(Image by Michal Jarmoluk from Pixabay)

A major victory for pregnant women was won recently when the Department of Health decided to allow the HSE to fund Cariban. Cariban is a drug used to treat Hyperemisis Gravidarium (HG), which is the technical term for severe nausea and vomiting during pregnancy. HG is not to be confused with nausea and vomiting, commonly known as “morning sickness”, that is experienced by a greater proportion of women during pregnancy. HG, on the other hand, effects only 1% of pregnant women in Ireland, but is a serious debilitating condition that can lead to hospitalisation for dehydration.

The good news is that there are several medications that can help manage the symptoms of HG. The first port of call is doxylamine and pyridoxine, known by the brand name of Cariban. Cariban is an effective treatment for HG, but this is what’s known as an “off-label” usage. There are various reasons a drug might be categorised as “off-label”, but one of the consequences was that Cariban was not available under the Drugs Payment Scheme (DPS). The DPS covers the cost of prescription medications to any household over a certain monthly limit (currently €80). So once a family spends more than €80 in any given month on prescription drugs, any further drugs they use that month are covered by the HSE via the DPS. Drugs that are not available under the DPS, however, must be covered by the patient out of pocket. This can add up, especially for a woman who is unfortunate enough to require several doses of Cariban per day for the entirety of her pregnancy. It was not unheard of for women to spend up to €3,000 over the course of her pregnancy accessing this vital drug.

Thankfully, due to a recent government decision, Cariban is now available under the DPS. This means that a woman who has been prescribed Cariban can have the cost covered, and is only liable for €80 per month towards the cost. However, there are still some barriers to access. In particular, Cariban must be prescribed in the first instance by a consultant obstetrician. For some women, this poses no barrier – women who opt for private maternity care will see a consultant at every appointment. For other women though, their maternity care can be provided by their GP, midwives, or non-consultant hospital doctors. It is a significant barrier to expect a woman who is in the early stages of pregnancy to get to casualty in her local maternity hospital and then wait around for up to a few hours before seeing a consultant and getting the necessary prescription. In particular, for a woman who has experienced HG on a previous pregnancy, there is a strong argument for starting medication as a preventative measure as soon as possible after discovering she is pregnant. The obvious person to prescribe Cariban in this instance is the woman’s GP, who knows her obstetric history and can send the prescription straight to the woman’s local pharmacy where she can fill it as soon as possible.

Consultant obstetricians themselves have been leading the charge in calling for the guidelines to be updated, allowing non-consultant hospital doctors, GPs, and nurses prescribers (nurses or midwives who are qualified and approved to prescribe certain medications) to prescribe Cariban in the first instance, without having to first wait for a consultant to deem Cariban necessary. This will allow women of all maternity care pathways access to the drug in the timeliest manner possible, and reduce demand on our consultant obstetricians. The pro-life movement should play its part in campaigning for this simple yet important change.