Methylprednisolone is an option in refractory
cases. In a randomized trial involving 40 women, methylprednisolone was superior to promethazine for treating nausea and vomiting in
pregnancy. However, a larger trial, involving 110
women, showed no difference in the rate of rehospitalization
for women who received methylprednisolone
as compared with those who received
placebo. In the latter trial, all patients received
promethazine at a dose of 25 mg and metoclopramide
(Reglan) at a dose of 10 mg intravenously,
as well as the glucocorticoid regimen.
As a result, there is a black-box warning associated
with its use in all patients, and it is recommended
that all patients undergo 12-lead ECG testing before,
during, and 3 hours after administration