Step

Pharmacotherapy

Dosing

Considerations

1

IV Fluid hydration with electrolyte and vitamins

Maintenance fluid requirements

Fluids used contained potassium, thiamine, magnesium

2

Pyridoxine

Oral pyridoxine 25 mg every 8 hours

If not tolerating oral, 25 mg added to IV fluid solution

3

Anti-histamines

Benadryl 25 mg IV every 8 hours

4

Ondansetron

4 mg IV every 8 hours

Prolonged QT interval

5

Metoclopramide

10 mg IV in 50 mL D5W administered IVPB

Extra-pyramidal side effects

6

Promethazine

25 mg rectal suppository every 6 hours

7

Corticosteroids

Methylprednisone 16 mg every 8 hours for 3 days, followed by 2-week taper to lowest effective dose

Concerns regarding birth defects with first trimester use