Home subcutaneous metochlopramide therapy for hyperemesis gravidarum

Objective: To evaluate the efficacy, safety, and economics of home subcutaneous metochlopramide (Reglan) therapy for hyperemesis gravidarum.Methods: All charts of patients who underwent home therapy via a standard protocol utilizing a pump to administer metochlopramide subcutaneously between January 1994 and December 1995 were reviewed. Data were collected on the resolution of symptoms, reason for discontinuance of therapy, additional antiemetic therapy before, during, and after subcutaneous metochlopramide therapy, and side effects.Results: A total of 301 patients received home subcutaneous therapy with metochlopramide: 195 (64.8%) patients had complete resolution of symptoms, 32 (10.6%) patients discontinued therapy because of side effects, and 43 (14.3%) discontinued therapy because of worsening symptoms. A total of 16 (5.2%) patients discontinued therapy for other/nonspecific reasons. Two hundred twenty-two (73.8%) patients received one or more antiemetics prior to subcutaneous metochlopramide therapy. This number decreased to 6 (3%) of the group successfully treated who required any maintenance antiemetic after therapy was completed. One hundred sixty-four (54.5%) patients experienced some side effects. The vast majority of these were mild and did not require discontinuation of therapy. Eleven patients experienced extra pyramidal symptoms, 9 of which were discontinued therapy. The average daily costs for each home therapy patient was $265.00/day. This compares to the average daily costs of $1,370.00 for inpatient therapy for the same Diagnosis Related Group (DRG) in a Midwest five-hospital system.Conclusion: Home subcutaneous metochlopramide therapy appears to be a safe and effective treatment for hyperemesis gravidarum. The home setting results in decreased costs compared to inpatient hospitalization and may constitute a therapeutic, less stressful environment.