25 publications

References 17 publications

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Efficacy of mirtazapine in preventing intrathecalmorphine‐induced nausea and vomiting after orthopaedic surgery*

Managing hyperemesis gravidarum: a multimodal challenge

Mirtazapine in Pregnancy and Lactation

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