I always assumed morning sickness was a normal, NBD part of being pregnant. I’m in my late 30s, which means many of my friends have already had kids and shared stories about the days they spent clutching their toilet bowls. The image of Katherine Heigl puking at work in Knocked Up is permanently seared into my mind.
But it wasn’t until I got pregnant last year—and, to my surprise, with twins—that I understood just how truly horrendous morning sickness can be (or that it tends to last all day). I am currently five months along, but when I tell you that the first four months were the trenches….
I tried everything to settle my stomach—sour candies, frequent and small meals, forcing myself to nap—but I could not overcome the overwhelming waves of nausea that hit me every 20 minutes and sent me running for the bathroom. That is, until my doctor prescribed me a magic pill called Zofran. I’d never heard of this drug, and was immediately freaked out—it seemed to me that everything you do while pregnant comes with some level of risk—but I was desperate. “I’m in,” I told him.
Now, I am here to pass on the wisdom I’ve gathered learning about Zofran—like how it works, how safe it is, and why it’s been stigmatized. Let’s dig in.
What is Zofran—and how does it work?
When you’re pregnant, your body undergoes massive hormonal changes (mainly, estrogen and a pregnancy hormone called human chorionic gonadotropin, or HCG, surges) that send your gut and brain through the ringer. At the same time, digestion slows down (hello, constipation!) and your lower esophageal sphincter relaxes, which could cause acid reflux. “All of that together is at the root of pregnancy nausea,” Arianna Cassidy, MD, a maternal fetal medicine specialist at UCSF Health, tells SELF.
Pregnancy nausea is extremely common, with estimates suggesting it impacts up to 80% of people. And roughly 1% to 2% of pregnant people (even more likely for those diagnosed with a hydatidiform mole—a rare mass that can grow in non-viable pregnancies—or who are carrying multiples) develop hyperemesis gravidarum (HG)—a condition that causes very intense, very relentless nausea and vomiting that can send you to a hospital.
While some lucky people never feel ill, that queasiness can be pretty debilitating for many others—more so in the first trimester, but occasionally throughout the entire pregnancy. “It can be very challenging for people to go through their normal day-to-day activities and routines if they’re constantly feeling nauseated,” Katherine Kohari, MD, FACOG, a maternal fetal medicine specialist with Yale Medicine, tells SELF. Plus, not being able to keep food down can, in serious cases, affect your baby’s growth and weight at birth.
Zofran, the brand name for ondansetron, is a prescription anti-nausea medication that blocks serotonin receptors in your gut and brain that, in turn, prevents them from triggering nausea and vomiting. It’s not specifically approved for pregnancy vomiting, so it’s technically given off-label.
Typically, doctors recommend trying a few other tricks first—eating products with ginger, taking a combo of the over-the-counter drugs doxylamine (Unisom) and vitamin B6, and even acupuncture. The next step is prescribing Diclegis or Bonjesta, two prescription drugs that contain a pre-dosed, time-released combination of doxylamine and vitamin B6. They’re taken at the same time (or times) every day to prevent nausea from striking and have been shown to be both pretty effective and safe, says Dr. Kohari.
“But there are some people who still feel miserable, and that’s when we get to next-line medications like Zofran,” says Dr. Cassidy. You usually take it as needed—when you start to feel icky—rather than on a routine schedule. The reason it’s a go-to for pregnant people like me who have trouble keeping down breakfast (and lunch, and dinner)? “It works really, really well,” Dr. Cassidy says. And I can confirm: It absolutely does.
If this is the first you’re hearing of Zofran, thank the stigma.
If you’ve never heard of Zofran before now, well, join the club. Like I said, I hadn’t either until my doctor suggested I take it. It’s not a new drug—in fact, it’s been around since the ’90s and was and is commonly prescribed to help pregnant people get through the day without constantly hurling. It’s also commonly prescribed for cancer patients who are experiencing nausea due to chemotherapy or radiation.
Years ago, some small studies came out suggesting Zofran was linked to an increased risk of birth defects, including cleft lip, cleft palate, and certain heart anomalies, but newer research tells a different story. “Many, many studies done more recently suggest the absolute risk of those defects is very low,” says Dr. Cassidy. In fact, recent studies show there really isn’t a greater risk of birth defects with Zofran at all, she adds. The current consensus: It’s a safe, low-risk drug to take during pregnancy.
Still, if and when any study links a drug to a fetal anomaly—even if it’s tiny, from years ago, or questionably conducted—it can be tough to change people’s minds or get rid of the stigma it fuels. “It’s really hard to unring that bell, even if studies come out later suggesting it’s not a real association or a significant association,” says Dr. Cassidy.
Plus, as Dr. Cassidy told me, people have always been a bit nervous to take any type of medicine—or putting anything foreign in their bodies—when pregnant. There’s a solid chance that in recent months, that reluctance has only grown—thanks to RFK Jr.’s war against Tylenol, as SELF previously reported.
Another reason this may be the first you’re hearing of Zofran for pregnancy: “People may feel embarrassed that they’re so sick they need a medication or, perhaps, they might be judged for exposing their baby to something,” Dr. Kohari suspects. So they keep it to themselves.
When to ask for—and take—Zofran safely
When I asked Dr. Cassidy if she offers Zofran to her patients, she said, “Yes, absolutely.” If you can get by without taking a pharmaceutical intervention, that’s great—go that route. “But many people can’t, so I prescribe Zofran frequently,” says Dr. Cassidy. Dr. Kohari felt the same: “I have no hesitation, for patients who really need it, of giving someone Zofran.”
Depending on how diabolical your nausea is, you can have four to eight milligrams of the drug, taken up to two to three times a day. It works best to pop it in right when your nausea hits, and not when you’re already in total misery, advises Dr. Kohari. “That’s when it’s harder to break those symptoms,” she says.
There are a few safety concerns to be aware of—as there are with any medication. People with underlying cardiovascular conditions, like long QT syndrome, should avoid Zofran as it can impact electrical signaling in the mother’s heart. It also interacts with certain medications, including some psychiatric medications and various antibiotics, that, when taken together, further increase the risk of cardiac complications. In these instances, there are alternative options, like Reglan, a prescription drug used to treat GERD plus nausea and vomiting, or rectal suppositories like promethazine, that may be a better fit.
This is all to say: If you’re gagging up a storm, especially when your roommate or partner cooks chicken (truly, how dare they?), it’s worth asking your doctor about this pill. It changed my life, and who knows, maybe it’ll help yours too.
Related:
- It’s Time to Get Real About How Long Postpartum Can Last
- What to Know About Bleeding During Pregnancy
- I Had Postpartum Preeclampsia Like Meghan Markle. Here’s What It Was Like
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