Why is pregnancy sickness drug not easily accessible to all?

When I first found out I was pregnant, I went to my local GP with chronic sickness.

I truly felt awful. I could barely get out of bed and couldn't hold much food down, but I assumed it was just morning sickness and that it would pass.

When the GP diagnosed me with Hyperemesis Gravidarum (HG) I realised this was not just usual pregnancy sickness and started considering my options.

I was told that there were a variety of first-line drug treatment options available on the NHS, including Doxylamine Succinate and Pyridoxine Hydrochloride, a drug which goes by the brand name Xonvea in the UK.

It really worked for me and access to it was straightforward, so I was surprised to find out that some pregnant women face challenges when trying to get hold of it.

Jasmeen Basi, a mum of three from Southampton, says she had to fight to get access: "I felt really hideous. It did get to a point where I went to the doctor and said: 'I am feeling really off and I am being sick about 10 times a day'.

"You can't eat anything. I would smell water and I would vomit.

"I would hit my head so hard against the wall in my house, that my head would throb and I would have relief from the sickness. It's really hard to explain how utterly horrific it is."

She was offered one of the first-line drug treatment options, but found that it didn't work: "It nowhere touched the sides. I was still being sick every day.

"But it was slightly less. Maybe I was vomiting six times rather than 10."

After spending a lot of her second pregnancy in A&E, by the time she was pregnant for the third time, she'd done her research and asked for Xonvea.

"As soon as I got that positive test result, I was on the phone to the GP and said I've got a really severe history of HG. I want to be put on to Xonvea. I've tried all the other drugs," she explains.

"There seemed to be this red tape, where the GP couldn't prescribe it and so she was having to get it approved by a consultant.

"I was on the phone almost every day chasing up."

After feeling like she wasn't getting anywhere Jasmeen paid for a private GP appointment and for a prescription: "I had a call with a private GP. It was less than four minutes long.

"And within about two minutes of me finishing that phone call, I had that prescription in my inbox.

"It was completely life-changing. I could function."

Marianne Eldridge, from the Pregnancy Sickness Support charity, says it has found Xonvea has positive results: "We did a survey about this last year because we wanted to gather some data about it.

"And actually the vast majority of women who'd had this medication said that they found it effective and actually more effective than other medications that they tried."

The drug however is not always the first to be prescribed.

Professor of Obstetric Medicine, Catherine Nelson-Piercy, was a Lead Developer of the national guidance for management of Hyperemesis.

She says that "of all the drugs that we use to manage nausea and vomiting in pregnancy, Xonvea is the only one that has a specific label for use to treat nausea, vomiting and hyperemesis".

Nelson-Piercy continues: "That means the Medicines Health Regulatory Authority (MHRA) has said this drug is safe, this drug is effective, we've reviewed all the evidence.

"Because of the different costs of Xonvea as opposed to these other first-line antihistamine anti-sickness drugs, it is actually unlikely to be the drug she's offered first if she goes to a general practitioner in this country.

"It costs about £28 per packet, whereas the older drugs, they are about £3 or £4, something like that.

"Xonvea isn't put above or below any of the others.

"It's an equally effective drug, or equally safe drug, as all the others, so the guideline doesn't specify use Xonvea before a different anti-histamine, or use it after, it's just equal place, it's one of the first line treatments."

In the UK, whether or not someone can get hold of this drug is down to the local Integrated Care Board (ICB).

In Hampshire and the Isle of Wight, Xonvea is included in its official list of approved prescription medications, called the formulary.

It was prescribed to Basi by her GP, but it took seven weeks.

Eldridge says: "Getting hold of Xonvea in the UK at the moment is really difficult. It's a postcode lottery drug.

"It's great that it is on the formulary now in Hampshire, however, it's one of these areas where they've added a few little criteria on to their prescribing list. So they've suggested that women who are not suitable for other antiemetics can try it.

"We are calling for equality of access to this medication for women in the UK who are suffering with pregnancy sickness and would like to try it, so we just want it to be an option for everybody if they would like to have it."

Chief Pharmacist for NHS Hampshire and Isle of Wight Neil Hardy says: "Xonvea is included on the local formulary as an option for treating nausea and vomiting in pregnancy.

"Following evidence review, it is not currently the preferred first-line treatment option, but it can be considered for women who have not responded to, or are not suitable for, other established treatments.

"We recognise that experiences of accessing medicines can vary, and we welcome the move towards a national formulary, of which we are an early adopter site, and aims to support greater consistency across the NHS."

A Department of Health and Social Care spokesperson said "decisions about what medicines to prescribe are made by the doctor responsible for the patient's care" and that includes "Xonvea for nausea and vomiting in pregnancy".

They continue: "Work is already underway to move towards a Single National Formulary for medicines, as committed in the 10 Year Health Plan which is being designed to improve equitable access to medicines across all parts of the country."

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