Mornidine: Now She Can Cook Breakfast Again
Thursday, June 17, 2010 at 8:15AM
By Jill-Unnecesarean
This advertisement appeared in Volume 81 of the Canadian Medical Association Journal on July 1, 1959.
The text reads:
NOW SHE CAN COOK BREAKFAST AGAIN… WHEN YOU PRESCRIBE NEW MORNIDINE ™ (BRAND OF PIPAMAZINE)
A new drug with specific effectiveness in nausea and vomiting of pregnancy, Mornidine eliminates the ordeal of morning sickness.
With its selective action on the vomiting center, or the medullary chemoreceptor “trigger zone,” Mornidine possess the advantages of the phenothiazine drugs without unwanted tranquilizing activity.
Doses of 5 to 10 mg., repeated at intervals of six to eight hours,, provide excellent relief all day. In patients who are unable to retain oral medication when first seen Mornidine may be administered intramuscularly in doses of 5 mg. (1 cc.).
Mornidine is supplied as tablets of 5 mg. and as ampuls of 5 mg (1 cc.).
G.D. Searle & Co., Chicago 80, Illinois- Research in the Service of Medicine.
According to the Pharmaceutical Manufacturing Encyclopedia, pipamazine was introduced in the United States in 1959 under the trade name “Mornidine” by G.D. Searle & Co. Mornidine had post-surgical applications as well.
The drug was ultimately withdrawn from the market for causing hepatic lesions in patients. From the Food and Drug Administration [Docket No. 98N-0655]:
Pipamazine: All drug products containing pipamazine. Pipamazine, formerly marketed as Mornidine tablets and injection, was associated with hepatic lesions. Approval of the NDA for Mornidine tablets andinjection was withdrawn on July 17, 1969 (see the Federal Register of July 17, 1969 (34 FR 12051)).
The marketing of Mornidine as a morning sickness drug overlapped with the widespread prescription of thalidomide in Europe as a safe morning sickness drug for pregnant women.
Doctors in Europe first prescribed thalidomide in the late 1950s to treat anxiety, insomnia and, in pregnant women, morning sickness. It was marketed in Europe as well as in Japan, Australia and Canada. It was withdrawn from the market in the early 1960s when doctors learned that it caused devastating birth defects. About 10,000 children around the world were born with major malformations because their mothers had taken the drug during early pregnancy (3).
[…]
In 1961, doctors in Germany, Australia and Great Britain noted a significant increase in the number of babies born with severely malformed or missing arms and legs. These birth defects were traced to the use of thalidomide during early pregnancy, when a baby’s arms and legs begin to form.
The most well-known defect, a severe shortening of the arms or legs with flipper-like hands or feet, is called phocomelia. Affected babies almost always have defects on both sides and often have both the arms and legs malformed. In especially severe cases, the babies have complete absence of limbs. The drug also causes malformations of the eyes and ears, heart, genitals, kidneys and digestive tract (including the lips and mouth) (3, 5). About 40 percent of babies exposed to the drug die before or soon after delivery (5).
Thalidomide is one of the most powerful human teratogens (drugs or other agents that cause abnormal development in the embryo or fetus). Taking even a single dose of thalidomide during early pregnancy may cause major birth defects (1). Women should never take thalidomide if they could become pregnant or if they are pregnant.
But at least Mother could wake up and cook everyone bacon. Heaven knows that Father can’t figure out the percolator.
Reader Comments (18)
God, it just makes me sick to my stomach. No pun intended. :(
That's unsurprising, but super scary. I had hyperemisis with my pregnancy and was on medication, which was the only thing that helped me to keep ANYTHING down. Although everyone assured me the medication was perfectly safe, I never felt completely comfortable taking it and tried to go off it several times. If the above is any indication, I had good reason to feel uneasy about the medical community's reassurances of "safety".
To be fair, Thalidomide WAS perfectly safe. . . for the mother. *eyeroll*
It actually raises a really interesting quandary. How do you medicate pregnant women? You can try not to, but women in pregnancy will frequently have conditions that require medication, and even more frequently will have conditions where it would be a lot easier if you could take a frickin pill like you would if you weren't pregnant. (Migraine, common cold, etc.) Ex post thalidomide, it is impossible to do drug research on pregnant women, and for damn good reason; a fetus is not capable of informed consent. You can do animal studies, but animals aren't people; animal studies were done with thalidomide, and the problems weren't found. (It turns out that thalidomide's birth defects are unusually species-specific; there are two separate optical isomers of the drug, only one of them causes phocomelia, and only a couple of species, humans among them, convert the good one to the bad one.) You can do computer modeling, which is exactly as accurate as your computer model is, for good or for ill. You can, in theory, do utterly ghoulish things like identifying women whose unborn children have 100% fatal defects and persuading them do let you do placental transfer tests before they terminate the pregnancy, but that's ethically abhorrent in about a thousand different ways. So, we run drug trials on animals and on non-pregnant humans, cross our fingers, and hope for the best, and then we watch reeeeeally carefully when we prescribe it in real life.
It's a bad system. But try as I might I can't figure out how to do it better.
<<It's a bad system. But try as I might I can't figure out how to do it better.>>
I have to agree with you in regards to testing of drugs.
And while I acknowledge that in some cases medications may be necessary, in many cases (like in birth), just knowing it's normal and this too shall pass and having a good support network can help a woman get through that phase. I realize, there are extreme cases where that doesn't apply...but in many cases, chewing a little peppermint gum, for example, will calm the stomach.
Too often, when we are just trying to make things better, we end up making them worse.
I'm with Jill on this one though...can't dad figure out the percolator?
Thank goodness I live now...my dh is the morning person and believe me he percolates, or there would be no percolation in our house :-)
Since I started working with midwives and talking to women about what and how much they ate, I've had only a few women whose nausea/vomiting was severe enough to consider medications. Acupuncture helped more than a few as well. Drugs have only been around for 60 years or so, interesting how quickly we've come to believe they are necessary.
I'm not saying that drugs are never helpful or that taking them is bad. I just know that some experience in handling things without drugs, beginning in childhood, leads to important wisdom that can guide decisions like how to treat nausea in pregnancy.
I am offended by the sexist imagery in the advertisement, but, honestly, it was pretty typical of the times. Today, we'd see an ad showing a woman headed off to the office, cause, heaven forbid a woman (or a man) take time for hers/hiself or her/his children! No matter if it's in a marriage, the workplace, or the community, we all seem to feel like we are indispensable. And we gotta keep the man happy. From the moment of conception, there's just nothing convenient about children. But thank the stars that people keep havin' em.
While I agree with comments that medication should be a last resort in pregnant women, especially for "normal" first trimester nausea and vomiting, I want to say that I too suffered from hyperemesis, which is a dangerous and sometimes life threatening condition. But because it presents like morning sickness and doctors are often reluctant to prescribe medicine to pregnant women, many many women are undertreated for this condition (and treated badly by other mothers who assume that some crackers and a cup of tea will cure their condition). So I just wanted to say to pregnant women who have uncontrollable vomiting - take your condition seriously and don't be afraid to take medication if it's necessary. I didn't like taking medication either while pregnant, but it was necessary in my case, and I like other hg mothers had two very healthy babies (consult the hyperemesis website helpher.org for more information on the condition and its treatments).
But it's way more political than this right? Because one thing that works very consistently on problems like hyperemisis with relatively few risks and no known side-effects is... marijuana. But nobody is going to recommend that, and if you even suggested that you self-medicated with it while pregnant in order to keep you and the baby from starving to death you may well have your parental rights terminated at birth. Why? Because no pharmaceutical company stands to make any money off it so there are no powerful lobbying groups supporting it. The thing is, there are no documented birth defects associated with pot. As far as I know tests on other mammals resulted in no birth defects, and studies on humans resulted in the same kinds of risks as smoking tobacco, but they didn't control for tobacco use, so many of the moms in the study were also smoking tobacco while pregnant. Based on even these flawed studies the worst risk seems to be low birth weight. Of course if you have severe morning sickness, that ship has already sailed, and everyone knows there are other ways to ingest pot than smoking it. So it's far more complicated than just "we want to find something that will help you with your morning sickness and be safe for you and the baby." It's more like "we want to find something that will help you with your morning sickness that feeds the pharmaceutical-industrial-complex in the right sort of way."
Which is not to say that I'm recommending everyone go out and smoke pot while pregnant ... and I didn't, but mostly because I didn't experience much nausea and didn't have access to pot that I could be sure was grown in a chemical-free environment. But it does seem like if the motive of helping pregnant moms and their babies was as pure as it's made out to be, there would be considerably more R&D going on in this area as well as a moratorium on all the punitive public health activities surrounding marijuana use and pregnancy.
Yes, currently it's usually better to either just deal, or use natural remedies to treat common pregnancy ailments like morning sickness. But, let's be honest, the *reason* it's better that way is because we can be sure it's safe for both mother and baby. If there was a pill to eliminate morning sickness that was as safe and effective as taking a Tylenol for a headache, I'd take it! I'm glad that the medical community at least tries to find or develop safe medications to make pregnancy more comfortable. (I just wish they'd be quicker about discontinuing treatments that turn out to be more trouble than they're worth, or limiting treatments to situations when they *are* worth the trouble.)
I also think Dana makes a great point that it's very difficult to determine what is and isn't safe for pregnant women and their babies. We can't just stop advancing medical science in the area of obstetrics -- the advances are often good! But we can't test on unborn babies, either.
As for the dated tone of the advertisement, I think it's worthwhile to realize that, for a lot of women in the 50s, taking care of home and hearth (including breakfast) was their main job. It was the way they contributed to the family (and, IMO, it's an important contribution). I don't know about you, but I don't like it when illness makes it hard for me to do my job. I value pregnancy, and my role as the only person in our family who can create new members, but I don't like feeling like I can't do basic tasks that I feel are also valuable and important ways that I contribute to my family. I don't like it when my husband has to do those things for me, even when he does so happily. Sort of the way my husband happens to feel right now, after his big plans to do some work around the house and give me a little time off during his vacation this week were derailed when he threw his back out. If a pill could make him feel well enough to install the new faucet in the bathroom, he'd be happy!
I don't understand why abortion is legal, but a pregnant woman can't consent to medical testing in drug trials. It seems inconsistent.
"But it's way more political than this right? Because one thing that works very consistently on problems like hyperemisis with relatively few risks and no known side-effects is... marijuana. "
A while back I read this book "The panic-free pregnancy : [an OB/GYN separates fact from fiction on food, exercise, travel, pets, coffee, medications, and other concerns you have when you are expecting]" by Michael S. Broder.
I was looking for a book to counter all the comments I was getting about my eating habits while pregnant. Egads, pregnant woman drinking coffee, eating brie and *yikes* a glass of wine!!! I thought having a book to back me up would be helpful. This book would do as such in regards to food,wine and pot. It would not be helpful in regards to labor, very medical model of care. So I didn't point any family to it.
My point in mentioning this book is that he writes about alcohol and recreational drugs. I don't have it in front of me, but I remember showing my husband what the author writes about the safety of pot and saying "if I have bad morning sickness, spark me up". I didn't have any nausea that ginger couldn't cure, so no pot for me.
You have a great point in the politics of meds in our country.
@Mari - how is it inconsistent? If a woman is having an abortion, she is doing so (usually) because she doesn't want the pregnancy and resultant baby. There is no baby (in the sense of a fully-developed infant, issues of language terms aside) to consider. A pregnant woman who is continuing with the pregnancy presumably does want a healthy baby: I think the legal issue is whether she can consent for her resultant baby as well as for herself.
Hyperemesis is no joke, and it is crippling and dangerous when it occurs, so I am completely sympathetic to women seeking relief from it.
I remember reading somewhere that there was a school of thought among some midwives about different types of vomiting in pregnancy and appropriate remedies that were different for each; it would be interesting to find out if any of those have been tested (aside from ginger).
Not being able to do testing is a huge obstacle for medication use while pregnant; I wonder what kind of research has been done on the mechanisms of nausea? For ex, lots of women (me inclu) get nauseous on our periods; seems likely some of the same hormones are at work. And we'd be a safe population to do testing on.
Did this post give people the impression that I think drugs for HG are bad? That was not my intention at all.
Most pregnant women can probably get by without the use of medication, and this is what women should probably strive for.
HG is pretty rare (between 1-3 percent of pregnant women), however HG is a form of starvation, warranting the use of medications. Otherwise, both mother and baby would die. For some women with severe HG, no antiemetic medications work. Physicians are then reluctant to initiate TPN for fear of infection and blood clots or even initiating simple tube feedings. In the case of parenteral nutrition, no one wants to take responsibility for a hyperemesis patient who could possibly develop sepsis.
I think that the previous posters do not want to minimalize the life-threatening threat HG poses on some mothers, especially when some women have to fight to get antinausea medications when their nausea and vomiting is excessive. Worse yet, is when hyperemesis patients are treated like they have a psychiatric illness and that the nausea and vomiting is caused by psychological instead of physiological factors. Women then have to wait to be treated untill they are too medically unstable to be ignored any longer. This is unfortunate and contributes to mothers feeling even more alone.
I think that we need some pot studies. I'm sure that we can gather some women on her.org that would participate for science and other suffering women! Woo-hoo! :)
Jill, I didn't think you were saying meds for hg were bad - I wrote my post because I hear over and over again from women with hg that they are either catastrophically undertreated by their doctors or because they themselves refuse medication out of fear, and I just wanted to say - don't let that happen to you! So everytime I hear horror stories about bad meds from the past it makes me think of how afraid I was to treat my HG, and how glad I am that I sucked it up and took the meds (two healthy beautiful children later, in spite of the phenargan and zofran). Of course HG is clearly one of those cases where the possible benefit outweighs the risk, *even if* the risk were some damage to the fetus, because HG is so dangerous to mothers and fetuses (as opposed to garden-variety morning sickness). (And I'm sorry if we derailed the original intention of the post!)
As for the issue of testing, in some ways women with HG ARE acting as testing subjects - it's not a controlled test of course, but anyone seeking some data about the effects of medications on pregnant women could find preliminary information by polling women who have had HG, what they've taken, rates of birth defects etc.
SS (Elizabeth) is right about what can happen to undertreated women, but leaves out something important - it is not uncommon for women with HG to terminate their pregnancies. If fact some have told stories of insurance companies pressuring them to terminate (b/c termination is MUCH cheaper than in-home nursing care, IV zofran, and a central line). The relative rareness of HG makes finding treatment more difficult because you're more likely to encounter a large amount of skepticism about your condition, from physicians, midwives, family, work, etc.
QoB, the sovereignty of the woman's rights, disregarding the fetus practically is the primary argument for abortion. That is, that she is free to do what she wishes with her body regardless of the presence of the fetus. So she should be able to choose to participate in medical testing if abortion is legal. She can't be refused alcohol in a bar/restaurant while pregnant on account of being pregnant, which is actually quite close to the situation with medical testing (that is, there is a potential risk of injury/harm to the fetus).
Sorry for jumping on the HG bandwagon again, but this topic is so close to my heart.
According to the HER Foundation, their 2005 survey revealed that 40 % of hyperemesis sufferers were told that their condition was a normal part of pregnancy, 18 % of hyperemesis sufferers were told that they simply had morning sickness, 1/3 of hyperemesis sufferers were told that their nausea and vomiting were caused from stress, psychological disorder, unconsious rejection of the pregnancy or a lack of support (what insane BS!!!!!!) and 26 % of hyperemesis sufferers were not offered medications.
It is very sad that women have to resort to termination. Sometimes the illness is just too debilitating and emotionally overwhelming, and sometimes it is the lack of support and treatment that lead women to believe that this is their only option. Erin, good point. Likewise, some women will refuse to have more children thus limiting their family size.
There needs to be better standardized treatment for hyperemesis sufferers such as anyone who is spilling ketones should not be ignored, and if you're going to get IVF's in the ER or antenatal unit because you haven't kept anything down, you should probably be getting multivitamins intravenously also (which aren't even expensive). Inadequate treatment and support is one of the biggest ways that we fail women as health care providers. We still live 50 years behind in terms of morning sickness and HG treatments.
I'm thinking we need an HG post in the near future. Thanks for all of the comments.