Ginger generally well tolerated. Large doses (>200 mg/day)

Ginger (Zingiber officinale)has been used for nausea related to pregnancy, motion sickness, and surgery.42A 2015 Cochrane review of ginger found limited and inconsistent evidence forits efficacy, although several studies suggested that ginger may be superior toplacebo in preventing NVP.3The review reported no difference in spontaneous abortion, congenitalabnormalities, or other fetal adverse outcomes, although the included studiesmay have had insufficient power.3Other data regarding the safety of the use of ginger in pregnancy are limited.Larger doses of ginger may lead to mild adverse GI effects, includingheartburn, diarrhea, and mouth irritation.43Some evidence suggests that ginger may have anticoagulant and hypotensiveeffects.

In some countries, such as Finland and Denmark, ginger carriescautionary warnings for its use in pregnancy.44Ginger can be dosed at 250 mg to 2 g perday in 3–4 divided doses although it appears that doses around 1 g/day are moreeffective than placebo.43Ginger may be as effective as pyridoxine for treating N/V. Compared with dimenhydrinate,ginger may cause fewer adverse effects.45(See Chapter51for an in-depth discussion of ginger.)Most ginger ale products often areartificially flavored or contain amounts of ginger that are too insignificantto be therapeutic.Pyridoxine (Vitamin B6)Pyridoxine is a water-soluble B vitaminthat is important in various metabolic functions, including protein metabolism,hemoglobin synthesis, and neurotransmitter function.36The dietary reference intake of pyridoxine in healthy adults is 1.

3–2 mg/day.Pyridoxine may be used in NVP. Typical dosing of pyridoxine for nausea is 10–25mg 3 times a day.

Pyridoxine is generally well tolerated.Large doses (>200 mg/day) of pyridoxine over longer periods of time (>2months) may result in adverse effects such as peripheral neuropathy, weakness,lethargy, and nystagmus.Pyridoxine has had mixed results forefficacy in treating N/V. Overall data suggest that pyridoxine is effective.28NVP is an off-label indication for pyridoxine.AcupressureThe use of acupressure involves directpressure on the pericardium-6 (P6) point on either wrist.

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The P6 point islocated approximately three finger widths from the middle crease of the wrist(see acupuncture-points.org).Pressure can be applied between the two tendons using either the finger or awristband.

Acupressure at P6 may be more effective for preventing postoperativeN/V than NVP.3,46The “dosing” of acupressure can vary from as needed, to 10 minutes 3 times aday, to continuous pressure. The dosing regimens showed mixed results forefficacy.47AromatherapyThe use of peppermint oil for thetreatment of N/V does not have reliable evidence to support its efficacy. Inaddition, the use of isopropyl alcohol may be more effective than a salineplacebo but less effective than other standard antiemetic medications (bothprescription and nonprescription).

This lack of efficacy was found in studiesthat looked at the use of rescue antiemeticsfor postoperative N/V. Evidence is lacking to support aromatherapy forself-treatment of N/V.48

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