But sometimes if morning sickness is left untreated—or if it morphs into hyperemesis gravidarum, a severe form of morning sickness—it can wreak havoc on your system, especially if accompanied by vomiting. In fact, if severe morning sickness is left untreated, it can potentially lead to significant weight loss, dehydration, and possibly even malnutrition. In extreme cases, it could even put your pregnancy at risk. When morning sickness gets extreme, most expectant parents start to explore their options for relief from the persistent—and sometimes overwhelming—nausea and vomiting. One option that pops up pretty regularly is the anti-nausea medication Zofran. Although Zofran is typically used to treat nausea and vomiting in cancer patients and those who struggle with migraines, doctors do sometimes prescribe Zofran for their pregnant patients. Often this is after other options have been exhausted, though. So, just how safe is it to use Zofran in pregnancy? Here we help you weigh the risks and benefits of taking Zofran in pregnancy as well as provide other options so that you can decide what is right for you.
What Is Zofran?
Sometimes called ondansetron, Zofran is a drug that blocks the effects of serotonin and is approved by the Food and Drug Administration (FDA) to treat nausea and vomiting associated with chemotherapy or following surgeries, says Nate Hux, RPH, a registered pharmacist, and owner of Pickerington Pharmacy in central Ohio. It also is prescribed to treat nausea and vomiting present with migraines. Because of its effectiveness at reducing vomiting and nauseousness, some doctors even prescribe the medication to treat morning sickness—which is considered an off-label use of the drug. Although there are several different ways that Zofran can be prescribed, one of the most common is in the form of a quick-dissolving tablet that you can place under your tongue. “Initially, [Zofran] was very expensive at $10 to $15 per pill, so it had a small population using the drug,” says Hux. “But over time, as generics became available, physicians began to prescribe Zofran more frequently. In my practice, what I see most is from the ER.”
Is It Safe to Take Zofran During Pregnancy?
Study results are mixed when it comes to taking Zofran in pregnancy to treat morning sickness. However, recent studies indicate that it can be a relatively safe drug to take when pregnant. For instance, the Centers for Disease Control and Prevention (CDC) indicates that for most of the birth defects looked at in a 2018 study, researchers found that taking ondansetron during early pregnancy did not appear to increase the chance of having a baby with a birth defect. Additionally, the FDA agrees with this assessment. They point out that available data does not make a reliable connection between ondansetron and an increased risk of cleft palate or heart defects. They believe other factors could have influenced the reported health issues because people with severe nausea often have metabolic changes and nutritional deficiencies, which also put babies at risk for defects. Meanwhile, a more recent meta-analysis of eight studies suggests that exposure to ondansetron in early pregnancy could have a very small increase in the risk of heart defects and cleft palate in babies. But, this increased risk was very minimal with an increased risk of .03% for cleft palate and .03% for heart defects. That said, many doctors are comfortable prescribing Zofran for morning sickness when the situation warrants it. In fact, the CDC indicates that the off-label use of Zofran for nausea in pregnancy went from 1 in 100 before 2000 to about 1 in 10 by 2011. “Taking Zofran while pregnant is low risk,” says Shannon Ho, MD, assistant medical director of maternal-fetal medicine at OhioHealth Dublin Methodist Hospital. “But as a general rule of thumb, if it’s not needed, I don’t recommend the drug.” Additionally, Dr. Ho says that she prefers ondansetron over other similar medications because it’s non-sedating and allows people who are pregnant to get through those early weeks of pregnancy that can be particularly challenging. This is especially important if they are trying to work, take care of their family, and manage morning sickness. What’s more, she says that she took Zofran in all of her pregnancies, so she feels comfortable prescribing it when it is needed. “For instance, some women will get significant relief just from taking their prenatal vitamins at night,” says Dr. Ho. “Others find relief following a bland diet, like the BRAT diet (bananas, rice, applesauce, and toast).” Fortunately, when it comes to morning sickness, it is usually short-lived and will pass by about 14 to 16 weeks, Dr. Ho says. But if you are suffering and you have tried other things, she encourages you to talk to your healthcare provider. “Women are doing so many things and wearing so many hats,” she says. “It’s hard to step back and say ‘I have to take care of me.’ When you get sick it affects the whole family unit. We are here to help you. I want my patients to be happy and healthy and I want them to take home happy and healthy babies.” Overall, Hux and Dr. Ho indicate that Zofran is a safe drug with very few side effects. Still, as with any medication, you have to compare the risk to benefit when determining if it is right for you, Hux says. “I always err on the side of caution,” he says. “I never want to be the one that says a drug is 100% safe and then something bad happens.”
What If I Take Zofran Before Realizing I Am Pregnant?
Because Zofran is generally a safe drug and typically not taken for long periods of time, Hux says that there is probably nothing to worry about if you took Zofran before finding out you were pregnant. Still, he would recommend that you talk to your healthcare provider. “Every drug is dose dependent—the higher the dose the greater the risk,” explains Hux. “But 99% of people only take Zofran when needed. There are a handful of people who take it regularly that have conditions that warrant the use every day, but for most people this is not the case.”
Safety Precautions
Typically, Zofran is only prescribed for morning sickness in pregnancy when absolutely needed. If your healthcare provider has prescribed the drug, it is likely because you have exhausted all other possibilities and the benefits outweigh the risks. After all, severe morning sickness can cause serious complications if it is left untreated. Typically, pregnant individuals who are prescribed Zofran are instructed to take smaller amounts than the dosage recommended for non-pregnant people. Once you start feeling better, you can typically discontinue its use. As with any drug, there are some potential side effects like drowsiness, lightheadedness, constipation, and headaches. Talk to your healthcare provider about anything you are experiencing. They may be able to alter the dosage or ask you to discontinue use if your symptoms warrant it. You also should contact your healthcare provider if you develop a rash or feel like you are not tolerating the medication well.
Pregnancy Safe Alternatives
If you are struggling with morning sickness and are looking for ways to find relief, Hux and Dr. Ho indicate there are some other non-pharmacological as well as over-the-counter options you can try before taking Zofran. Aside from avoiding food and drinks that trigger nausea for you and taking your prenatal vitamins at night, here are some other ways to address nausea in pregnancy.
Ask About Unisom and Vitamin B6
Both Dr. Ho and Hux recommend talking to a healthcare provider about taking vitamin B6 as well as Unisom (or doxylamine). In fact, the American Congress of Obstetrics and Gynecology (ACOG) recommends starting with 10 to 25 mg of vitamin B6 three or four times a day to treat nausea and vomiting in pregnancy. Then, if taking vitamin B6 doesn’t improve your symptoms, they recommend adding doxylamine (or Unisom). In fact, research has shown that combining vitamin B6 with doxylamine has been associated with a 70% reduction in nausea and vomiting in pregnant women. And, for those that do not want to try to determine how much to take of each, there is a drug called Diclegis that combines the two. This drug can be prescribed by a healthcare provider, but tends to be very expensive, Hux says.
Try Ginger Products
Hux recommends trying ginger gum or ginger candies to help alleviate nausea. In fact, multiple studies have shown that ginger is a safe, effective, and inexpensive treatment for nausea and vomiting in pregnancy.
A Word From Verywell
If you are struggling with severe morning sickness—or even hyperemesis gravidarum—don’t try to power through it. Talk to a healthcare provider about your symptoms. Together you can come up with a plan that is right for you. Sometimes that plan might include non-pharmacological options like ginger candy and saltines, other times it might require taking Zofran or another medication for a short period of time. The important thing is that you focus on taking care of yourself so that you can have a safe and healthy pregnancy.
